医疗保险D部分药品计划的未来——圆桌讨论结果

The future of Medicare Part D drug plans--results from a roundtable discussion.

作者信息

Balfour Donald C, Evans Steven, Januska Jeff, Lee Helen Y, Lewis Sonya J, Nolan Steve R, Noga Mark, Stemple Charles, Thapar Kishan

机构信息

Sharp Rees-Stealy Medical Group, San Diego, California 92101-2600, USA.

出版信息

J Manag Care Pharm. 2009 Jan-Feb;15(1 Suppl A):18-21. doi: 10.18553/jmcp.2009.15.s1.18.

DOI:10.18553/jmcp.2009.15.s1.18

PMID:19125557

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10437764/

Abstract

BACKGROUND

The Medicare Prescription Drug, Improvement, and Modernization Act, signed into law in 2003, provided access to prescription drugs for elderly Americans. The Part D benefit continues to evolve. Changes in plan designs, the impact of the doughnut hole on beneficiaries, and increased cost shifting have the potential to hamper the future of the Part D benefit.

OBJECTIVE

To discuss factors that will likely have the most impact on the future of Medicare Part D from a patient and payer perspective.

SUMMARY

The continued growth of the elderly population is expected to place an increasing burden on the services provided through Medicare. Given the current financial situation, it has been predicted that Medicare's Hospital Insurance Trust Fund will be depleted by 2019. To provide quality benefits and remain competitive, health plans are continually evaluating and redesigning their Part D benefits. However, the current regulatory environment is preventing plans from offering innovative products and designs that could lower costs to beneficiaries. The growing number of beneficiaries hitting the doughnut hole is also becoming a concern for both beneficiaries and health plans. More beneficiaries are reaching the doughnut hole, and this has resulted in changes in beneficiary behaviors, including stopping medications, switching to alternative drug classes, and reducing medication use. Because of the increasing concerns about Medicare's sustainability, it is anticipated that the government may become more involved.

CONCLUSION

As the health care landscape continues to change, payers will be challenged to offer benefit designs that are affordable to elderly beneficiaries. For its part, the government must allow plans to design benefits that will improve the overall quality of care. Additionally, closer attention must be given to the growing number of beneficiaries hitting the doughnut hole and its potential adverse clinical and economic consequences.

摘要

背景

2003年签署成为法律的《医疗保险处方药、改进与现代化法案》为美国老年人提供了获得处方药的途径。D部分福利仍在不断发展。计划设计的变化、“甜甜圈洞”对受益人的影响以及成本转移的增加有可能阻碍D部分福利的未来发展。

目的

从患者和支付方的角度讨论可能对医疗保险D部分的未来产生最大影响的因素。

总结

预计老年人口的持续增长将给通过医疗保险提供的服务带来越来越大的负担。鉴于当前的财政状况，有人预测医疗保险的医院保险信托基金将在2019年耗尽。为了提供优质福利并保持竞争力，健康计划不断评估和重新设计其D部分福利。然而，当前的监管环境阻碍了计划提供能够降低受益人成本的创新产品和设计。越来越多的受益人陷入“甜甜圈洞”也成为受益人和健康计划都关心的问题。越来越多的受益人进入“甜甜圈洞”，这导致了受益人行为的改变，包括停药、改用其他药物类别以及减少药物使用。由于对医疗保险可持续性的担忧日益增加，预计政府可能会更多地介入。