PGY-2 Health-System Pharmacy Administration Resident.
University of Kentucky College of Pharmacy, Lexington.
J Manag Care Spec Pharm. 2020 Jan;26(1):76-80. doi: 10.18553/jmcp.2020.26.1.76.
National spending on specialty medications accounted for approximately $193 billion in 2016. The coverage design for Medicare Parts B and D has shifted medication costs to patients, which may prohibit patients from starting or maintaining therapy due to affordability. As a result, patients have enrolled in safety net financial options, such as patient assistance and foundation programs. Safety net options may provide savings not otherwise realized by Medicare; however, they may have a negative financial effect on health systems and pharmaceutical manufacturers.
To (a) quantify financial savings to Medicare as a result of patient enrollment in patient assistance programs and (b) quantify the financial effect of safety net options for patients, manufacturers, and the academic medical center that participated in this study.
A single-center, nonrandomized, retrospective pilot study of Medicare beneficiaries was conducted. Patients who were prescribed hematology/oncology specialty medications and enrolled in safety net options between July 2015 and June 2017 were included. Investigators collected data related to fill history, drug cost, and prescription coverage. The primary outcome was the overall cost savings to Medicare as a result of patient enrollment in patient assistance programs. Secondary outcomes included total patient out-of-pocket savings as a result of foundation copayment support, financial effect on manufacturers as a result of patient assistance programs, and health system revenue impact as a result of safety net options. Descriptive statistics were used.
This study included 114 patients. Medicare saved $5,083,816.83 over 2 years as a result of patient assistance programs. Eight foundations provided $240,350.04 in patient insurance copayments. Nine manufacturers provided 2,243 free drug doses, valued at $3,379,032.34. The participating medical center missed the opportunity for $6,481,543.55 in revenue due to patient assistance programs.
The participating medical center's efforts to improve access to oncology care took considerable time and resources. These activities, as well as unreimbursed infusion services, were costs to the medical center that may not be recognized by Medicare. Manufacturers also supported patient access through their sponsored patient assistance programs. The use of these services and safety net options resulted in cost savings to Medicare and their beneficiaries.
No outside funding supported this study. The authors have nothing to disclose. Findings from this study were part of a podium research presentation at the Great Lakes Pharmacy Residency Conference; April 25, 2018; West Lafayette, IN.
2016 年，美国在专科药物上的支出约为 1930 亿美元。医疗保险 B 部分和 D 部分的覆盖范围将药物成本转嫁给了患者，这可能会导致患者因负担能力而无法开始或维持治疗。因此，患者已经注册了安全网财务选项，例如患者援助和基金会计划。安全网选项可能会提供医疗保险无法实现的节省；然而，它们可能对卫生系统和制药制造商产生负面影响。
(a) 量化患者参与患者援助计划对医疗保险的财务节省，以及 (b) 量化安全网选项对参与这项研究的患者、制造商和学术医疗中心的财务影响。
这是一项单中心、非随机、回顾性试点研究，纳入了 2015 年 7 月至 2017 年 6 月期间接受血液学/肿瘤学专科药物治疗并注册安全网选项的医疗保险受益人的数据。研究人员收集了与填充历史、药物成本和处方覆盖相关的数据。主要结果是患者参与患者援助计划对医疗保险的总体成本节省。次要结果包括基金会共同支付支持带来的患者总自付费用节省、患者援助计划对制造商的财务影响以及安全网选项对卫生系统收入的影响。采用描述性统计。
这项研究共纳入 114 名患者。2 年来，由于患者援助计划，医疗保险节省了 5083816.83 美元。八家基金会提供了 240350.04 美元的患者保险共付额。九家制造商提供了 2243 次免费药物剂量，价值 3379032.34 美元。参与的医疗中心因患者援助计划而错失了 6481543.55 美元的收入机会。
参与医疗中心为改善肿瘤学治疗的可及性付出了大量的时间和资源。这些活动以及未报销的输注服务都是该医疗中心的成本，医疗保险可能没有对此进行补偿。制造商还通过其赞助的患者援助计划支持患者获得药物。这些服务和安全网选项的使用为医疗保险及其受益人节省了成本。
本研究无外部资金支持。作者没有任何利益冲突。这项研究的结果是在大湖药房住院医师会议上的一次演讲中提出的；2018 年 4 月 25 日；印第安纳州拉斐特。
