The Amyloidosis Center Knight Cardiovascular InstituteOregon Health & Science University Portland OR.
J Am Heart Assoc. 2022 Apr 5;11(7):e023895. doi: 10.1161/JAHA.121.023895. Epub 2022 Mar 18.
Advancement in the diagnosis and treatment of transthyretin amyloid cardiomyopathy has made great strides in recent years. Novel therapeutics for transthyretin amyloidosis such as tafamidis, patisiran, and inotersen have shown significant benefits in a not-so-rare disease but come with high listing price tags ranging from a quarter to more than a half million dollars per year. These costs create significant financial barriers for the majority of patients, especially those with existing Medicare insurance plans. Of 72 patients reviewed, 67% were Medicare beneficiaries. Financial assistance was explored for the majority, and 37 (51%) patients with Medicare Part D received financial assistance that reduced their copayments to $0. Only one-third of our patients were able to afford these medications without any forms of financial assistance. Of these patients, 4 (6%) had the highest copayments ranging from $13 000 to $15 000 per year. To navigate the complexities of prescribing and affordability in amyloidosis, a multidisciplinary team including a dedicated clinical pharmacist is crucial in guaranteeing patients' success to secure these novel therapeutics. In this article, we discuss our experiences with prescribing, acquiring insurance authorizations, and financing these life-saving medications based on patient-specific insurance plans and socioeconomic status.
近年来，转甲状腺素蛋白淀粉样心肌病的诊断和治疗取得了重大进展。新型治疗转甲状腺素蛋白淀粉样变性的药物，如塔法米替、帕替沙尼和伊奥替南，在这种并不常见的疾病中显示出显著的疗效，但价格高昂，每年的费用从四分之一到五十多万美元不等。这些费用给大多数患者，尤其是那些有医疗保险计划的患者，带来了巨大的经济障碍。在 72 名接受评估的患者中，有 67%是医疗保险受益人群。大多数患者都在探索经济援助方案，有 37 名（51%）接受了医疗保险 D 部分的经济援助，从而将自付额降低到 0 美元。只有三分之一的患者无需任何经济援助就能负担得起这些药物。其中 4 名（6%）患者的自付额最高，每年从 13000 美元到 15000 美元不等。为了应对淀粉样变性症在处方和可负担性方面的复杂性，一个包括专职临床药师在内的多学科团队对于确保患者成功获得这些新型治疗药物至关重要。在本文中，我们根据患者特定的保险计划和社会经济状况，讨论了我们在开具这些救命药物的处方、获取保险授权和融资方面的经验。
