Hill Steven C, Miller G Edward, Ding Yao
Steven C. Hill (
G. Edward Miller is deputy director of the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, AHRQ.
Health Aff (Millwood). 2020 Nov;39(11):1970-1976. doi: 10.1377/hlthaff.2019.01830.
Specialty drugs are expensive, but spending on specialty drugs is difficult to measure because of proprietary rebate payments by manufacturers to insurers, pharmacy benefit managers, and state Medicaid agencies. Our study extends recent research that documented growing use of and spending on specialty drugs by incorporating manufacturer rebates for both public and private payers. Although specialty drugs make up a small portion of retail prescriptions filled, we found that they accounted for 37.7 percent of retail and mail-order prescription spending net of rebates in 2016-17. From 2010-11 to 2016-17, spending net of rebates tripled for Medicare Part D beneficiaries and more than doubled for people with private insurance. Medicaid spending net of rebates rose more slowly. These results can help inform decision makers as they strive to balance the costs and benefits of innovative drugs.
专科药物价格昂贵，但由于制造商向保险公司、药品福利管理机构和州医疗补助机构支付专有回扣，专科药物的支出难以衡量。我们的研究扩展了最近的研究，该研究记录了专科药物使用和支出的增长情况，纳入了制造商对公共和私人支付方的回扣。尽管专科药物在零售处方中所占比例很小，但我们发现，在2016 - 2017年，扣除回扣后，它们占零售和邮购处方支出的37.7%。从2010 - 2011年到2016 - 2017年，医疗保险D部分受益人的回扣后支出增长了两倍，有私人保险的人的支出增长了一倍多。医疗补助回扣后支出增长较为缓慢。这些结果有助于为决策者提供信息，使他们努力平衡创新药物的成本和效益。
