Atzinger Christopher B, Guo Jeff J
Graduate student, College of Pharmacy, University of Cincinnati, OH, and Associate Director, Pharmerit International, Bethesda, MD.
Professor, Pharmacoepidemiology & Pharmacoeconomics, College of Pharmacy, University of Cincinnati.
Am Health Drug Benefits. 2017 Feb;10(1):27-36.
Spending on biologic drugs is a significant driver of drug expenditures for payers in private health plans. Biologic disease-modifying antirheumatic drugs (DMARDs) are some of the most effective and costly treatments in a physician's arsenal. Understanding the total annual expenditure, the average cost per prescription, and the impact of cost-sharing is important for drug benefit managers.
To assess drug utilization, expenditures, out-of-pocket (OOP) cost, and price trends of biologic DMARDs in patients with rheumatoid arthritis (RA) in a large managed care organization.
We conducted a retrospective database analysis of pharmacy claims data from January 2004 to December 2013 using the Optum Clinformatics Data Mart database, which covers 13.3 million lives. Pharmacy claims for 40,373 patients with RA were identified during the study period. In all, 9 biologic DMARDs approved for the treatment of RA, including infliximab, etanercept, adalimumab, certoizumab, golimumab, tocilizumab, anakinra, abatacept, and rituximab, and 1 nonbiologic oral, small molecule-targeted synthetic drug, tofacitinib, were included in this study. Descriptive statistics were used to analyze the total annual number of prescriptions, the total annual expenditures, the average annual cost per drug (a proxy of drug price), and the average OOP cost (copay plus deductible and coinsurance). All measurements were also stratified by study drugs and by insurance type.
Of the 40,373 patients with RA included in the study, approximately 76% were female (mean age, 55 years at diagnosis). Approximately 77% of the patients were white, and almost 48% lived in the South or Midwest region of the United States. Approximately 62% of patients had a point of service insurance plan. Expenditures on biologic DMARDs increased from $166 million in 2004 to $243 million in 2013, and the number of prescriptions and refills increased from 59,960 in 2004 to 105,295 in 2013. Prescriptions for biologic DMARDs increased more than 20% per patient from 2004 to 2013. The average cost per prescription remained relatively unchanged, at approximately $2300 per prescription, but the OOP expenditures increased from $36 (2.5%) per prescription to $128 (7%) during the study period. The OOP expenditures increased the most in HMO plans and in plans categorized as other (284% and 388%, respectively).
Spending on biologic DMARDs has been primarily driven by an increase in prescribing rates, as the average amount reimbursed per prescription remained relatively unchanged over time, despite a regular annual increase to the average wholesale acquisition cost of 2% to 10%. The OOP burden for patients has increased, but this does not appear to have limited the use of biologic DMARDs. The entrance of new biologic and nonbiologic DMARDs into the market in the past few years is eroding the market share for several established drugs, and may lead to different results, warranting a study of new trends.
生物药物支出是私人健康保险计划中支付方药品支出的重要驱动因素。生物性改善病情抗风湿药（DMARDs）是医生可用治疗手段中最有效但成本也最高的一些药物。了解年度总支出、每张处方的平均成本以及费用分摊的影响，对药品福利管理人员而言至关重要。
评估一家大型管理式医疗组织中类风湿关节炎（RA）患者使用生物性DMARDs的药物利用情况、支出、自付费用（OOP）及价格趋势。
我们利用涵盖1330万人的Optum临床信息数据集市数据库，对2004年1月至2013年12月的药房报销数据进行了回顾性数据库分析。在研究期间，共识别出40373例RA患者的药房报销记录。本研究纳入了9种已获批用于治疗RA的生物性DMARDs，包括英夫利昔单抗、依那西普、阿达木单抗、赛妥珠单抗、戈利木单抗、托珠单抗、阿那白滞素、阿巴西普和利妥昔单抗，以及1种非生物性口服小分子靶向合成药物托法替布。采用描述性统计分析年度处方总数、年度总支出、每种药物的年均成本（代表药物价格）以及平均OOP成本（自付额加免赔额和共保费用）。所有测量指标还按研究药物和保险类型进行了分层。
在纳入研究的40373例RA患者中，约76%为女性（诊断时平均年龄55岁）。约77%的患者为白人，近48%居住在美国南部或中西部地区。约62%的患者拥有服务点保险计划。生物性DMARDs的支出从2004年的1.66亿美元增至2013年的2.43亿美元，处方及续方数量从2004年的59960张增至2013年的105295张。2004年至2013年，每位患者的生物性DMARDs处方量增长超过20%。每张处方的平均成本相对保持不变，约为每张处方2300美元，但在研究期间，OOP支出从每张处方36美元（2.5%）增至128美元（7%）。HMO计划和归类为其他的计划中，OOP支出增长最多（分别为284%和388%）。
生物性DMARDs支出的增加主要是由于处方率上升，尽管平均批发采购成本每年有2%至10%的常规增长，但每张处方的报销金额随时间相对保持不变。患者的OOP负担有所增加，但这似乎并未限制生物性DMARDs的使用。过去几年新的生物性和非生物性DMARDs进入市场，正在侵蚀几种现有药物的市场份额，可能会导致不同结果，因此有必要研究新趋势。
