Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Intern Med. 2021 Jun 1;181(6):758-764. doi: 10.1001/jamainternmed.2021.0733.
Despite ongoing debate regarding the high prices that patients pay for prescription drugs, to our knowledge, little is known regarding the use of coupons, vouchers, and other types of copayment "offsets" that reduce patients' out-of-pocket drug spending. Although offsets reduce patients' immediate cost burden, they may encourage the use of higher-cost products and diminish health insurers' ability to optimize pharmaceutical value.
To examine the drugs most commonly covered by offsets, the percentage of out-of-pocket costs covered by offsets, and the characteristics of patients using offsets for retail pharmacy transactions in the United States in 2017 through 2019.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort analysis was conducted of a 5% nationally random sample of anonymized pharmacy claims from IQVIA's Formulary Impact Analyzer, which captures more than 60% of all US pharmacy transactions. This analysis focused on 631 249 individuals who used at least 1 offset between October 1, 2017, and September 30, 2019.
Offset source, types of drugs covered by offsets, offset dollar value and percentage of out-of-pocket payment covered, and county characteristics of offset recipients.
The 631 249 individuals in the study (361 855 female participants [57.3%]; mean [SD] age, 45.7 [18.6] years) had approximately 33 million prescription fills, of which 12.8% had an offset used. Of these, 50.2% originated from a pharmaceutical manufacturer, 47.2% originated from a pharmacy or pharmacy benefit manager (PBM), and 2.6% originated from a state assistance program. A total of 80.0% of manufacturer-sponsored offsets were concentrated among 6.2% of unique products, and 79.9% of pharmacy-PBM offsets were concentrated among 4.9% of unique products. Most manufacturer offsets (88.2%) were for branded products, while most pharmacy-PBM offsets were for generic products (90.5%). The median manufacturer offset was $51.00, covering 87.1% of out-of-pocket costs; the median pharmacy-PBM offset was $16.30, covering 39.3% of out-of-pocket costs. There was no meaningful association between offset magnitude and county-level income, health insurance coverage, or race/ethnicity.
In this analysis of patient-level pharmacy claims from 2017 to 2019, approximately half of all offsets involved pharmacy-PBM contractual arrangements, and half were offered by manufacturers. All offsets were associated with a significant reduction in patients' out-of-pocket costs, were highly concentrated among a few drugs, and were generally not more generous among individuals in counties with lower income or larger Black or uninsured populations.
尽管人们一直在争论患者为处方药物支付的高昂价格，但据我们所知，对于减少患者自付药费的优惠券、代金券和其他类型的共付额“减免”的使用知之甚少。尽管减免减轻了患者的即时经济负担，但它们可能会鼓励使用更高成本的产品，并削弱健康保险公司优化药品价值的能力。
本研究旨在调查 2017 年至 2019 年期间，美国使用零售药房交易中最常见的减免药物种类、减免覆盖的自付费用比例，以及使用减免药物的患者特征。
设计、地点和参与者：本研究采用回顾性队列分析方法，对 IQVIA 的处方影响分析器中全国随机抽取的 5%的匿名药房理赔数据进行了分析，该分析器涵盖了超过 60%的美国所有药房交易。本研究主要关注了 2017 年 10 月 1 日至 2019 年 9 月 30 日期间至少使用过 1 次减免的 631249 名个体。
减免来源、减免覆盖的药物种类、减免金额和自付费用比例，以及减免接受者所在县的特征。
在这项研究中，631249 名个体（57.3%为女性参与者[361855 名]；平均[标准差]年龄为 45.7[18.6]岁）进行了约 3300 万次处方配药，其中 12.8%的处方使用了减免。其中，50.2%的减免来源于制药商，47.2%来源于药房或药房福利管理机构（PBM），2.6%来源于州援助计划。制药商赞助的减免中，80.0%集中在 6.2%的独特产品中，而药房-PBM 赞助的减免中，79.9%集中在 4.9%的独特产品中。大多数制药商赞助的减免（88.2%）是针对品牌产品，而大多数药房-PBM 减免是针对通用产品（90.5%）。制药商赞助的减免中位数为 51.00 美元，覆盖了 87.1%的自付费用；药房-PBM 赞助的减免中位数为 16.30 美元，覆盖了 39.3%的自付费用。减免金额与县一级的收入、医疗保险覆盖范围或种族/民族之间没有明显的关联。
在对 2017 年至 2019 年期间的患者级药房理赔数据进行的这项分析中，大约一半的减免涉及药房-PBM 的合同安排，另一半则由制造商提供。所有的减免都显著降低了患者的自付费用，高度集中在少数几种药物上，而且在收入较低或黑人或未参保人口比例较大的县，减免对个人来说并不更慷慨。
