Continuum (Minneap Minn). 2024 Aug 1;30(4):1259-1271. doi: 10.1212/CON.0000000000001456.
As newer, innovative neurology drugs enter the US health care system, neurologists should consider the cost of these treatments in addition to their efficacy, safety, and tolerability. To do so thoughtfully requires an understanding of how prescription drugs are priced in the United States. The process of drug pricing is linked to the distribution supply chain and the many stakeholders involved. Stakeholders include pharmaceutical manufacturers; wholesalers; pharmacies; pharmacy benefit managers; payers, including health insurers; hospital systems; neurologists and other clinicians; and patients. Drug pricing has taken center stage as the Inflation Reduction Act of 2022 has set maximum out-of-pocket expenses for Medicare beneficiaries for the first time in the program's history and limits drug price increases for a select group of Medicare Part D drugs. This article describes the US drug distribution supply chain and its stakeholders and introduces key drug pricing terms; a brief description of how rebates are generally estimated will also be discussed. Finally, as newer neurology outpatient drugs enter the market, the "value" of drugs will be described through cost-effectiveness terminology and their utility for the clinical neurologist.
随着更新、创新的神经科药物进入美国医疗保健系统，神经科医生除了考虑这些治疗方法的疗效、安全性和耐受性外，还应考虑其成本。要做到这一点，需要了解美国处方药的定价方式。药品定价过程与药品分销供应链以及涉及的众多利益相关者有关。利益相关者包括制药商、批发商、药店、药品福利管理公司、支付方（包括健康保险公司）、医院系统、神经科医生和其他临床医生以及患者。随着 2022 年《降低通胀法案》首次为医疗保险受益人设定了医疗保险计划历史上的最大自付费用上限，并限制了选定的医疗保险 D 部分药物的价格上涨，药品定价已成为关注焦点。本文描述了美国药品分销供应链及其利益相关者，并介绍了药品定价的关键术语；还将简要介绍回扣的一般估算方法。最后，随着更新的神经科门诊药物进入市场，将通过成本效益术语来描述药物的“价值”及其对临床神经科医生的效用。
