James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
Ann Pharmacother. 2012 Apr;46(4):503-12. doi: 10.1345/aph.1Q618. Epub 2012 Mar 27.
Although it is well-known that drug costs in the US have risen precipitously over the last 25 years, what is much less appreciated is how this rise in cost has occurred across so many seemingly distinct drug markets.
To describe trends in the utilization, spending, and average per-prescription cost of benzodiazepines individually, in subgroups, and overall, in the Medicaid program. Medicaid has been the primary public payer for benzodiazepines over the past 2 decades.
A retrospective, descriptive analysis was performed for the years 1991-2009 using the publicly available national Summary Files from the Medicaid State Drug Utilization Data maintained by the Centers for Medicare & Medicaid Services. Quarterly prescription counts and reimbursement amounts were calculated for all benzodiazepines reimbursed by Medicaid. Average per-prescription spending as a proxy for drug price was found by dividing reimbursement by the number of prescriptions.
Prescriptions for benzodiazepines among Medicaid beneficiaries increased from 8.0 million in 1991 to 17.1 million in 2009. Expenditures rose from $131.6 million to $171.1 million over the same time period. The average per-prescription price was a little over $10 in 2009. Whereas utilization of intermediate- and long-acting agents increased over time, prescriptions for short-acting drugs fell from 1.1 million to 0.3 million (1991-2009). The percentage rise in Medicaid spending on benzodiazepines since 1991 (30.0%) was less than the general rate of inflation (57.5%), as measured by the percentage change in the consumer price index over the same time period.
Relative to the rise in the number of Medicaid beneficiaries (more than doubled over the study period), there is no evidence of an extraordinary rise in the utilization of benzodiazepines. Moreover, both nominal and real average prices of benzodiazepines have fallen, primarily because of generic entry over the last 2 decades.
尽管人们熟知美国的药品成本在过去 25 年中急剧上升，但人们对这种成本增长如何在如此众多看似不同的药品市场中发生的认识却要少得多。
描述在过去 20 年中，医疗补助计划（Medicaid）中苯二氮䓬类药物的利用、支出和每处方平均成本的个体、亚组和总体趋势。在过去的 20 年中，医疗补助计划一直是苯二氮䓬类药物的主要公共支付方。
使用医疗保险和医疗补助服务中心维护的医疗补助州药物利用数据的公开可用国家汇总文件，对 1991-2009 年进行回顾性描述性分析。计算了所有由医疗补助报销的苯二氮䓬类药物的每季度处方数和报销金额。通过将报销金额除以处方数来计算每处方平均支出作为药物价格的代理。
医疗补助受益人的苯二氮䓬类药物处方从 1991 年的 800 万张增加到 2009 年的 1710 万张。同期支出从 1.316 亿美元增加到 1.711 亿美元。2009 年每处方的平均价格略高于 10 美元。虽然中效和长效制剂的利用率随着时间的推移而增加，但短效药物的处方从 110 万张减少到 30 万张（1991-2009 年）。自 1991 年以来，医疗补助计划在苯二氮䓬类药物上的支出增长了 30.0%，低于同期消费者价格指数（CPI）变化的 57.5%，这一涨幅是衡量通胀的指标。
与医疗补助受益人数的增长（在研究期间增加了一倍以上）相比，苯二氮䓬类药物的利用并没有明显增加。此外，苯二氮䓬类药物的名义和实际平均价格都有所下降，主要是由于过去 20 年的仿制药进入市场。
