Am J Respir Crit Care Med. 2018 Dec 1;198(11):1367-1374. doi: 10.1164/rccm.201810-1865ST.
Mounting evidence indicates that out-of-pocket costs for prescription medications, particularly among low- and middle-income patients with chronic diseases, are imposing financial burden, reducing medication adherence, and worsening health outcomes. This problem is exacerbated by a paucity of generic alternatives for prevalent lung diseases, such as asthma and chronic obstructive pulmonary disease, as well as high-cost medicines for rare diseases, such as cystic fibrosis. Affordability and access challenges are especially salient in the United States, as citizens of many other countries pay lower prices for and have greater access to prescription medications.
The American Thoracic Society convened a multidisciplinary committee comprising experts in health policy pharmacoeconomics, behavioral sciences, and clinical care, along with individuals providing industry and patient perspectives. The report and its recommendation were iteratively developed over a year of in-person, telephonic, and electronic deliberation.
The committee unanimously recommended the establishment of a publicly funded, politically independent, impartial entity to systematically draft evidence-based pharmaceutical policy recommendations. The goal of this entity would be to generate evidence and action steps to ensure people have equitable and affordable access to prescription medications, to maximize the value of public and private pharmaceutical expenditures on health, to support novel drug development within a market-based economy, and to preserve clinician and patient choice regarding personalized treatment. An immediate priority is to examine the evidence and make recommendations regarding the need to have essential medicines with established clinical benefit from each drug class in all Tier 1 formularies and propose recommendations to reduce barriers to timely generic drug availability.
By making explicit, evidence-based recommendations, the entity can support the establishment of coherent national policies that expand access to affordable medications, improve the health of patients with chronic disease, and optimize the use of public and private resources.
越来越多的证据表明，处方药物的自付费用，尤其是患有慢性病的中低收入患者，正在造成经济负担，降低药物依从性，并导致健康状况恶化。由于缺乏常见肺部疾病（如哮喘和慢性阻塞性肺疾病）的仿制药替代品，以及囊性纤维化等罕见疾病的高价药物，这个问题更加严重。在许多其他国家，公民为处方药物支付的价格更低，获得的渠道更多，因此，美国的负担能力和获取渠道方面的挑战尤为突出。
美国胸科学会召集了一个多学科委员会，成员包括卫生政策、药物经济学、行为科学和临床护理方面的专家，以及提供行业和患者观点的个人。报告及其建议在一年多的面对面、电话和电子讨论中逐步制定。
委员会一致建议成立一个由公共资金资助、政治独立、公正的实体，系统地起草基于证据的药物政策建议。该实体的目标是生成证据和行动步骤，以确保人们能够公平、负担得起地获得处方药物，最大限度地提高公共和私人药物支出对健康的价值，在基于市场的经济中支持新药开发，并维护临床医生和患者对个性化治疗的选择。当务之急是检查证据，并就每个药物类别在所有第一级处方集都需要具有既定临床益处的基本药物提出建议，并提出减少及时获得仿制药障碍的建议。
通过明确、基于证据的建议，该实体可以支持建立连贯的国家政策，扩大负担得起的药物获取渠道，改善慢性病患者的健康状况，并优化公共和私人资源的利用。
