患者给药止吐药的事先授权、数量限制和分步治疗。

IF 9.7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Kaitlyn Vu, Arjun Gupta, Fumiko Chino, Justin Barnes, Bridgette Thom, Michael Anne Kyle
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引用次数: 0

摘要

重要性:止吐药在改善癌症患者的生活质量和治疗耐受性方面具有1级证据支持;它们是优质护理的重要组成部分。保险公司实施使用管理(事先授权、分步治疗和数量限制),以提高有效性和效率,并控制成本。目的:描述患者保护和平价医疗法案(ACA)市场和医疗补助计划中止吐药的使用管理政策。设计、环境和参与者:这项横断面研究使用了2024年与美国食品和药物管理局国家药物代码相关的所有可用的医疗补助和ACA药物处方的国家样本。确定了13种最常见的自我给药(口服、舌下、透皮)止吐药的配方。暴露:计划的事先授权、数量限制和分步治疗政策。主要结果和测量:计算了按覆盖类型(ACA、Medicaid、Medicaid管理式医疗、州Medicaid)、仿制药与品牌药以及按州地理位置进行使用管理的止吐药的份额。结果:共纳入561个处方(ACA 301个[53.7%],Medicaid 260个[46.3%]),共计348 215个独特药物计划处方(ACA 173个 607个[49.9%],Medicaid 174个 608个[50.1%])。总体而言,使用管理影响了ACA计划中66 981种止吐药物(39.7%)和医疗补助计划中75 727种(43.4%)。在ACA计划中,仿制药配方面临限制的比例高于品牌药(仿制药[67 931 / 167 587]占40.5%,品牌药[1050 / 6020]占17.4%)。在医疗补助中,情况正好相反:82.5%的品牌药(5280中有4357种)和42.2%的仿制药(169中有71 370种 328种)面临限制。利用管理政策因计划和州而异;一些计划对100%的止吐配方实施了至少一项覆盖限制,而其他计划则没有。数量限制是最普遍的使用管理工具,适用于ACA(64 198[37.0%])和Medicaid计划(55 585[38.1%])覆盖的止吐配方的三分之一以上。结论和相关性:在这项医疗补助和ACA处方的横断面研究中,不同保险类型和州以及药物类型、用途和类别对止吐药的使用管理要求存在实质性差异。努力提高利用管理政策的标准化,可以减轻患者的行政负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prior Authorization, Quantity Limits, and Step Therapy for Patient-Administered Antiemetics.

Importance: Antiemetics have level 1 evidence supporting their role in improving quality of life and treatment tolerability for patients with cancer; they are an essential part of quality care. Utilization management (prior authorization, step therapy, and quantity limits) is implemented by insurance companies to improve effectiveness and efficiency and to control costs.

Objective: To characterize utilization management policies for antiemetics for Patient Protection and Affordable Care Act (ACA) Marketplace and Medicaid plans.

Design, setting, and participants: This cross-sectional study used a national sample of all available Medicaid and ACA drug formularies in 2024 linked to the US Food and Drug Administration's National Drug Codes. Formulations of the 13 most common self-administered (oral, sublingual, transdermal) antiemetics were identified.

Exposure: Plans' prior authorization, quantity limit, and step therapy policies.

Main outcomes and measures: The share of antiemetics subject to utilization management by coverage type (ACA, Medicaid, Medicaid managed care, state Medicaid), generic vs brand, and geographically by state was calculated.

Results: A total of 561 formularies (301 [53.7%] ACA; 260 [46.3%] Medicaid) were included, amounting to 348 215 unique drug-plan formulations (173 607 [49.9%] ACA; 174 608 [50.1%] Medicaid). Overall, utilization management affected 66 981 covered antiemetic medications in ACA plans (39.7%) and 75 727 in Medicaid plans (43.4%). In ACA plans, a greater proportion of generic formulations faced restrictions than brand-name drugs (40.5% of generic [67 931 of 167 587] vs 17.4% of brand [1050 of 6020]). In Medicaid, this was the opposite: 82.5% of brand drugs (4357 of 5280) vs 42.2% of generic drugs (71 370 of 169 328) faced restrictions. Utilization management policies varied greatly by plan and state; some plans imposed at least 1 coverage restriction on 100% of antiemetic formulations, and others none. Quantity limits were the most prevalent utilization management tool, applying to more than one-third of covered antiemetic formulations in ACA (64 198 [37.0%]) and Medicaid plans (55 585 [38.1%]).

Conclusions and relevance: In this cross-sectional study of Medicaid and ACA formularies, there was substantial variation in utilization management requirements for antiemetics across insurance type and state as well as drug type, use, and class. Efforts to increase standardization of utilization management policies may alleviate administrative burden for patients.

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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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