供应链中介在引导医院产品选择中的作用:集团采购组织与生物仿制药

E. B. Dean, Reekarl Pierre, Samuel Carter, Amelia M Bond
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引用次数: 0

摘要

在美国,超过 95% 的医院使用被称为 "集团采购组织"(GPO)的联合联盟来采购药品、器械和用品。虽然 GPO 通过降低价格和减少管理负担为医院节约了成本,但批评者认为,这些供应链中介减少了竞争,尤其是当 GPO 集中向规模较大、占主导地位的制造商采购时。我们采用混合方法设计,研究了 GPO 是否会影响医院的采购行为,并探讨了 GPO 使用的合同机制。我们以 2015-2019 年间面临仿制药竞争的四种高成本生物制剂分子为重点,发现与三家顶级 GPO 中的两家相关联的医院与较小的 GPO 相比,传统医疗保险患者的生物仿制药使用率高出 16-23%。生物仿制药使用量的增加主要是由单一生物仿制药品牌推动的,这些品牌因 GPO 而异。根据定性访谈,这两家 GPO 采用了更积极的签约策略,引导会员医院使用特定的生物仿制药品牌。迄今为止,使用 GPO 和这些积极的签约策略似乎增加了生物仿制药的使用,表明为支付方和患者节省了费用。但从长远来看,单一来源的 GPO 合同可能会抑制竞争或造成短缺。对 GPO 的进一步评估需要 GPO 实践和定价策略的透明度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of Supply Chain Intermediaries in Steering Hospital Product Choice: Group Purchasing Organizations and Biosimilars
Over 95% of hospitals in the United States use pooling alliances, known as Group Purchasing Organizations (GPOs), to purchase medications, devices, and supplies. While GPOs create savings for hospitals through lowered prices and reduced administrative burden, critics allege that these supply chain intermediaries reduce competition, particularly if GPOs concentrate purchasing from larger, dominant manufacturers. Using a mixed-method design, we studied whether GPOs influence hospital purchasing behavior and explored the contracting mechanisms used by GPOs. Focusing on four high-cost biologic molecules that face competition from generic-like biosimilars between 2015-2019, we found that biosimilar uptake was 16-23% higher among Traditional Medicare patients in hospitals associated with two of the three top GPOs as compared to smaller GPOs. The increase in biosimilar use was driven by single biosimilar brands that varied by GPO. Based on qualitative interviews, these two GPOs used more aggressive contracting strategies to steer member hospitals to specific biosimilar brands. To date, the use of GPOs and these aggressive contracting strategies appear to have increased biosimilar use, suggesting savings for payers and patients. However, single-source GPO contracting could inhibit competition or create shortages in the long term. Transparency on GPO practices and pricing strategies is needed for further GPO evaluations.
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