平衡证据与需求:美国商业支付机构对 Esketamine 的承保范围存在差异。

IF 3.2 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Ekwu B. Ochigbo RPhPhD, Molly T. Beinfeld MPH, James D. Chambers MPharmPhD
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引用次数: 0

摘要

目的:美国商业健康计划承保政策的不同会影响患者获得药物的方式。医保计划在治疗准入标准、治疗方案和处方要求方面可能各不相同。在本研究中,我们考察了盐酸艾司卡胺(Spravato)治疗重度抑郁症(MDD)和治疗耐受性抑郁症(TRD)的承保范围,以回答以下问题:美国商业健康计划如何承保艾司卡胺,以及它们如何指导患者及时获得该药物?我们使用了塔夫茨医学中心专科药物证据与覆盖数据库中的信息,该数据库包括美国 18 家大型商业医疗保险计划发布的覆盖政策。我们整理并分析了 2022 年 12 月有效的 MDD 和 TRD Esketamine 承保政策。我们根据阶梯疗法协议、患者亚组限制和处方要求标准对承保政策进行了比较,通过限制的数量和包含每项标准的计划比例来评估患者的可及性:与 MDD 相比,医保计划对 TRD 患者使用埃斯卡他敏的阶梯治疗要求更多,MDD 患者的治疗≤9 个阶梯,而 TRD 患者的治疗≤1 至 5 个阶梯。在两种适应症中,医保计划要求患者首先尝试的疗法也各不相同,在治疗失败后才允许患者使用艾司氯胺酮。用于评估抑郁症状严重程度的阈值和评分量表的临床覆盖要求也各不相同:医保计划在埃斯氯胺酮的治疗方案和临床承保要求方面各不相同。医疗计划覆盖政策的差异可能会导致患者和临床医生在接受治疗时遭遇不公平待遇,增加治疗的复杂性,从而延误紧急治疗:Gov 标识符:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Balancing Evidence and Need: Variation in US Commercial Payer Coverage of Esketamine

Purpose

Variations in US commercial health plan coverage policies affect how patients access medications. Plans may vary in treatment access criteria, line of therapy, and prescriber requirements. In this study, we examined coverage of esketamine hydrochloride (Spravato) for major depressive disorder (MDD) and treatment-resistant depression (TRD) to answer the following question: how do US commercial health plans cover esketamine, and how do they guide prompt patient access to the drug?

Methods

We used information from the Tufts Medical Center Specialty Drug Evidence and Coverage database, which includes coverage policies issued by 18 large commercial health plans in the United States. Esketamine coverage policies for MDD and TRD active in December 2022 were collated and analyzed. We compared coverage policies according to step therapy protocols, patient subgroup restrictions, and prescriber requirement criteria, evaluating patient access using the number of restrictions and proportion of plans including each criterion.

Findings

Plans more often imposed step therapy requirements for access to esketamine for TRD than for MDD, with line of treatment of ≤9 steps for MDD compared with 1 to 5 steps for TRD. Plans also varied with respect to the therapies they required patients to first try and experience treatment failure before granting access to esketamine for both indications. Clinical coverage requirements varied in thresholds and rating scales used to assess severity of depressive symptoms.

Implications

Plans vary in terms of line of therapy and clinical coverage requirements for access to esketamine. Variation in health plan coverage policies may result in inequitable access and added complexity for patients and clinicians navigating care, which may delay access to urgent treatment.

ClinicalTrials.gov identifiers

Not applicable.
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来源期刊
Clinical therapeutics
Clinical therapeutics 医学-药学
CiteScore
6.00
自引率
3.10%
发文量
154
审稿时长
9 weeks
期刊介绍: Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.
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