Department of General and Thoracic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Pharmacoeconomics. 2024 Nov;42(11):1279-1286. doi: 10.1007/s40273-024-01426-3. Epub 2024 Aug 21.
The exceedingly high US spending per capita on prescription medications is mediated, at least in part, by the inefficiencies of existing generic pharmaceutical distribution and reimbursement systems; yet, the extent of potential savings and areas for targeted interventions for generic drug prescribers remains underexplored.
We aimed to analyze 2021 Medicare Part D spending on generic drugs in comparison with pricing of a low-cost generic drug program, the Mark Cuban Cost Plus Drug Company (MCCPDC), to gauge the extent of achievable potential savings.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, observational study, we performed a systematic analysis of potential Medicare Part D savings when using MCCPDC generic pricing. The 2023 MCCPDC data, as of August 2023, were obtained from the provider's publicly available database. The 2021 Medicare Part D data and prescriber datasets were obtained from the US Centers for Medicare and Medicaid Services.
Outcomes included total prescription volume, proportion of drugs with savings, total US dollar Medicare savings, and average weighted price reduction per unit drug. Results were stratified by medical and surgical subspecialties to identify areas for targeted interventions. Subspecialty-wise contribution to total savings versus contribution to total prescription volume was characterized.
Total estimated Medicare Part D savings were $8.6 billion using 90-day MCCPDC pricing, with surgical drugs accounting for over $900 million. Nearly 80% of the examined drugs were more price effective through MCCPDC using 90-day supply. Commonly prescribed drugs in cardiology, psychiatry, neurology, transplant surgery, and urology demonstrated the highest estimated absolute savings. The most disproportionate savings relative to prescription volume were observed for drugs in oncology, gynecology, infectious disease, transplant surgery, and colorectal surgery.
This study underscores the significant potential for Medicare Part D savings through strategies that address the systemic overpayment for generic medications. We identified key areas for reform as well as specific medical and surgical subspecialties where targeted interventions could yield substantial savings.
美国在处方药物方面的人均支出极高，这至少部分是由于现有的仿制药分销和报销系统效率低下造成的；然而，针对仿制药开方医生的潜在节省和目标干预领域的范围仍未得到充分探索。
我们旨在分析 2021 年医疗保险 D 部分（Medicare Part D）对仿制药的支出，并与低成本仿制药项目——马克·库班成本加成药品公司（Mark Cuban Cost Plus Drug Company，MCCPDC）的定价进行比较，以衡量可实现的潜在节省程度。
设计、设置和参与者：在这项回顾性观察研究中，我们对使用 MCCPDC 仿制药定价时实现医疗保险 D 部分潜在节省的情况进行了系统分析。截至 2023 年 8 月，2023 年 MCCPDC 数据来自提供商公开可用的数据库。2021 年医疗保险 D 部分数据和处方医生数据集来自美国医疗保险和医疗补助服务中心。
结果包括总处方量、有节省药物的比例、医疗保险节省的总美元数以及单位药物的平均加权降价。结果按医学和外科学专科进行分层，以确定目标干预领域。以专科为单位，分析了总节省量与总处方量的贡献。
使用 90 天 MCCPDC 定价，估计医疗保险 D 部分节省总额为 86 亿美元，其中外科药物占 1 亿多美元。近 80%的检查药物通过 MCCPDC 使用 90 天供应量更具价格效益。心脏病学、精神病学、神经病学、移植外科和泌尿科的常用处方药物显示出最高的估计绝对节省。与处方量相比，肿瘤学、妇科、传染病、移植外科和结直肠外科的药物节省幅度最大。
这项研究强调了通过解决对仿制药的系统超额支付的策略，医疗保险 D 部分有很大的节省潜力。我们确定了需要改革的关键领域以及外科专科中可以实现大量节省的具体医学和外科专科。
