Clinical Development, Medical and Regulatory Affairs, Strategic Scientific Communications, Novo Nordisk Inc., Princeton, NJ 08540, USA.
J Med Econ. 2011;14(6):720-8. doi: 10.3111/13696998.2011.613975. Epub 2011 Sep 8.
The perception in the US is that insulin formulations prescribed for type 1 and type 2 diabetes and delivered via insulin pens are more costly to patients than the same or similar products provided in vials, and that basal insulin analogs offered either in pens or vials are likewise more costly to patients than human insulin formulations. This study compares levels of coverage and copays by private and Medicare Part D plans for insulin pens and vials containing basal insulin analogs and for NPH formulations in vials.
A commercially available formulary database (Access Point, Pinsonault Associates; updated quarterly) was analyzed as of January 2010 for private insurance plans and as of March 2010 for Medicare Part D plans. Analyses were performed for Tier-level coverage and copays per prescription for basal insulin analogs in pens and vials, and NPH in vials.
Basal insulin analogs in pens were covered by >91% of private and Part D plans. NPH coverage was reported by >92% of private plans and 69-95% of Part D plans, depending on brand. Irrespective of delivery mode, copays in the majority of private plans for basal insulin analogs and NPH were in the >$10-35 range. Copays were higher in Part D plans, with the majority of plans and subscribers in a >$35-50 range. Prior authorization was required by <10% of insurance plans for insulin analog pen prescriptions, and <3% of plans for insulin analog or NPH prescriptions in vials.
This analysis was descriptive, copay stratification was not based on a statistical model but on copay ranges typically used by the plans, and there were no direct correlations performed on the numbers of subscribers per plan vs copay or Tier level.
These results counter the widely held perception that insurance coverage is less extensive for insulin pens vs vials. Medicare Part D plans often had higher copay requirements than private plans for the same product at the same copay Tier.
在美国，人们普遍认为，与瓶装相比，用于 1 型和 2 型糖尿病的胰岛素制剂和通过胰岛素笔注射给药的胰岛素制剂对患者来说成本更高；而且，无论是以笔还是以瓶的形式提供的基础胰岛素类似物，其价格对患者而言也比人胰岛素制剂更昂贵。本研究比较了私人保险计划和医疗保险部分 D 计划对笔芯和瓶装基础胰岛素类似物以及瓶装 NPH 制剂的胰岛素笔和胰岛素瓶的覆盖水平和共付额。
截至 2010 年 1 月，分析了一个商业上可用的处方集数据库（Access Point，Pinsonault Associates；每季度更新），以分析私人保险计划；截至 2010 年 3 月，分析了医疗保险部分 D 计划。对笔芯和瓶装基础胰岛素类似物和瓶装 NPH 的每个处方的分层覆盖范围和共付额进行了分析。
笔芯中的基础胰岛素类似物得到了超过 91%的私人保险计划和医疗保险部分 D 计划的覆盖。NPH 的覆盖率由超过 92%的私人计划和 69-95%的医疗保险部分 D 计划报告，具体取决于品牌。无论交付模式如何，大多数私人计划对基础胰岛素类似物和 NPH 的共付额都在>10-35 美元范围内。在医疗保险部分 D 计划中，共付额更高，大多数计划和订户的共付额在>35-50 美元范围内。仅有不到 10%的保险计划需要胰岛素类似物笔注射处方的事先授权，不到 3%的计划需要胰岛素类似物或 NPH 处方的事先授权。
本分析是描述性的，共付额分层不是基于统计模型，而是基于计划中常用的共付额范围，而且没有对每个计划的订户数量与共付额或级别进行直接相关性分析。
这些结果与人们普遍认为的保险覆盖范围对胰岛素笔不如胰岛素瓶广泛的看法相反。对于相同产品的相同共付额级别，医疗保险部分 D 计划的共付额要求通常高于私人计划。
