Trish Erin, Joyce Geoffrey, Goldman Dana P
Erin Trish is a postdoctoral fellow at the Schaeffer Center for Health Policy and Economics, University of Southern California, and in the Department of Health Policy and Management at the Fielding School of Public Health, University of California, Los Angeles.
Geoffrey Joyce (
Health Aff (Millwood). 2014 Nov;33(11):2018-24. doi: 10.1377/hlthaff.2014.0538.
Specialty pharmaceuticals include most injectable and biologic agents used to treat complex conditions such as rheumatoid arthritis, multiple sclerosis, and cancer. We analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007-11 pharmacy claims data from a 20 percent sample of Medicare beneficiaries. Annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, from $2,641 to $8,976. However, specialty drugs accounted for only 6.7 percent of total drug spending per beneficiary in 2007 and 9.1 percent in 2011. Moreover, in 2011 cost-sharing reductions under the Affordable Care Act significantly reduced specialty drug users' out-of-pocket burden, which decreased 26 percent from 2010. Oral cancer agents accounted for a significant proportion of the increase in specialty drug spending among the study population. This suggests that the migration of specialty drug coverage from Medicare's Part B medical benefit to the Part D pharmacy benefit because of new treatment options may play an important role in specialty pharmacy trends. This shift is likely to continue as pharmaceutical innovations enable more specialty therapeutics to be self-administered and to be covered under the pharmacy instead of the medical benefit.
专科药物包括大多数用于治疗类风湿性关节炎、多发性硬化症和癌症等复杂病症的注射剂和生物制剂。我们利用来自20%医疗保险受益人的样本的2007 - 2011年药房报销数据，分析了65岁及以上医疗保险受益人的专科药物支出趋势。在研究期间，使用专科药物的每位受益人的年度专科药物支出大幅增加，从2641美元增至8976美元。然而，专科药物在2007年仅占每位受益人总药物支出的6.7%，在2011年占9.1%。此外，2011年《平价医疗法案》下的费用分担削减显著减轻了专科药物使用者的自付负担，自付负担较2010年下降了26%。口服癌症药物在研究人群的专科药物支出增长中占很大比例。这表明，由于新的治疗选择，专科药物覆盖范围从医疗保险的B部分医疗福利转移到D部分药房福利可能在专科药房趋势中发挥重要作用。随着药物创新使更多专科治疗药物能够自我给药并纳入药房福利而非医疗福利覆盖范围，这种转变可能会持续下去。
