Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.
School of Pharmacy, University of Southern California, Los Angeles.
JAMA Netw Open. 2021 May 3;4(5):e219030. doi: 10.1001/jamanetworkopen.2021.9030.
Prior research has documented the increase in prescription drug rebates and the coincident increase in out-of-pocket burden for patients paying coinsurance tied to list prices.
To describe the out-of-pocket burden on patients with coinsurance and assess its association with pharmaceutical competition, which increases payers' leverage to seek higher rebates.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used branded prescription drugs with US sales reported by publicly traded companies. The study included drugs with nonmissing, nonnegative rebates between 2014 and 2018 from SSR Health. Data analysis was conducted from June to December 2020.
Level of branded and generic competition and calendar year.
Retail price markup (ie, the ratio of rebate to net price) paid by patients at the point of sale and effective out-of-pocket share (ie, coinsurance multiplied by list price divided by net price) of a standard Part D plan. Trends in these outcomes were examined and then stratified by degree of competition.
There were 3322 unique National Drug Codes in the analysis, representing 232 distinct molecules from 138 therapeutic classes in 34 disease areas. The ratio of rebate to net prices was higher and increased faster for drugs with branded and generic competitors (from 83% to 172%) than for drugs with only branded competitors (from 61% to 115%) and those without generic equivalents (from 33% to 49%). Hypothetical patients paying standard Part D coinsurance on drug list prices would have experienced an effective out-of-pocket share increase from 48% to 64% in the initial coverage phase, and from 10% to 13% in the catastrophic coverage phase between 2014 and 2018. In the coverage gap, the share increased from 92% in 2014 to 98% in 2016 and then decreased to 90% in 2018. Compared with drugs with no competition, effective out-of-pocket share paid by patients grew 50% faster for drugs with branded competitors and 100% faster for those with branded and generic competitors.
This study found substantial increases in cost-sharing burden for patients paying coinsurance on drug list prices between 2014 and 2018, especially in markets with more pharmaceutical competition. Payers passing rebates through to patients at the point of sale could restore the benefits of competition and rebates.
先前的研究记录了处方药回扣的增加，以及与标价挂钩的患者自付额的相应增加，这些自付额与共同保险有关。
描述具有共同保险的患者的自付负担，并评估其与药品竞争的关系，药品竞争增加了支付者寻求更高回扣的影响力。
设计、地点和参与者：本回顾性队列研究使用了公开上市公司报告的美国销售额的品牌处方药。研究包括 2014 年至 2018 年期间 SSR Health 报告的非缺失、非负回扣的药物。数据分析于 2020 年 6 月至 12 月进行。
品牌和仿制药竞争的程度和日历年。
患者在销售点支付的零售价格加价（即回扣与净价之比）和标准 Part D 计划的有效自付份额（即共同保险乘以标价除以净价）。检查了这些结果的趋势，然后按竞争程度进行分层。
分析中共有 3322 个唯一的国家药品代码，代表 34 个疾病领域的 138 个治疗类别中的 232 种不同分子。对于具有品牌和仿制药竞争的药物（从 83%增加到 172%），与仅具有品牌竞争的药物（从 61%增加到 115%）和没有仿制药的药物（从 33%增加到 49%）相比，回扣与净价的比率更高且增加更快。假设患者按照药品标价支付标准 Part D 共同保险，在初始覆盖期内，有效自付份额将从 2014 年的 48%增加到 64%，在灾难性覆盖期内将从 10%增加到 13%。在覆盖缺口期间，该份额从 2014 年的 92%增加到 2016 年的 98%，然后在 2018 年下降到 90%。与没有竞争的药物相比，具有品牌竞争的药物的患者支付的有效自付份额增长了 50%，具有品牌和仿制药竞争的药物增长了 100%。
本研究发现，2014 年至 2018 年期间，支付药品标价共同保险的患者的自付费用负担大幅增加，尤其是在药品竞争更为激烈的市场。支付者将回扣转嫁给销售点的患者，可以恢复竞争和回扣的好处。
