Sheingold Steven, Nguyen Nguyen Xuan
U.S. Department of Health and Human Services-Office of the Assistant Secretary for Planning and Evaluation.
Medicare Medicaid Res Rev. 2014 Jan 2;4(1). doi: 10.5600/mmrr.004.01.a01. eCollection 2014.
This study estimates the effects of generic competition, increased cost-sharing, and benefit practices on utilization and spending for prescription drugs.
We examined changes in Medicare price and utilization from 2007 to 2009 of all drugs in 28 therapeutic classes. The classes accounted for 80% of Medicare Part D spending in 2009 and included the 6 protected classes and 6 classes with practically no generic competition. All variables were constructed to measure each drug relative to its class at a specific plan sponsor.
We estimated that the shift toward generic utilization had cut in half the rate of increase in the price of a prescription during 2007-2009. Specifically, the results showed that (1) rapid generic penetration had significantly held down costs per prescription, (2) copayment and other benefit practices shifted utilization to generics and favored brands, and (3) price increases were generally greater in less competitive classes of drugs.
In many ways, Part D was implemented at a fortuitous time; since 2006, there have been relatively few new blockbuster drugs introduced, and many existing high-volume drugs used by beneficiaries were in therapeutic classes with multiple brands and generic alternatives. Under these conditions, our paper showed that plan sponsors have been able to contain costs by encouraging use of generics or drugs offering greater value within therapeutic classes. It is less clear what will happen to future Part D costs if a number of new and effective drugs for beneficiaries enter the market with no real competitors.
本研究评估仿制药竞争、成本分担增加及医保福利政策对处方药使用和支出的影响。
我们研究了2007年至2009年28个治疗类别的所有药物在医疗保险中的价格和使用情况变化。这些类别在2009年占医疗保险D部分支出的80%，包括6个受保护类别和6个几乎没有仿制药竞争的类别。所有变量的构建都是为了衡量特定计划赞助商处每种药物相对于其所属类别的情况。
我们估计，向仿制药使用的转变使2007 - 2009年期间处方药价格的上涨速度减半。具体而言，结果表明：（1）仿制药的迅速普及显著压低了每张处方的成本；（2）共付额和其他医保福利政策使使用转向仿制药并偏袒品牌药；（3）在竞争较小的药物类别中，价格上涨幅度通常更大。
在很多方面，D部分在一个幸运的时间实施；自2006年以来，新推出的重磅炸弹药物相对较少，受益人群使用的许多现有高销量药物所在的治疗类别中有多个品牌和仿制药替代品。在这些情况下，我们的论文表明计划赞助商能够通过鼓励在治疗类别中使用仿制药或更具性价比的药物来控制成本。如果有多种对受益人群有效的新药进入市场且没有真正的竞争对手，未来医疗保险D部分的成本会怎样则不太清楚。
