Ung Brian L, Mullins C Daniel
University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD 21201, USA.
University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD 21201, USA.
Res Social Adm Pharm. 2015 May-Jun;11(3):459-67. doi: 10.1016/j.sapharm.2014.08.004. Epub 2014 Aug 12.
The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.
美国《患者保护与平价医疗法案》（以下简称《平价医疗法案》或ACA）于2010年3月23日签署成为法律。该法案的目标包括减少未参保人数、控制医疗保健成本和支出、提高所提供医疗服务的质量以及增加保险覆盖福利。本文着重探讨《平价医疗法案》在患者配药时对药房福利管理人员和消费者的影响。药房福利管理人员使用药品目录和使用控制工具，引导药物使用转向具有成本效益且有效的药物。我们开发了一个逻辑模型来解释这项新立法的影响。该模型借鉴了关于美国当前和未来医疗改革的同行评审文献及灰色文献评论。结果被确定为期望和不期望的影响以及预期的意外后果。《平价医疗法案》将医疗保险福利扩大到近3200万人，并为那些收入高达贫困线400%的人提供财政援助。获得医疗服务的机会增加导致总体医疗需求和使用量出现类似增长。预计这种短期增长将减少疾病治疗的下游支出，并抑制医疗保健成本的持续增长，但可能无意中加剧当前初级保健医生短缺的问题。《平价医疗法案》消除了保险限制并扩大了福利范围。在线医疗保险交易所为患者提供了一个有多种保险选择的集中场所。《平价医疗法案》未解决处方药可负担性问题以及药房福利管理人员使用的使用控制工具问题。通过创新的医疗服务提供模式或增加健康信息技术的使用来改善美国医疗系统内部的沟通，将有助于缓解医疗保健支出和可负担性问题。
