Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, La Jolla, California.
Division of Geriatrics, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California.
J Am Geriatr Soc. 2018 Aug;66(8):1621-1624. doi: 10.1111/jgs.15443. Epub 2018 Jul 4.
Access to prescription medications is critical as the U.S. population ages. Escalating drug costs have garnered mounting attention from the public with increasing federal scrutiny. The Medicare Part D program will increasingly be relied upon to support the health of our nation's older people. We reviewed the publically available Medicare Part D usage data from 2011 to 2015 to quantify the cost of the 10 costliest medications for Part D, evaluated the number of beneficiaries treated with these medications, and measured beneficiaries' out-of-pocket costs. We observed over the analysis period, an increase in spending for these medications, a reduction in number of patients that received them, with increased out-of-pocket costs for the patient. In 2015 U.S. dollars, the amount Medicare Part D spent on the 10 costliest medications increased from $21.5 billion in 2011 to $28.4 billion in 2015-a 32% increase. The number of beneficiaries who received 1 of the 10 costliest medications fell from 12,913,003 in 2011 to 8,818,471-a 32% drop, with an average annual decrease of 7.9%. Out of pocket spending by patients that use these medications increased over the study period. For beneficiaries without the low-income subsidy, the average out-of-pocket cost share for 1 of the 10 costliest medications increased from $375 in 2011 to $1,366 in 2015-a 264% increase overall and an average 66% increase per year. Specialty medications are a growing portion of the costliest medications. As medication costs continue to escalate, and specialty medications become more common, the U.S. will be increasingly challenged with devising mechanisms to access sustainable, affordable medications for all older adults.
获得处方药物对于美国人口老龄化至关重要。不断上涨的药品成本引起了公众越来越多的关注，也受到了联邦政府越来越多的审查。随着 Medicare Part D 计划越来越依赖于支持我国老年人的健康，这一计划将发挥更大的作用。我们回顾了 2011 年至 2015 年 Medicare Part D 公开可用的使用数据，以量化 Medicare Part D 中 10 种最昂贵药物的成本，评估用这些药物治疗的受益人数，并衡量受益人的自付费用。在分析期间，我们观察到这些药物的支出增加，接受这些药物的患者数量减少，而患者的自付费用增加。按 2015 年美元计算，Medicare Part D 在这 10 种最昂贵药物上的支出从 2011 年的 215 亿美元增加到 2015 年的 284 亿美元，增长了 32%。接受 1 种 10 种最昂贵药物之一的受益人数从 2011 年的 12913003 人下降到 2015 年的 8818471 人，下降了 32%，平均每年下降 7.9%。在研究期间，使用这些药物的患者的自付费用增加了。对于没有低收入补贴的受益人来说，1 种 10 种最昂贵药物之一的自付费用从 2011 年的 375 美元增加到 2015 年的 1366 美元，总体增加了 264%，平均每年增加 66%。专科药物是最昂贵药物中增长最快的部分。随着药物成本的不断攀升，以及专科药物变得越来越普遍，美国将越来越需要设计机制，为所有老年人获得可持续、负担得起的药物。
