Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Tufts University School of Medicine, Boston, MA, USA.
BMJ. 2019 Jul 17;366:l4257. doi: 10.1136/bmj.l4257.
To characterize the trends, drivers, and potential modifiers of increased spending by US Medicare beneficiaries on medicines deemed essential by the World Health Organization.
Retrospective cost analysis of Medicare Part D Prescriber Public Use File, detailing annual generic and brand name drug prescribing and spending from 2011 through 2015 by Medicare Part D participants who filled prescriptions for WHO essential medicines.
US Medicare System.
Total and per beneficiary Medicare spending, total and per beneficiary out-of-pocket patient spending, cumulative beneficiary count, claim count, and per unit drug cost. All spending measures were adjusted for inflation and reported in 2015 US dollars.
Medicare Part D expenditures on 265 WHO essential medicines between 2011 and 2015 was $87.2bn (£68.4bn; €76.5bn), with annual spending increasing from $11.9bn in 2011 to $25.8bn in 2015 (116%). Patients' out-of-pocket spending for essential medicines over the same period was $12.1bn. Total annual out-of-pocket spending increased from $2.0bn to $2.9bn (47%), and annual per beneficiary out-of-pocket spending on these drugs increased from $20.42 to $21.17 (4%). Total prescription count increased from 376.1m to 498.9m (33%), and cumulative beneficiary count grew from 95.9m to 135.8m (42%). Of the essential medicines included in the study, the per unit cost of 133 (50%) agents increased faster than the average inflation rate during this period. Overall, approximately 58% of the increase in total spending during this period can be attributed to the introduction of novel agents.
Spending associated with essential medicines grew substantially from 2011 to 2015, driven largely by the increased use of two expensive novel drugs used in treating hepatitis C. Approximately 22% of increased total spending during this period can be attributed to increases in per unit cost of existing drugs. These trends may limit patients' access to essential drugs while also increasing healthcare system costs.
描述美国医疗保险受益人在购买世界卫生组织认定的基本药物方面支出增加的趋势、驱动因素和潜在影响因素。
对 2011 年至 2015 年医疗保险处方公共使用文件的回顾性成本分析，详细说明了医疗保险 D 部分参与者每年开处方使用世界卫生组织基本药物的通用名和品牌名药物的情况以及支出情况。
美国医疗保险系统。
医疗保险支出总额和每位受益人的支出、每位受益人的自付医疗费用支出总额和人均支出、累计受益人数、处方数量和每单位药物成本。所有支出数据均经过通胀调整，并以 2015 年美元表示。
2011 年至 2015 年，医疗保险 D 部分用于 265 种世界卫生组织基本药物的支出为 872 亿美元（684 亿英镑；765 亿欧元），年支出从 2011 年的 119 亿美元增加到 2015 年的 258 亿美元（116%）。同期患者用于基本药物的自付费用为 121 亿美元。同期，总年度自付费用从 20 亿美元增加到 29 亿美元（47%），每位受益人在此类药物上的年度自付费用从 20.42 美元增加到 21.17 美元（4%）。处方总数从 3.761 亿张增加到 4.989 亿张（33%），受益人数从 9590 万增加到 1.358 亿（42%）。在纳入研究的基本药物中，133 种（50%）药物的单位成本增速快于这一时期的平均通胀率。总体而言，这一时期总支出增加的约 58%可归因于新型药物的引入。
从 2011 年到 2015 年，与基本药物相关的支出大幅增长，主要原因是两种用于治疗丙型肝炎的昂贵新型药物的使用量增加。这一时期总支出增加的约 22%可归因于现有药物单位成本的增加。这些趋势可能会限制患者获得基本药物的机会，同时也增加医疗保健系统的成本。
