From the University of Utah (A.d.H., A.D., S.D., P.W., N.S.), Salt Lake City; University of Michigan (B.C.), Ann Arbor; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA; American Academy of Neurology (B.M.), Minneapolis, MN; and University of Colorado (K.V.N.), Denver.
Neurology. 2021 Apr 20;96(16):e2132-e2137. doi: 10.1212/WNL.0000000000011712. Epub 2021 Mar 10.
To determine whether there was an increase in payments for neurologist-prescribed drugs, we performed a retrospective analysis of prescription claims in the Medicare Part D Prescriber Public Use Files from 2013 to 2017.
We included claims prescribed by providers with the taxonomy "neurology" and included drugs present in all 5 years. Drugs were designated in 2013 as generic (GEN), brand name only (BNO), and brand name prescribed even though a generic equivalent is available (BNGE). To observe payment trends, the percentage change in the per claim payment was compared between drug classes.
We included 520 drugs, of which 322 were GEN, 61 were BNO, and 137 were BNGE, representing 90,716,536 claims and generating payments of $26,654,750,720. While the number of claims from 2013 to 2017 increased only 7.6%, the total payment increased 50.4%. Adjusted for inflation, claim payments for GEN drug increased 0.6%, compared to significant increases in BNO and BNGE drugs of 42.4% and 45.0% ( < 0.001). The percentage of overall GEN claims increased from 81.9% to 88.0%, BNO increased from 4.9% to 6.2%, and BNGE decreased from 13.3% to 5.8%. Neuroimmunology/multiple sclerosis drugs represented >50% of the total payments despite being only 4.3% of claims.
Payments for neurologist-prescribed brand name, but not generic, drugs in Medicare Part D increased consistently and well above inflation from 2013 to 2017. Unless the overall trend stabilizes or is reversed or high cost-to-claim drugs are addressed, this trend will place an increasing burden on the neurologic Medicare budget.
为了确定神经科医生开具的药物的支付金额是否增加，我们对 2013 年至 2017 年医疗保险部分 D 处方医生公共使用文件中的处方索赔进行了回顾性分析。
我们纳入了使用分类学“神经病学”的提供者开具的索赔，并纳入了所有 5 年都存在的药物。在 2013 年，药物被指定为通用（GEN）、仅品牌名称（BNO）和即使有通用等效药物也开具品牌名称（BNGE）。为了观察支付趋势，比较了不同药物类别之间每笔索赔支付金额的百分比变化。
我们纳入了 520 种药物，其中 322 种为 GEN，61 种为 BNO，137 种为 BNGE，代表了 90716536 份索赔，产生了 26654750720 美元的支付。虽然 2013 年至 2017 年的索赔数量仅增加了 7.6%，但总支付额增加了 50.4%。经通胀调整后，GEN 药物的索赔支付金额增长了 0.6%，而 BNO 和 BNGE 药物的支付金额则分别显著增长了 42.4%和 45.0%（<0.001）。总的 GEN 索赔比例从 81.9%增加到 88.0%，BNO 从 4.9%增加到 6.2%，BNGE 从 13.3%减少到 5.8%。神经免疫学/多发性硬化症药物的支付总额占比超过 50%，尽管仅占索赔总额的 4.3%。
从 2013 年到 2017 年，医疗保险部分 D 中神经科医生开具的品牌名称（而非通用名称）药物的支付金额持续且大幅高于通胀水平。除非总体趋势稳定或逆转，或者高成本药物的索赔得到解决，否则这一趋势将给神经科医疗保险预算带来越来越大的负担。
