Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.
JAMA Netw Open. 2020 Apr 1;3(4):e203969. doi: 10.1001/jamanetworkopen.2020.3969.
The closure of the Medicare Part D coverage gap from 2010 to 2019 was intended to help decrease out-of-pocket costs for beneficiaries, especially those taking high-cost drugs. However, yearly increases in list prices and the introduction of newer and more expensive drugs may have limited savings for beneficiaries.
To assess the association of closure in the Medicare Part D coverage gap with projected annual out-of-pocket costs from 2010 through 2019 for rheumatoid arthritis (RA) biologics.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used data from the Medicare Formulary and Pricing Files for the first quarter (January 1 to March 31) in each calendar year from 2010 to 2019 for 17 RA biologic drug and strength combinations.
Medicare Part D plan design and drug price by year.
Expected annual out-of-pocket costs for 1 year of treatment.
Among the 17 drug and strength combinations assessed, list prices increased each year for every product, with a mean increase of 160% for the 6 drugs available during the entire study period. For the 6 products available during the entire study period, projected mean (SD) annual out-of-pocket costs were 34% (2%) lower in 2011 than in 2010 ($6108 in 2010 to $4026 in 2011) but only 21% (8%) lower in 2019 ($4801) because of yearly increases in list price. All 4 products with higher out-of-pocket costs in 2019 than in the first year available entered the market between 2011 and 2015. For all products studied, the percentage of money spent in the catastrophic phase increased each year and was a mean (SD) of 22% (14%) higher in 2019 than in 2010 or the year first available.
Although beneficiaries experienced large reductions in out-of-pocket spending from 2010 to 2011, more than half of those savings were lost by 2019 because of annual increases in list prices, even as the coverage gap continued to close in subsequent years.
从 2010 年到 2019 年，医疗保险部分 D 覆盖缺口的关闭旨在帮助降低受益人的自付费用，特别是那些服用高成本药物的人。然而，每年的目录价格上涨和新的、更昂贵的药物的引入可能使受益人节省的费用有限。
评估 2010 年至 2019 年医疗保险部分 D 覆盖缺口的关闭与类风湿关节炎 (RA) 生物制剂预计每年自付费用的关系。
设计、地点和参与者：这项横断面分析使用了 2010 年至 2019 年每个日历年度第一季度（1 月 1 日至 3 月 31 日）的医疗保险配方和定价文件的数据，共涉及 17 种 RA 生物药物和强度组合。
按年划分的医疗保险部分 D 计划设计和药物价格。
治疗 1 年的预期年度自付费用。
在所评估的 17 种药物和强度组合中，每种药物的目录价格每年都在上涨，在整个研究期间可用的 6 种药物的平均涨幅为 160%。在整个研究期间可用的 6 种产品中，2011 年的预计平均（SD）年度自付费用比 2010 年低 34%（2010 年为 6108 美元，2011 年为 4026 美元），但由于每年的目录价格上涨，2019 年仅低 21%（2019 年为 4801 美元）。在 2019 年自付费用高于最初可用年份的 4 种产品均在 2011 年至 2015 年期间进入市场。对于所有研究的产品，灾难性阶段的支出比例每年都在增加，2019 年比 2010 年或最初可用年份高 22%（2019 年为 22%，2010 年或最初可用年份为 14%）。
尽管受益人的自付支出从 2010 年到 2011 年大幅减少，但由于每年的目录价格上涨，到 2019 年，这些节省中的一半以上已经流失，尽管随后几年覆盖缺口继续缩小。
