Schrier Elizabeth, Himmelstein David U, Gaffney Adam, McCormick Danny, Woolhandler Steffie
Internal Medicine Residency Program, Department of Medicine, University of California, San Francisco, CA, USA.
City University of New York at Hunter College, New York, NY, USA.
J Gen Intern Med. 2025 May;40(6):1325-1332. doi: 10.1007/s11606-024-09032-x. Epub 2024 Oct 24.
Drug prices affect government budgets directly through spending on public programs like Medicare and Medicaid, and indirectly via private coverage for public employees and tax subsidies for private insurance. Yet, the Senate parliamentarian ruled that the Senate could not use streamlined Budget Reconciliation to extend the Inflation Reduction Act's controls on insulin co-payment or drug prices to private insurers on the grounds that their expenditures do not affect the federal budget.
To quantify insulin and other drug costs borne by federal, state, and local governments, including direct expenditures and indirect government subsidies that flow through private insurers.
Cross-sectional analysis of expenditures for outpatient retail prescription drugs reported by respondents and their pharmacies in the 2019 Medical Expenditure Panel Survey (adjusted downward for drug rebates), supplemented with information on employment-related insurance from the US Office of Management and Budget and other sources.
The civilian non-institutionalized US population.
Direct (payments by public health insurance programs) and indirect (taxpayer-funded payments via private insurers) government expenditures for outpatient retail drugs.
Direct government expenditures for outpatient retail prescription drugs totaled $154.85 billion in 2019, including $15.68 billion for insulin. Indirect government expenditures channeled through private insurers totaled $53.59 billion (including $5.48 billion for insulins). Those indirect expenditures encompassed $32.32 billion in tax subsidies for employer-sponsored private coverage, $25 million for subsidies to private Affordable Care Act marketplace plans, and $21.24 billion for government-paid premiums for public employees and retirees. Overall, government expenditures for outpatient retail prescription drugs totaled $208.44 billion, 58.76% of all-payer spending and 65.96% of spending for insulin.
Governments directly or indirectly fund most drug purchases, including substantial expenditures that flow through private insurers. Hence, prices paid by private insurers impact government budgets, supporting the view that government should be allowed to regulate drug prices.
药品价格通过医疗保险和医疗补助等公共项目的支出直接影响政府预算，并通过为公职人员提供的私人保险以及对私人保险的税收补贴间接影响政府预算。然而，参议院议事规则专家裁定，参议院不能利用简化的预算协调程序将《降低通胀法案》对胰岛素自付费用或药品价格的管控措施扩展至私人保险公司，理由是其支出不会影响联邦预算。
量化联邦、州和地方政府承担的胰岛素及其他药品成本，包括直接支出以及通过私人保险公司的间接政府补贴。
对2019年医疗支出小组调查中受访者及其药房报告的门诊零售处方药支出进行横断面分析（根据药品回扣向下调整），并补充美国管理与预算办公室及其他来源的与就业相关保险的信息。
美国非机构化平民人口。
政府用于门诊零售药品的直接支出（公共医疗保险计划的支付）和间接支出（通过私人保险公司由纳税人资助的支付）。
2019年政府用于门诊零售处方药的直接支出总计1548.5亿美元，其中胰岛素支出为156.8亿美元。通过私人保险公司的间接政府支出总计535.9亿美元（包括胰岛素支出54.8亿美元）。这些间接支出包括323.2亿美元的雇主赞助私人保险税收补贴、2500万美元的《平价医疗法案》私人市场计划补贴以及212.4亿美元的公职人员和退休人员政府支付保费。总体而言，政府用于门诊零售处方药的支出总计2084.4亿美元，占所有支付方支出的58.76%，占胰岛素支出的65.96%。
政府直接或间接为大多数药品采购提供资金，包括通过私人保险公司的大量支出。因此由私人保险公司支付的价格会影响政府预算，支持政府应被允许监管药品价格这一观点。
