Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Manag Care Spec Pharm. 2024 Mar 1;30(3):269-278. doi: 10.18553/jmcp.2023.23153. Epub 2023 Dec 23.
The 2022 Inflation Reduction Act authorizes Medicare to negotiate the prices of 10 drugs in 2026 and additional drugs thereafter. Understanding the sociodemographic and spending characteristics of beneficiaries taking these specific drugs could be important describing the impact of the legislation.
To describe sociodemographic and spending characteristics of Medicare beneficiaries who use the 10 prescription drugs ("negotiated drugs") that will face Medicare drug price negotiations in 2026.
A 20% sample of Medicare Part D beneficiaries from 2020 (n = 10,224,642) was used. Sociodemographic and spending characteristics were descriptively reported for beneficiaries taking the negotiated drugs, including subgroups by low-income subsidy (LIS) status and by drug, and for Part D beneficiaries not taking negotiated drugs.
Part D beneficiaries taking a negotiated drug compared with Part D beneficiaries not taking a negotiated drug overall had similar sociodemographic characteristics, more comorbidities (3.9 vs 2.2) and higher mean [median] Medicare ($33,882 [$18,251] vs $12,366 [$3,429]) and out-of-pocket (OOP) spending ($813 [$307] vs $441 [$160]). There was variation in characteristics by LIS status. The mean age was highest among non-LIS beneficiaries taking a negotiated drug compared with LIS beneficiaries taking a negotiated drug and beneficiaries not taking a negotiated drug (76.2 vs 69.9 vs 71.4). Among beneficiaries using negotiated drugs, a higher percentage of LIS beneficiaries compared with non-LIS was female (59.7% vs 48.0%), was Black (20.9% vs 6.6%), and resided in lower-income areas (39.1% vs 20.3%). Mean [median] annual Part D OOP spending for negotiated drugs was $115 [$59] for beneficiaries with LIS and $1,475 [$1,204] for beneficiaries without LIS. There were also differences depending on which negotiated drug was used. Drugs for cancer and blood clots had the highest proportions of White users, whereas type 2 diabetes and heart failure drugs had the highest proportions of Black users and beneficiaries residing in lower-income areas. Annual Part D OOP costs were lowest for sitagliptin (LIS: $104 [$60], non-LIS: $1,391 [$1,153]) and highest for ibrutinib (LIS: $649 [$649], non-LIS: $6,449 [$6,867]). Among non-LIS beneficiaries, 24% (22% to 76%) had more than $2,000 in OOP costs.
Inflation Reduction Act OOP spending caps and LIS expansion will lower prescription drug costs for beneficiaries with OOP costs exceeding $2,000 who are mostly White and live in higher-income areas, insulin users who are disproportionately Black with multiple chronic conditions, and beneficiaries with low incomes. However, these provisions will not impact the 76% of non-LIS beneficiaries using negotiated drugs who have OOP costs that are still substantial but below $2,000. Negotiations could reduce OOP costs through reduced coinsurance payments for this group, which is older and has more chronic conditions compared with beneficiaries not taking negotiated drugs. Part D plan design, spending, and utilization changes should be monitored after negotiation to determine if further solutions are needed to lower OOP costs for this group.
2022 年《降低通胀法案》授权医疗保险在 2026 年对 10 种药物进行谈判，并在此后对其他药物进行谈判。了解使用这些特定药物的受益人的社会人口统计学和支出特征对于描述立法的影响可能很重要。
描述在 2026 年将面临医疗保险药品价格谈判的 10 种处方药（“谈判药品”）的医疗保险受益人的社会人口统计学和支出特征。
使用了 2020 年医疗保险 D 部分受益人的 20%样本（n=10,224,642）。对服用谈判药品的受益人和未服用谈判药品的受益人的社会人口统计学和支出特征进行描述性报告，包括按低收入补贴（LIS）状况和药物的亚组进行报告，并对服用谈判药品的受益人和未服用谈判药品的受益人的社会人口统计学和支出特征进行报告。
与未服用谈判药品的医疗保险 D 部分受益人的整体相比，服用谈判药品的医疗保险 D 部分受益人的社会人口统计学特征相似，但共病更多（3.9 与 2.2），医疗保险（33882 美元[18251 元]与 12366 美元[3429 元]）和自付费用（OOP）支出（813 美元[307 元]与 441 美元[160 元]）更高。按 LIS 状况存在差异。与服用谈判药品的 LIS 受益人和未服用谈判药品的受益相比，服用谈判药品的非 LIS 受益人的平均年龄最高（76.2 岁与 69.9 岁与 71.4 岁）。在使用谈判药品的受益人中，与非 LIS 受益相比，LIS 受益的女性比例更高（59.7%与 48.0%），黑种人比例更高（20.9%与 6.6%），居住在低收入地区的比例更高（39.1%与 20.3%）。服用 LIS 的谈判药品的年医疗保险 OOP 支出为 115 美元[59 元]，服用非 LIS 的谈判药品的年医疗保险 OOP 支出为 1475 美元[1204 元]。根据使用的谈判药品不同，也存在差异。癌症和血栓形成药物的白人使用者比例最高，而 2 型糖尿病和心力衰竭药物的黑人使用者和居住在低收入地区的受益人的比例最高。西他列汀（LIS：104 美元[60 元]，非 LIS：1391 美元[1153 元]）的年医疗保险 OOP 成本最低，而依鲁替尼（LIS：649 美元[649 美元]，非 LIS：6449 美元[6867 美元]）的年医疗保险 OOP 成本最高。在非 LIS 受益人中，24%（22%至 76%）的 OOP 支出超过 2000 美元。
降低通胀法案的 OOP 支出上限和 LIS 扩大将降低 OOP 支出超过 2000 美元的受益人的处方药成本，这些受益人大都是白人，居住在高收入地区，胰岛素使用者主要是黑人，有多种慢性病，而低收入受益人的收入较低。然而，这些规定不会影响 76%的服用谈判药品的非 LIS 受益人的 OOP 支出，这些受益人的 OOP 支出仍然很大，但仍低于 2000 美元。谈判可以通过降低这一组的共付保险费来降低 OOP 成本，这一组比不服用谈判药品的受益人的年龄更大，有更多的慢性病。在进行谈判后，应监测医疗保险 D 计划的设计、支出和使用情况的变化，以确定是否需要进一步降低这一组的 OOP 成本。
