Pragya Kakani (
Michael Anne Kyle, University of Pennsylvania, Philadelphia, Pennsylvania.
Health Aff (Millwood). 2024 Oct;43(10):1420-1427. doi: 10.1377/hlthaff.2024.00273.
Medicare Part D does not allow plans to exclude drugs in six protected classes from their formularies, which may limit plans' ability to negotiate rebates and lead to higher spending. We estimated the association between protected-class status, US-level estimated rebates, and formulary coverage during the period 2011-19. We found that protected classes indeed had significantly lower exclusion rates in Medicare Part D during this period relative to nonprotected classes, and this difference was larger than the corresponding difference in commercial plans. US-level average rebates grew 22.5 percentage points less in protected than in nonprotected classes during 2011-19, a period when formulary exclusions increased. Relative to nonprotected classes, US-level average rebates in protected classes were especially low among drugs with high Medicare market share. These results suggest that Medicare Part D protected-class policy may reduce rebates.
医疗保险处方药部分不允许计划将六种受保护类别的药物从其处方中排除，这可能限制了计划协商回扣的能力，并导致更高的支出。我们估计了在 2011 年至 2019 年期间，受保护类别地位、美国层面的估计回扣和处方覆盖之间的关联。我们发现，在这段时间里，医疗保险处方药部分的受保护类别确实比非受保护类别具有更低的排除率，而且这种差异大于商业计划中相应的差异。在 2011 年至 2019 年期间，受保护类别的美国平均回扣增长率比非受保护类别的平均增长率低 22.5 个百分点，而同期处方排除率有所上升。与非受保护类别相比，受保护类别的美国平均回扣在医疗保险市场份额较高的药物中尤其低。这些结果表明，医疗保险处方药部分的受保护类别政策可能会降低回扣。
