McRae Jacquelyn, Vogenberg F Randy, Beaty Silky Webb, Mearns Elizabeth, Varga Stefan, Pizzi Laura
Thomas Jefferson University, 901 Walnut St., Philadelphia, PA, 19107, USA.
Institute for Integrated Healthcare, and Access Market Intelligence, PO Box 17217, Greenville, SC, 29606, USA.
Pharmacoeconomics. 2017 Feb;35(2):215-223. doi: 10.1007/s40273-016-0458-0.
Since passage of the Affordable Care Act (ACA) in 2010, US stakeholders are increasingly being held accountable for the value of healthcare services and drugs administered to patients. Pharmacoeconomic analyses offer one method of demonstrating a product's value, yet there is a lack of resources specific to US drug costs relevant to each stakeholder. The aim of this study was to review current US drug costs (post-ACA). A literature review aimed at finding evidence on outpatient prescription drug costs was performed using the following sources: PubMed, governmental agencies, news websites, the Academy of Managed Care Pharmacy (AMCP) website, and Google Scholar. Articles were limited to those published in the years "2010-2016" and the "English" language, and those that described drug acquisition costs, reimbursement costs, and rebates or discounting for Medicare, Medicaid, and commercial payors. The Drug Cost Focus Group (DCFG) was convened to supplement the literature review; the DCFG provided their expertise on US drug costs and emerging issues affecting drug costs. ACA legislation increased drug rebates for manufacturers participating in the Medicaid Drug Rebate Program. Acquisition costs commonly referred to in the literature include the wholesale acquisition cost and average manufacture price. Drugs reimbursed by Medicaid are currently based on the actual acquisition cost and ACA-Federal Upper Limit. Evidence suggests that reimbursement methods in the public market are varied. Current gaps in the literature regarding commercial insurers' drug costs (post-ACA) present barriers to the application of relevant drug costs to pharmacoeconomic analyses.
自2010年《平价医疗法案》（ACA）通过以来，美国的利益相关者越来越需要对提供给患者的医疗服务和药物的价值负责。药物经济学分析提供了一种证明产品价值的方法，但缺乏针对每个利益相关者的与美国药物成本相关的特定资源。本研究的目的是回顾当前美国的药物成本（ACA实施后）。通过以下来源进行了旨在寻找门诊处方药成本证据的文献综述：PubMed、政府机构、新闻网站、管理式医疗药学学会（AMCP）网站和谷歌学术。文章限于2010 - 2016年发表且为英文的，以及描述药物采购成本、报销成本以及医疗保险、医疗补助和商业支付方的回扣或折扣的文章。召集了药物成本焦点小组（DCFG）以补充文献综述；DCFG提供了他们关于美国药物成本及影响药物成本的新出现问题的专业知识。ACA立法增加了参与医疗补助药物回扣计划的制造商的药物回扣。文献中通常提到的采购成本包括批发采购成本和平均制造成本。医疗补助报销的药物目前基于实际采购成本和ACA联邦上限。有证据表明公共市场中的报销方法各不相同。当前文献中关于商业保险公司药物成本（ACA实施后）的空白给将相关药物成本应用于药物经济学分析带来了障碍。
