医院和付款人对化疗生物仿制药不一致的首选药物状况的影响。

IF 0.9 4区 医学 Q4 ONCOLOGY
Journal of Oncology Pharmacy Practice Pub Date : 2025-10-01 Epub Date: 2025-07-17 DOI:10.1177/10781552251355509
Isha Rana, Zhili Fu, Erika N Brown, Rodrigo M De La Torre, Cynthia El Rahi
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引用次数: 0

摘要

随着FDA批准的生物仿制药数量的增加,以及降低美国医疗保健和患者自付费用的预期优势,关于支付者指定其首选处方药物的影响的问题仍然存在。目的评估化疗生物仿制药对卫生系统的财务影响,特别是曲妥珠单抗和贝伐单抗,以及当付款人指定的首选产品与卫生系统首选处方产品不同时,其参考产品的使用情况。方法:本研究是一项基于国家综合癌症网络(NCCN)指南和标准的曲妥珠单抗、贝伐珠单抗及其各自的生物仿制药处方的保险拒绝的回顾性研究。主要结果是使用多种产品的财务影响,因为付款人的偏好是通过医院的成本来衡量的。次要结果是一旦最初的生物仿制药授权被拒绝,由于重新提交过程和新的财务许可所需的周转时间。结果452例接受曲妥珠单抗或贝伐单抗治疗的患者中有18例(4%)患者被拒绝使用医院首选的生物仿制药,转而使用患者保险规定的生物仿制药。这导致医院实际购置成本增加1.28%。对管理时间的影响包括总共额外70小时的IT时间、10.5小时的药剂师时间和18小时的患者访问协调员处理时间。本研究的结果表明,根据患者的保险计划,多种生物类似药的使用对医疗保健系统继续正常运行的财务和运营影响增加了负担。需要进一步的研究来描述将生物仿制药的覆盖范围限制在有限产品的医疗保险计划对患者的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of discordant preferred drug status between hospitals and payers for chemotherapeutic biosimilars.

BackgroundWith increasing numbers of FDA approved biosimilars, and the expected advantages of lowering United States (U.S.) healthcare and patient out of pocket costs, questions remain regarding the impact of payers designating their preferred formulary drug(s).ObjectiveTo assess the financial impact to health-systems of chemotherapeutic biosimilars, specifically trastuzumab and bevacizumab, and its reference product utilization when a payer designates their preferred product(s) that is(are) different than the health-system's preferred formulary product.MethodsThis study is a retrospective review of insurance denials for orders of trastuzumab, bevacizumab, and their respective biosimilars, prescribed based on National Comprehensive Cancer Network (NCCN) guidelines and standards. The primary outcome was the financial impact of utilizing multiple products due to the payer's preference measured by cost to the hospital. The secondary outcome was the turnaround time required due to resubmission process and new financial clearance once the initial biosimilar authorization was denied.Results18 patients out of 452 (4%) patients, who received trastuzumab or bevacizumab treatment, were denied for hospital preferred biosimilar product and switched to the patient's insurance mandated biosimilar product. This resulted in a 1.28% increase in hospital actual acquisition costs. Impact on administrative time included a total of additional 70 h of IT time, 10.5 h of pharmacist time, and 18 h of patient access coordinator processing time.ConclusionThe results of this study demonstrate the added burden to include financial and operational impacts on healthcare systems to continue to operate functionally for the utilization of multiple biosimilar products, as dictated by the patient's insurance plan. Further research is required to describe the impact to patients from their medical insurance plans that restrict biosimilar coverage to limited products.

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来源期刊
CiteScore
2.70
自引率
7.70%
发文量
276
期刊介绍: Journal of Oncology Pharmacy Practice is a peer-reviewed scholarly journal dedicated to educating health professionals about providing pharmaceutical care to patients with cancer. It is the official publication of the International Society for Oncology Pharmacy Practitioners (ISOPP). Publishing pertinent case reports and consensus guidelines...
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