Taylor Erin A, Khodyakov Dmitry, Predmore Zachary, Buttorff Christine, Kim Alice
RAND, Health Care, Santa Monica, CA 90401, USA.
RAND, Health Care, Boston, MA 02116, USA.
Health Aff Sch. 2024 Sep 27;2(10):qxae118. doi: 10.1093/haschl/qxae118. eCollection 2024 Oct.
Specialty drugs are high-cost medications often used to treat complex chronic conditions. Even with insurance coverage, patients may face very high out-of-pocket costs, which in turn may restrict access. While the Inflation Reduction Act of 2022 included policies designed to reduce specialty drug costs, relatively few policies have been enacted during the past decade. In 2022-2023, we conducted a scoping literature review to identify a range of policy options and selected a set of 9 that have been regularly discussed or recently considered to present to an expert stakeholder panel to seek consensus on (1) the feasibility of implementing each policy and (2) its likely impact on drug costs. Experts rated only 1 policy highly on both feasibility and impact: grouping originator biologics and biosimilars under the same Medicare Part B reimbursement code. They rated 3 policies focused on setting payment limits as likely to have positive (downward) impact on costs but of uncertain feasibility. They considered 4 policies as uncertain on both criteria. Experts rated capping monthly out-of-pocket costs as feasible but unlikely to reduce specialty drug costs. Based on these results, we offer 4 recommendations to policymakers considering ways to reduce specialty drug costs.
专科药物是常用于治疗复杂慢性病的高成本药物。即使有保险覆盖，患者仍可能面临非常高的自付费用，这反过来可能限制了可及性。虽然2022年的《降低通胀法案》包含了旨在降低专科药物成本的政策，但在过去十年中实施的政策相对较少。在2022年至2023年期间，我们进行了一项范围界定文献综述，以确定一系列政策选项，并选择了9项经常被讨论或最近被考虑的政策，提交给一个专家利益相关者小组，以就以下两点寻求共识：（1）实施每项政策的可行性；（2）其对药物成本可能产生的影响。专家们在可行性和影响方面都给予高度评价的政策只有1项：将原研生物制品和生物类似药归入相同的医疗保险B部分报销代码。他们认为3项侧重于设定支付限额的政策可能对成本产生积极（降低）影响，但可行性不确定。他们认为4项政策在这两个标准上都不确定。专家们认为设定每月自付费用上限是可行的，但不太可能降低专科药物成本。基于这些结果，我们向考虑降低专科药物成本方法的政策制定者提出4条建议。
