College of Pharmacy, University of Texas at Austin, University Station, A1900, Austin, TX 78712, USA.
J Am Pharm Assoc (2003). 2009 Sep-Oct;49(5):617-22. doi: 10.1331/JAPhA.2009.08099.
To describe dual eligibles' claims before and after Medicare Part D and to evaluate the effect that Medicare Part D has had on the claim percent gross margin (CPGM) earned by Texas community independent pharmacies.
Nonexperimental time series study.
Texas, October 2005 through September 2006.
313 community independent pharmacies.
Review of more than 150,000 Medicaid and 300,000 Medicare Part D claims acquired from a drug claims processor.
CPGM per prescription claim before and after the implementation of Medicare Part D, controlling for generic/brand drug status.
The mean CPGM for prescriptions dispensed before Part D (Medicaid claims) was 26.7%. The mean CPGM for claims dispensed after Part D (Medicare claims) was 17.0% (using ingredient costs in 2006 dollars) or 20.4% (using ingredient costs adjusted to 2005 dollars), a reduction of 36.3% and 23.6%, respectively. Under both Medicaid and Part D, pharmacies earned higher margins for generic drugs (39.9% and 29.5%, respectively) than for brand-name drugs (8.7% and 8.3%, respectively).
These results support community pharmacy assertions of lower reimbursements from Part D payers compared with Medicaid payers. Based on these results, pharmacies can respond to this evolving environment by carefully reviewing their Part D plans' impact on CPGM and taking available steps to increase the proportion of generic drugs dispensed to Medicare beneficiaries.
描述医疗保险 D 部分实施前后双重合格者的索赔情况，并评估医疗保险 D 部分对德克萨斯州社区独立药房获得的处方毛利润率（CPGM）的影响。
非实验性时间序列研究。
德克萨斯州，2005 年 10 月至 2006 年 9 月。
313 家社区独立药房。
从一家药品理赔处理商处查阅了超过 15 万份医疗补助和 30 万份医疗保险 D 部分的索赔。
在实施医疗保险 D 部分前后，每份处方索赔的 CPGM，控制了仿制药/品牌药的状况。
在 D 部分（医疗补助索赔）之前发放的处方的平均 CPGM 为 26.7%。在 D 部分之后发放的索赔（医疗保险索赔）的平均 CPGM 为 17.0%（使用 2006 年美元的成分成本）或 20.4%（使用成分成本调整至 2005 年美元），分别减少了 36.3%和 23.6%。在医疗补助和 D 部分下，药店从仿制药（分别为 39.9%和 29.5%）获得的利润率高于品牌药（分别为 8.7%和 8.3%）。
这些结果支持社区药房关于 D 部分付款人比医疗补助付款人报销更低的说法。根据这些结果，药店可以通过仔细审查其 D 部分计划对 CPGM 的影响，并采取可用措施来增加向医疗保险受益人发放的仿制药比例，来应对这一不断变化的环境。
