2012-2019 年新胰岛素产品上市后胰岛素价格和折扣的估计变化。
Estimated Changes in Insulin Prices and Discounts After Entry of New Insulin Products, 2012-2019.
机构信息
West Health Policy Center, Washington, DC.
Division of Clinical Pharmacy, University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla.
出版信息
JAMA Health Forum. 2023 Jun 2;4(6):e231430. doi: 10.1001/jamahealthforum.2023.1430.
IMPORTANCE
Despite the political salience of insulin prices, no study to date has quantified trends in insulin prices that account for manufacturer discounts (net prices).
OBJECTIVE
To describe trends in insulin list prices and net prices faced by payers from 2012 to 2019 and estimate changes in net prices after the 2015 to 2017 entry of new insulin products.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal study included an analysis of Medicare, Medicaid, and SSR Health drug pricing data from January 1, 2012, to December 31, 2019. Data analyses were performed from June 1, 2022, to October 31, 2022.
EXPOSURES
US sales of insulin products.
MAIN OUTCOMES AND MEASURES
Net prices faced by payers were estimated for insulin products as list prices minus manufacturer discounts negotiated in commercial and Medicare Part D markets (ie, commercial discounts). Trends in net prices were evaluated before and after the entry of new insulin products.
RESULTS
Net prices of long-acting insulin products increased at an annual rate of 23.6% from 2012 to 2014 but decreased at an annual rate of 8.3% after the introduction of insulin glargine (Toujeo and Basaglar) and degludec (Tresiba) in 2015. Net prices of short-acting insulin increased at an annual rate of 5.6% from 2012 to 2017 but then decreased from 2018 to 2019 after the introduction of insulin aspart (Fiasp) and lispro (Admelog). For human insulin products, which did not experience entry of new products, net prices increased at an annual rate of 9.2% from 2012 to 2019. From 2012 to 2019, commercial discounts increased from 22.7% to 64.8% for long-acting insulin products, from 37.9% to 66.1% for short-acting insulin products, and from 54.9% to 63.1% for human insulin products.
CONCLUSIONS AND RELEVANCE
In this longitudinal study of US insulin products, results suggest that insulin prices substantially increased from 2012 to 2015, even after accounting for discounts. The introduction of new insulin products was followed by substantial discounting practices that lowered net prices faced by payers.
尽管胰岛素价格具有政治重要性，但迄今为止，尚无研究对计入制造商折扣（净价）的胰岛素价格趋势进行量化。
目的
描述 2012 年至 2019 年期间支付者面临的胰岛素目录价格和净价格趋势，并估计在 2015 年至 2017 年新胰岛素产品上市后的净价格变化。
设计、地点和参与者：这项纵向研究分析了 2012 年 1 月 1 日至 2019 年 12 月 31 日期间医疗保险、医疗补助和 SSR Health 药品定价数据。数据分析于 2022 年 6 月 1 日至 2022 年 10 月 31 日进行。
暴露情况
胰岛素产品在美国的销售情况。
主要结果和措施
为胰岛素产品估计了支付者面临的净价格，方法是将目录价格减去商业和医疗保险 D 部分市场（即商业折扣）中谈判的制造商折扣。在新胰岛素产品上市前后评估了净价格趋势。
结果
从 2012 年到 2014 年，长效胰岛素产品的净价格以每年 23.6%的速度上涨，但在 2015 年胰岛素甘精（Toujeo 和 Basaglar）和德谷胰岛素（Tresiba）上市后，以每年 8.3%的速度下降。从 2012 年到 2017 年，短效胰岛素的净价格以每年 5.6%的速度上涨，但在 2018 年至 2019 年新上市的胰岛素门冬氨酸（Fiasp）和赖脯胰岛素（Admelog）后下降。对于没有新产品上市的人胰岛素产品，从 2012 年到 2019 年，净价格以每年 9.2%的速度上涨。从 2012 年到 2019 年，长效胰岛素产品的商业折扣从 22.7%增加到 64.8%，短效胰岛素产品从 37.9%增加到 66.1%，人胰岛素产品从 54.9%增加到 63.1%。
结论和相关性
在这项对美国胰岛素产品的纵向研究中，结果表明，即使考虑到折扣，胰岛素价格从 2012 年到 2015 年也大幅上涨。新胰岛素产品上市后，实行了大量的折扣，降低了支付者面临的净价格。
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