Hartung Daniel M, Johnston Kirbee A, Bourdette Dennis N, Chen Randi, Tseng Chien-Wen
College of Pharmacy (DMH, KAJ), Oregon State University, Portland; Department of Neurology (DNB), Oregon Health & Science University, Portland; Pacific Health Research and Education Institute (RC, C-WT), Honolulu, HI; and Department of Family Medicine and Community Health (C-WT), University of Hawai'i John A. Burns School of Medicine, Honolulu.
Neurol Clin Pract. 2021 Aug;11(4):298-303. doi: 10.1212/CPJ.0000000000000929.
To determine whether closing the Part D coverage gap (donut hole) between 2010 and 2019 lowered patients' out-of-pocket costs for disease-modifying therapies (DMTs) for multiple sclerosis (MS).
Using nationwide Medicare Formulary and Drug Pricing Files, we analyzed Part D drug benefit design and DMT prices in 2010, 2016, and 2019. We calculated average monthly list prices for DMTs available in each year (4 DMTs in 2010, 11 DMTs in 2016, and 14 DMTs in 2019). We projected patients' annual out-of-pocket cost for each DMT alone under a standard Part D plan in that year. We estimated potential savings attributable to closing the coverage gap between 2010 and 2019 (beneficiaries' cost sharing dropped from 100% to 25%) under 3 scenarios: no increase in price, an inflation-indexed price increase (3% annually), and the observed price increase.
Median monthly DMT prices rose from $2,804 to $5,987 to $7,009 over the years 2010, 2016, and 2019, respectively. Median projected annual out-of-pocket costs rose from $5,916 to $6,229 to $6,618. With unchanged or inflation-indexed DMT price changes, closing the coverage gap would have reduced annual out-of-pocket costs by $2,260 (38% reduction) and $1,744 (29% reduction), respectively. Despite having the lowest monthly price, generic glatiramer acetate had among the highest out-of-pocket costs ($6,731 to $6,939 a year) in 2019.
Medicare Part D beneficiaries can pay thousands of dollars yearly out of pocket for DMTs. Closing the Part D coverage gap did not reduce out-of-pocket costs for patients because of simultaneous increases in DMT prices.
确定在2010年至2019年期间缩小D部分覆盖缺口（甜甜圈洞）是否降低了患者用于治疗多发性硬化症（MS）的疾病修正疗法（DMT）的自付费用。
利用全国医疗保险处方集和药品定价文件，我们分析了2010年、2016年和2019年D部分药品福利设计和DMT价格。我们计算了每年可用DMT的平均每月标价（2010年有4种DMT，2016年有11种DMT，2019年有14种DMT）。我们根据当年的标准D部分计划预测了每种DMT单独的患者年度自付费用。我们估计了在2010年至2019年期间缩小覆盖缺口（受益人的费用分担从100%降至25%）在三种情况下可节省的潜在费用：价格无上涨、按通胀指数调整的价格上涨（每年3%）以及观察到的价格上涨。
2010年、2016年和2019年，DMT的月中位数价格分别从2804美元升至5987美元再升至7009美元。预计年度自付费用中位数从5916美元升至6229美元再升至6618美元。在DMT价格不变或按通胀指数调整的情况下，缩小覆盖缺口分别可将年度自付费用降低2260美元（降低38%）和1744美元（降低29%）。尽管醋酸格拉替雷的月价格最低，但在2019年其自付费用却处于最高水平（每年6731美元至6939美元）。
医疗保险D部分的受益人每年可能要自掏数千美元用于DMT治疗。由于DMT价格同时上涨，缩小D部分覆盖缺口并未降低患者的自付费用。
