Shan Divya M, Greenzaid Jonathan D, Greene Estay, Feldman Steven R
Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Amwins Rx, North Kingstown, RI, USA.
J Psoriasis Psoriatic Arthritis. 2024 Jul;9(3):115-120. doi: 10.1177/24755303241253203. Epub 2024 May 7.
Pharmaceutical expenditures in the United States, particularly in dermatology, have grown rapidly, driven by expensive topical and biologic treatments. Insurers are employing cost-containing strategies such as step therapy, which mandates the use of lower-cost treatments before more expensive medications. The bipartisan Safe Step Act aims to enhance step therapy policies by introducing a transparent process for requesting exceptions and reasonable timelines for the process. However, there is limited analysis on how the Safe Step Act would affect the healthcare environment. We examine the policies of the Safe Step Act and existing literature on prior authorizations and discuss how the bill could affect patients, physicians, and insurers. While the act could expedite access to necessary medications and prevent irreversible harm to patients from delaying efficacious treatment, it falls short in relieving the administrative burdens on dermatology clinics. Although there is no ideal solution for managing healthcare costs, measures like step therapy encourage cost-effective treatments and optimizing care for the population. Curtailing step therapy with the exemptions process of the Safe Step Act might streamline patient access to treatments but could impede cost-containment strategies, weaken the bargaining power of insurers, and result in higher insurance premiums.
在美国,尤其是皮肤科领域,由于昂贵的局部用药和生物治疗的推动,药品支出迅速增长。保险公司正在采用诸如阶梯治疗等成本控制策略,该策略要求在使用更昂贵的药物之前先使用成本较低的治疗方法。两党合作的《安全阶梯法案》旨在通过引入透明的例外申请程序和合理的处理时间来加强阶梯治疗政策。然而,关于《安全阶梯法案》将如何影响医疗环境的分析有限。我们研究了《安全阶梯法案》的政策以及关于事先授权的现有文献,并讨论了该法案可能如何影响患者、医生和保险公司。虽然该法案可以加快必要药物的获取,并防止因延迟有效治疗而对患者造成不可逆转的伤害,但它在减轻皮肤科诊所的行政负担方面做得不够。尽管在管理医疗成本方面没有理想的解决方案,但阶梯治疗等措施鼓励采用具有成本效益的治疗方法,并优化人群护理。通过《安全阶梯法案》的豁免程序减少阶梯治疗可能会简化患者获得治疗的途径,但可能会阻碍成本控制策略,削弱保险公司的议价能力,并导致保险费上涨。