Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Carey Business School, Baltimore, MD, USA.
Value Health. 2024 Jan;27(1):35-42. doi: 10.1016/j.jval.2023.10.005. Epub 2023 Oct 24.
This study aimed to characterize products using pharmacy-pharmacy benefit manager (PBM) discounts and to estimate the association among such discounts, prescription utilization, and out-of-pocket costs.
This is a retrospective cohort study using IQVIA's Formulary Impact Analyzer, which contains anonymized, individual-level pharmacy claims representing US retail pharmacy transactions. We focused on 20 products with the greatest number of transactions using a pharmacy-PBM discount. Our unit of analysis was a treatment episode, defined as the length of time from an incident fill to no continuous use for 60 consecutive days after allowing for indefinite stockpiling. Outcome measures included products with greatest pharmacy-PBM discount use, characteristics of treatment episodes, and out-of-pocket costs with and without pharmacy-PBM discount.
Across all products, 3.82% of transactions and 7.69% of treatment episodes were accompanied by a pharmacy-PBM discount. Commonly discounted products included generic treatments for chronic disease (lisinopril, levothyroxine, metformin) and neuropsychiatric conditions (alprazolam, amphetamine, buprenorphine, hydrocodone). The median postdiscount out-of-pocket cost was >2.5-fold higher during treatment episodes with a discount than those without ($15.15, interquartile range [IQR] $8.53-32.00, vs $5.88, IQR $1.40-15.00). Median treatment episode duration was 249 days (IQR 132-418) with discount use compared with 236 days (IQR 121-396) without discount use, although treatment episodes that began with a discount had fewer transactions per treatment episode and were shorter (median 212 days, IQR 114-360) than those that did not (313 days, IQR 178-500).
Pharmacy-PBM discounts may foster market competition and improve access for under- and uninsured individuals; however, these programs may not generate savings for many insured individuals.
本研究旨在对利用药房-药房福利管理（PBM）折扣的产品进行特征描述，并评估此类折扣与处方使用和自付费用之间的关系。
这是一项回顾性队列研究，使用 IQVIA 的处方影响分析器，其中包含代表美国零售药房交易的匿名、个人层面的药房理赔数据。我们专注于使用药房-PBM 折扣的交易数量最多的 20 种产品。我们的分析单位是一个治疗期，定义为从一个事件填充到在允许无限期囤货的情况下连续 60 天没有连续使用的时间长度。结果测量包括使用最大药房-PBM 折扣的产品、治疗期的特征以及使用和不使用药房-PBM 折扣的自付费用。
在所有产品中，3.82%的交易和 7.69%的治疗期伴随着药房-PBM 折扣。常见的折扣产品包括用于治疗慢性病（赖诺普利、左甲状腺素、二甲双胍）和神经精神疾病（阿普唑仑、安非他命、丁丙诺啡、氢可酮）的通用治疗药物。在有折扣的治疗期内，自付费用中位数（中值）比没有折扣的治疗期高出 2.5 倍以上（15.15 美元，四分位距 [IQR] 8.53-32.00 美元，而 5.88 美元，IQR 1.40-15.00 美元）。有折扣使用的治疗期中位数为 249 天（IQR 132-418），而没有折扣使用的治疗期中位数为 236 天（IQR 121-396），尽管开始有折扣的治疗期每治疗期的交易次数较少且较短（中位数 212 天，IQR 114-360 天），而没有折扣的治疗期则较多（313 天，IQR 178-500 天）。
药房-PBM 折扣可能促进市场竞争并提高未参保和无保险个人的可及性；然而，对于许多参保个人来说，这些计划可能不会产生节省。
