Egilman Alexander C, Kesselheim Aaron S, Rome Benjamin N
Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Health Serv Res. 2025 Jul 14:e70012. doi: 10.1111/1475-6773.70012.
To examine whether the new Medicare inflation rebate policy was associated with changes in manufacturer pricing behavior.
In this cross-sectional study of 156 top-selling brand-name drugs, we used linear regression to evaluate whether there was an association between drugs' exposure to the policy (i.e., Medicare's share of net US sales) and differences in year-over-year price changes before (2021-2022) versus after (2022-2023, 2023-2024) the policy took effect.
The study used Medicare spending data and average sales prices from the Centers for Medicare and Medicaid Services, wholesale acquisition costs from Eversana NAVLIN's Price & Access database, and sales revenue and estimated rebates from SSR Health. Vaccines, biosimilars, drugs approved after 2020, and those with generic or biosimilar competition before 2023 were excluded. Drugs were stratified by whether they derived most sales from Medicare Part B or Part D.
The median Medicare share of net sales was 28% (IQR: 18%-37%) for 50 Part B drugs and 32% (IQR: 16%-49%) for 106 Part D drugs. Median year-over-year price changes in 2021-2022, 2022-2023, and 2023-2024 were 3.2%, 2.9%, and 3.4% for Part B drugs and 5.0%, 5.9%, and 4.9% for Part D drugs. There was no association between drugs' Medicare share of net sales and differences in price changes pre- vs. post-policy for Part B drugs (2023: p = 0.99; 2024: p = 0.09). For Part D drugs, each 10% increase in drugs' share of Medicare sales was associated with a 0.18% (95% CI, 0.01%-0.35%, p = 0.04) higher price change in the first year after policy implementation; there was no significant association in the second year (p = 0.17).
Medicare inflation rebates were not associated with smaller price increases among the top-selling drugs most affected by the policy. Additional measures are needed to prevent drug manufacturers from raising prices each year, such as extending inflation rebates to commercially insured patients.
研究新的医疗保险通胀回扣政策是否与制造商定价行为的变化相关。
在这项对156种畅销品牌药的横断面研究中，我们使用线性回归来评估药品受该政策影响的程度（即医疗保险在美国净销售额中的占比）与政策生效前（2021 - 2022年）和生效后（2022 - 2023年、2023 - 2024年）逐年价格变化差异之间是否存在关联。
本研究使用了医疗保险和医疗补助服务中心的医疗保险支出数据及平均销售价格、Eversana NAVLIN价格与准入数据库中的批发采购成本，以及SSR Health的销售收入和估计回扣。疫苗、生物类似药、2020年后获批的药物以及2023年前有仿制药或生物类似药竞争的药物被排除。药物按其大部分销售额来自医疗保险B部分还是D部分进行分层。
50种B部分药物的医疗保险净销售额中位数占比为28%（四分位间距：18% - 37%），106种D部分药物为32%（四分位间距：16% - 49%）。2021 - 2022年、2022 - 2023年和2023 - 2024年B部分药物的逐年价格变化中位数分别为3.2%、2.9%和3.4%，D部分药物分别为5.0%、5.9%和4.9%。对于B部分药物，药品医疗保险净销售额占比与政策前后价格变化差异之间无关联（2023年：p = 0.99；2024年：p = 0.09）。对于D部分药物，药品医疗保险销售额占比每增加10%，在政策实施后的第一年价格变化就高出0.18%（95%置信区间，0.01% - 0.35%，p = 0.04）；在第二年无显著关联（p = 0.17）。
医疗保险通胀回扣与受该政策影响最大的畅销药品价格涨幅较小无关。需要采取额外措施来防止药品制造商每年提高价格，比如将通胀回扣扩大到商业保险患者。
