Department of Dermatology, Northwestern University Feinberg School of Medicine, 2701 Patrio Blvd, Glenview, Chicago, IL, USA.
Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Arch Dermatol Res. 2020 Oct;312(8):559-565. doi: 10.1007/s00403-020-02042-9. Epub 2020 Feb 13.
The cost of prescription drugs has increased at rates far exceeding general inflation in recent history, with topical drugs increasing at a disproportionate rate compared to other routes of administration. We assessed the relationship between net changes in the number of therapeutic options, defined as any approved drug or therapeutic equivalent on the market, and prescription topical drug spending. Drugs were divided based on the category of use through pairing of Medicare Part D Prescriber Public Use and Food and Drug Administration (FDA) approved drug products databases. Across drug classes, we modeled the log of the ratio of total spending per unit in 2015 to total spending per unit in 2011 as a linear function of net number of topical therapeutic options over this time period. Primary outcomes include total Medicaid Part D spending on topical drugs and net change in the number of available therapeutic options within each category of use. Total spending on topical drugs increased by 61%, while the number of units dispensed increased by only 18% from 2011-2015. The greatest total spending increases were in categories with few new therapeutic options, such as topical corticosteroid and antifungal medications. Each net additional therapeutic option during 2011-2015 was associated with an reduction in how much relative spending per unit increased (95% CI 2.5%-14.4%, p = 0.013). Stimulating greater competition through increasing the net number of therapeutic options within each major topical category of use may place downward pressure on topical prescription drug spending under medicare Part D.
近年来，处方药的价格涨幅远超整体通胀水平，其中局部用药物的涨幅远超其他给药途径。我们评估了治疗选择数量（定义为市场上任何已批准的药物或治疗等效药物）的净变化与处方局部用药物支出之间的关系。根据使用类别，通过将医疗保险处方药物公共使用数据库和食品和药物管理局（FDA）批准的药物产品数据库进行配对，将药物进行分类。在所有药物类别中，我们将 2015 年单位总支出与 2011 年单位总支出之比的对数建模为该时间段内局部治疗选择数量净变化的线性函数。主要结果包括 Medicaid 部分 D 用于局部药物的总支出和每个使用类别中可用治疗选择数量的净变化。2011 年至 2015 年，局部药物总支出增长 61%，而单位分发量仅增长 18%。总支出增长最大的是新治疗选择较少的类别，如局部皮质类固醇和抗真菌药物。2011 年至 2015 年期间，每个新增的治疗选择与单位相对支出增加幅度降低相关（95%CI 2.5%-14.4%，p=0.013）。通过在每个主要局部用药类别中增加治疗选择数量来刺激更大的竞争，可能会对医疗保险部分 D 下的局部处方药物支出产生下行压力。
