Prime Therapeutics LLC, Eagan, MN.
Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis.
J Manag Care Spec Pharm. 2022 Nov;28(11):1200-1206. doi: 10.18553/jmcp.2022.28.11.1200.
As new rare-disease drug therapy, gene therapies, and high-priced cancer drugs receive US Food and Drug Administration approval, there is an increasing potential for drug super spender individuals with more than $250,000 annual drug cost. To categorize all members in a large, commercially insured population by their total annual combined drug costs from both medical and pharmacy benefits and to determine the trend in drug super spender prevalence. Using a commercially insured population with integrated medical and pharmacy benefits, all unique members with any enrollment between January 2016 and December 2019 were identified. The sum of total cost for all pharmacy claims plus all medical benefit claim lines for drugs was determined for each member, for each calendar year. Cost was defined as the plan plus member liability at network-discounted price, with no further adjustment for any coupons or rebates. Descriptive statistics were used to describe the drug super spender growth. There was an average of 17.9 million members per year with at least 1 month of eligibility through the 4-year study period. In 2016, a total of 2,994 members with more than $250,000 drug cost per member accounted for $1,324 million drug spend. In 2019, there were 5,894 super spender members (97% increase), accounting for $2,579 million drug cost (95% increase), which was 9.6% of $26,618 million total drug spend. In this large, commercially insured population, a small (32 per 100,000) number of drug super spender members comprise a disproportionate portion of the total drug expenditures, at $1 of every $10 dollars of total drug expenditures. Health plans need to understand the drug super spender trend and develop strategies to maintain health care affordability. This study was funded internally by Prime Therapeutics LLC. Drs Starner and Gleason are employees of Prime Therapeutics LLC, a pharmacy benefits management company. Dr Bowen is a former employee of Prime Therapeutics LLC.
随着新的罕见病药物治疗、基因疗法和高价癌症药物获得美国食品和药物管理局的批准，每年药物支出超过 25 万美元的药物超级消费者的潜在人数不断增加。通过对大型商业保险人群进行分类，根据他们从医疗和药品福利中获得的全年药物总费用，确定药物超级消费者的流行趋势。利用一个具有医疗和药品福利整合的商业保险人群，确定了 2016 年 1 月至 2019 年 12 月期间任何一次入保的所有唯一成员。确定了每个成员在每个日历年内所有药品索赔的总成本和所有药物福利索赔线的总和。费用定义为按网络折扣价计算的计划加成员责任，不再对任何优惠券或回扣进行进一步调整。使用描述性统计数据来描述药物超级消费者的增长情况。在 4 年的研究期间，每年平均有 1790 万成员至少有 1 个月的参保资格。2016 年，共有 2994 名成员每人的药物费用超过 25 万美元，药物支出为 13.24 亿美元。2019 年，有 5894 名超级消费者（增长 97%），药物支出为 25.79 亿美元（增长 95%），占 266.18 亿美元总药物支出的 9.6%。在这个大型商业保险人群中，一小部分（每 10 万人中有 32 人）药物超级消费者占总药物支出的不成比例的一部分，占总药物支出的每 10 美元中的 1 美元。医疗计划需要了解药物超级消费者的趋势，并制定策略来维持医疗保健的可负担性。本研究由 Prime Therapeutics LLC 内部资助。Starner 博士和 Gleason 博士是 Prime Therapeutics LLC 的员工，Prime Therapeutics LLC 是一家药品福利管理公司。Bowen 博士曾是 Prime Therapeutics LLC 的员工。
