1850Suffolk University Law School, Boston, MA, USA.
Int J Health Serv. 2021 Jul;51(3):379-391. doi: 10.1177/0020731421996168. Epub 2021 Mar 9.
To identify pharmaceutical spending-control options for the United States, we analyzed the policies of the United Kingdom, France, and Germany, which encourage drugmakers to undertake innovations that improve health while controlling spending. Their main strategies today include: using legislation to set default rules that increase the insurer's bargaining position, employing health technology assessment that measures cost-effectiveness or comparative effectiveness and caps the purchase or reimbursement price, setting a single maximum price for similar drugs (reference group pricing), capping prices near prices in other European countries (external reference pricing), prohibiting price increases, contracting to obtain discounts as sales volume rises, procuring drugs through competitive bids, and requiring manufacturers to pay rebates when spending exceeds a global budget. Each strategy addresses a distinct cause of high spending and supports overall goals. Most recent US reform proposals recommend incremental changes that would not address the major sources of high and increasing pharmaceutical prices. However, some US reform proposals resemble certain European strategies and could bring more significant change. US policymakers should consider adopting each of the strategies employed in these countries.
为了确定美国的药品支出控制方案，我们分析了鼓励制药商进行既能改善健康又能控制支出的创新的英国、法国和德国的政策。这些国家的主要策略包括：利用立法设定默认规则，增强保险公司的议价地位；采用衡量成本效益或比较效益并限制购买或报销价格的卫生技术评估；为类似药物设定单一最高价格（参考组定价）；限制接近其他欧洲国家价格的价格（外部参考定价）；禁止涨价；通过签订合同随销量上升获得折扣；通过竞标采购药品；当支出超过全球预算时，要求制造商支付回扣。每种策略都针对高支出的一个特定原因，并支持总体目标。最近的美国改革提案建议采取渐进式变革，这些变革不会解决造成药品价格居高不下和不断上涨的主要原因。然而，某些美国改革提案类似于某些欧洲策略，可能会带来更大的变革。美国政策制定者应该考虑采用这些国家所采用的每种策略。
