The Moran Company, Arlington, Virginia 22209, USA.
Clin J Am Soc Nephrol. 2013 Jun;8(6):1043-7. doi: 10.2215/CJN.11621112. Epub 2013 Apr 18.
Oral prescription drugs for treatment of bone and mineral disorders (phosphate binders and calcimimetics) in patients undergoing dialysis (i.e., those with ESRD) will be integrated into the Medicare Part B ESRD bundled payment system in 2016. Payment will be denied under Medicare Part D. Integrating Part D drugs into Part B payment at this level of scale lacks any policy precedent. Providers and patients have serious concerns about the potential for inadequate funding, and the Centers for Medicare & Medicaid Services (CMS) has been silent about the methods and other critical policy used to guide its decisions. We believe an adequate policy framework to support valuation of the targeted oral drugs depends on use of the most recent available Medicare Part D data, measurement of mean utilization for all target drugs based on a minimum of 6 months of complete data for prescriptions and dialysis treatments, use of appropriate price proxies to monetize drug volume to dialysis provider acquisition cost, adjustment to account for change in adherence due to change in patient out-of-pocket expenses, inclusion of valuation for dispensing and administrative cost, and a mechanism for adjusting payment to future changes in adherence.
2016 年，接受透析治疗（即患有终末期肾病）的患者的骨和矿物质疾病（磷酸盐结合剂和钙敏感受体激动剂）的口服处方药将被纳入医疗保险 B 部分终末期肾病捆绑支付系统。医疗保险 D 部分将拒绝支付这些药物。将医疗保险 D 部分的药物纳入 B 部分支付的这种规模缺乏任何政策先例。提供者和患者对资金不足的可能性表示严重关切，而医疗保险和医疗补助服务中心（CMS）一直对用于指导其决策的方法和其他关键政策保持沉默。我们认为，支持目标口服药物估值的充分政策框架取决于使用最新的医疗保险 D 部分数据，根据处方和透析治疗的完整数据至少 6 个月，基于所有目标药物的平均利用率进行测量，使用适当的价格代理来将药物数量货币化到透析提供者收购成本，调整以考虑因患者自付费用变化而导致的依从性变化，包括配药和管理成本的估值，以及调整支付以适应未来依从性变化的机制。
