复杂的癌症护理覆盖环境——立法的作用是什么？来自马萨诸塞州的案例研究。
The Complex Cancer Care Coverage Environment - What is the Role of Legislation? A Case Study from Massachusetts.
机构信息
Christine Leopold, Ph.D., M.Sc., conducted this research while she was a senior research fellow in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. She received her Ph.D. from Utrecht University and her Master of Science degree in international healthcare management, economics and policy from Bocconi University. Rebecca L. Haffajee, J.D., Ph.D., M.P.H., is a Policy Researcher at RAND Corporation and an Adjunct Assistant Professor of Health Management and Policy at the University of Michigan School of Public Health. She received her law degree from Harvard Law School and a Master in Public Health degree from Harvard T.H. Chan School of Public Health. She completed her Ph.D. in health policy with a concentration in evaluative science and statistics at Harvard University in 2016. Christine Y. Lu, M.Sc, Ph.D., is an Associate Professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute and she co-directs the PRecisiOn Medicine Translational Research Center. She received her M.Sc. in biopharmaceuticals and a Ph.D. from the University of New South Wales. Anita K. Wagner, Pharm.D., M.P.H, Dr.P.H., is Associate Professor at the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. She serves as the Director of the Harvard Pilgrim Health Care Ethics Program. She received her Master of Public Health degree in international health and Doctor of Public Health degree in epidemiology from the Harvard School of Public Health.
出版信息
J Law Med Ethics. 2020 Sep;48(3):538-551. doi: 10.1177/1073110520958879.
Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immuno-oncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications - including high prices and often limited evidence of efficacy at approval - compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates.
在过去的几十年中，癌症治疗方法从细胞毒性化疗迅速发展到靶向治疗，包括口服靶向药物以及免疫肿瘤学和细胞治疗的注射药物。新的抗癌药物以越来越高的价格进入市场，医疗保险的覆盖范围对于患者获得这些治疗方法至关重要。州法律旨在促进抗癌治疗的保险覆盖。以马萨诸塞州为例，我们确定了五项当前的癌症保险州法律，并采访了专家，了解他们对这些法律的相关性的看法，以及考虑到治疗方法的快速变化，这些法律在多大程度上满足了当前癌症护理的需求。受访者强调，与许多其他治疗领域相比，癌症治疗是独特的，因为保险立法针对其覆盖范围。他们认为，口服化疗平等法导致商业保险中治疗成本增加。对于商业保险公司来说，覆盖范围的强制规定，加上新癌症药物的实际情况——包括批准时的高价格和通常有限的疗效证据——使得情况更加复杂。受访者建议采取政策措施来应对这一具有挑战性的保险环境，包括实施封闭式处方集、利用成本效益研究来指导覆盖范围决策，以及应用基于价值的定价概念。鉴于癌症治疗方法的发展，可能是时候评估癌症覆盖范围强制规定的好处和挑战了。
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