De Lott Lindsey B, Burke James F, Kerber Kevin A, Skolarus Lesli E, Callaghan Brian C
From the Department of Neurology, University of Michigan, Ann Arbor.
Neurology. 2016 Apr 19;86(16):1491-8. doi: 10.1212/WNL.0000000000002589. Epub 2016 Mar 23.
To describe neurologists' Medicare Part D prescribing patterns and the potential effect of generic substitutions and price negotiation, which is currently prohibited.
The 2013 Medicare Part D Prescriber Public Use and Summary files were used. Payments for medications were aggregated by provider and drug (brand or generic). Payment, proportion of generic claims or day's supply, and median payment per monthly supply of medication were calculated by physician specialty and drug. Savings from generic substitution were estimated for brand drugs with a generic available. Medicare prices were compared to drug prices negotiated by the federal government with pharmaceutical manufacturers for the Veterans Administration (VA).
Neurologists comprised 13,060 (1.2%) providers with $5.0 billion (4.8%) in total payments, third highest of all specialties, with a median monthly payment of $141 (interquartile range $85-225). Multiple sclerosis drugs had the highest payments ($1.8 billion). Within neurologic disease groups ($3.4 billion in payments), 54.2%-91.8% of monthly supplies were generic, but 11.9%-71.3% of the payment was for generic medications. Generic substitution resulted in a $269 million (6.5%) payment decrease. VA pricing resulted in $1.5 billion (44.5% of $3.4 billion) in savings.
High payment per monthly supply of medication underlies the high total neurology drug payments and is driven by multiple sclerosis drugs. Lowering drug expenditures by Medicare should focus on drug prices.
描述神经科医生在医疗保险D部分的处方模式，以及目前被禁止的非专利药品替代和价格谈判的潜在影响。
使用2013年医疗保险D部分处方者公共使用和汇总文件。按提供者和药品（品牌或非专利）汇总药品支付情况。按医生专业和药品计算支付金额、非专利药品报销比例或日供应量以及每月药品供应的中位数支付金额。对有非专利药品可用的品牌药估计非专利药品替代带来的节省。将医疗保险价格与联邦政府与制药商就退伍军人管理局（VA）药品谈判达成的价格进行比较。
神经科医生有13,060名（占1.2%），总支付金额为50亿美元（占4.8%），在所有专业中排第三，每月支付中位数为141美元（四分位距为85 - 225美元）。治疗多发性硬化症的药物支付金额最高（18亿美元）。在神经疾病组（支付金额为34亿美元）中，每月供应量的54.2% - 91.8%是非专利药品，但支付金额的11.9% - 71.3%用于非专利药品。非专利药品替代使支付金额减少了2.69亿美元（6.5%）。退伍军人管理局的定价节省了15亿美元（占34亿美元的44.5%）。
每月药品供应的高支付金额是神经科药品总支付金额高的基础，这是由治疗多发性硬化症的药物推动的。医疗保险降低药品支出应关注药品价格。
