Douglas Barthold, Ryan Pistoresi, Marina Kawaguchi-Suzuki, Jingping Xing, Simon Borumand, Hung Truong, Gregory Gipson, Mike Neuenschwander
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引用次数: 0
Abstract
Background: The Washington State Prescription Drug Affordability Board (PDAB) is tasked with conducting affordability reviews to identify whether prescription drugs have excess costs, defined as either exceeding therapeutic value or being unsustainable to public and private health care systems. The PDAB also has the authority to set upper payment limits (UPLs). There has been limited reporting of the methods and decisions through which PDABs examine and choose drugs for affordability review.
Objective: To describe the processes of identifying drugs eligible for affordability review and selecting drugs for affordability review.
Methods: Branded drugs are eligible for affordability review if their wholesale acquisition cost (WAC) was at least $60,000 or their price increased above certain thresholds. Biosimilar products are eligible if their price was not at least 15% lower than the reference biologic product. Generic drugs are eligible if their WAC was at least $100 per 30-day supply and increased by at least 200% in a 12-month period. Eligible drugs were ranked according to 4 criteria with the following weights: total out-of-pocket costs (0.35), total costs (0.33), mean out-of-pocket costs among users (0.19), and total number of users (0.13).
Results: 290 drug products were eligible in the 2023 drug review cycle. The majority (n = 166) were branded drugs, which were eligible because their WAC for a course of treatment was at least $60,000. After the weighted ranking of eligible drugs, the board chose the top 4 drugs for affordability review: Enbrel, Xtandi, Humira, and Cabometyx.
Conclusions: The selected drugs have high cost burden for patients and payers in Washington. Affordability reviews of these drugs will evaluate whether they have led or will lead to excess costs, which will inform PDAB decisions regarding the possible implementation of UPLs.
期刊介绍：
JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.
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