{"title":"医疗保险 D 部分的福利设计和生物仿制药覆盖范围:近期改革的证据和影响》。","authors":"Luca Bertuzzi, Luca Maini","doi":"10.1377/hlthaff.2023.01297","DOIUrl":null,"url":null,"abstract":"<p><p>There is substantial disparity between Medicare Part D and employer-sponsored health insurance plans in the coverage of biosimilars and their reference biologics. These disparities may be due to design elements of Part D plans that encourage the adoption of more expensive biologic drugs. We undertook several analyses to illustrate the dynamics of benefit design incentives over time, compare formulary coverage in Part D plans with that of employer-sponsored plans, and study how the Bipartisan Budget Act of 2018 affected Part D formulary coverage. Using these analyses of Part D reforms enacted through the Bipartisan Budget Act, we discuss the implications of elements of the Inflation Reduction Act of 2022 that will be implemented in 2025. Biosimilar coverage increased by 23 percentage points five quarters after the Bipartisan Budget Act was implemented. We predict that the Inflation Reduction Act will also have a positive effect on biosimilar coverage. Given ample evidence of a relationship between drug coverage and utilization, our results suggest that Medicare patients and the federal government could realize substantial savings if Part D formularies resembled those of employer-sponsored plans.</p>","PeriodicalId":50411,"journal":{"name":"Health Affairs","volume":null,"pages":null},"PeriodicalIF":8.6000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Benefit Design And Biosimilar Coverage In Medicare Part D: Evidence And Implications From Recent Reforms.\",\"authors\":\"Luca Bertuzzi, Luca Maini\",\"doi\":\"10.1377/hlthaff.2023.01297\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>There is substantial disparity between Medicare Part D and employer-sponsored health insurance plans in the coverage of biosimilars and their reference biologics. These disparities may be due to design elements of Part D plans that encourage the adoption of more expensive biologic drugs. We undertook several analyses to illustrate the dynamics of benefit design incentives over time, compare formulary coverage in Part D plans with that of employer-sponsored plans, and study how the Bipartisan Budget Act of 2018 affected Part D formulary coverage. Using these analyses of Part D reforms enacted through the Bipartisan Budget Act, we discuss the implications of elements of the Inflation Reduction Act of 2022 that will be implemented in 2025. Biosimilar coverage increased by 23 percentage points five quarters after the Bipartisan Budget Act was implemented. We predict that the Inflation Reduction Act will also have a positive effect on biosimilar coverage. Given ample evidence of a relationship between drug coverage and utilization, our results suggest that Medicare patients and the federal government could realize substantial savings if Part D formularies resembled those of employer-sponsored plans.</p>\",\"PeriodicalId\":50411,\"journal\":{\"name\":\"Health Affairs\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":8.6000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health Affairs\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1377/hlthaff.2023.01297\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Affairs","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1377/hlthaff.2023.01297","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
医疗保险 D 部分和雇主赞助的医疗保险计划在生物仿制药及其参照生物制剂的承保范围方面存在巨大差异。造成这些差异的原因可能是 D 部分计划的设计因素鼓励采用更昂贵的生物制剂药物。我们进行了多项分析,以说明福利设计激励因素随时间推移而产生的动态变化,比较 D 部分计划与雇主赞助计划的处方集覆盖范围,并研究 2018 年《两党预算法案》对 D 部分处方集覆盖范围的影响。利用这些对通过《两党预算法案》颁布的 D 部分改革的分析,我们讨论了将于 2025 年实施的《2022 年通货膨胀削减法案》内容的影响。在《两党预算法案》实施五个季度后,生物仿制药的覆盖率增加了 23 个百分点。我们预测,《通货膨胀削减法》也将对生物仿制药的覆盖率产生积极影响。鉴于有大量证据表明药品覆盖率和使用率之间存在关系,我们的研究结果表明,如果 D 部分的药品目录与雇主赞助计划的药品目录相似,那么医疗保险患者和联邦政府就可以节省大量资金。
Benefit Design And Biosimilar Coverage In Medicare Part D: Evidence And Implications From Recent Reforms.
There is substantial disparity between Medicare Part D and employer-sponsored health insurance plans in the coverage of biosimilars and their reference biologics. These disparities may be due to design elements of Part D plans that encourage the adoption of more expensive biologic drugs. We undertook several analyses to illustrate the dynamics of benefit design incentives over time, compare formulary coverage in Part D plans with that of employer-sponsored plans, and study how the Bipartisan Budget Act of 2018 affected Part D formulary coverage. Using these analyses of Part D reforms enacted through the Bipartisan Budget Act, we discuss the implications of elements of the Inflation Reduction Act of 2022 that will be implemented in 2025. Biosimilar coverage increased by 23 percentage points five quarters after the Bipartisan Budget Act was implemented. We predict that the Inflation Reduction Act will also have a positive effect on biosimilar coverage. Given ample evidence of a relationship between drug coverage and utilization, our results suggest that Medicare patients and the federal government could realize substantial savings if Part D formularies resembled those of employer-sponsored plans.
期刊介绍:
Health Affairs is a prestigious journal that aims to thoroughly examine significant health policy matters both domestically and globally. Our publication is committed to addressing issues that are relevant to both the private and public sectors. We are enthusiastic about inviting private and public decision-makers to contribute their innovative ideas in a publishable format. Health Affairs seeks to incorporate various perspectives from industry, labor, government, and academia, ensuring that our readers benefit from the diverse viewpoints within the healthcare field.