随着药店支付仿制药恩替卡韦的价格暴跌，患者的自付费用

StephenW

随着药店支付仿制药恩替卡韦的价格暴跌，患者的自付费用增加
2022 年 2 月 2 日
克里斯汀布兰克

JAMA Network Open 报告的调查结果显示，随着抗病毒药物的仿制药供应商数量从 1 家增加到 11 家，慢性乙型肝炎患者并没有从价格竞争中获益。

仿制药本应刺激价格竞争，事实上，恩替卡韦是一种用于治疗慢性乙型肝炎的一线抗病毒药物。

但发表在 JAMA Network Open 上的一项研究表明，患者并没有从价格下跌中受益。

恩替卡韦的助理教授 Jonathan Alpern 医学博士表示，随着获得批准的恩替卡韦仿制药制造商的数量从 2014 年的 1 家增加到 2018 年的 11 家，药店支付的药物价格从每片 0.50 毫克片剂 30.12 美元暴跌至 1.93 美元。明尼苏达大学传染病学部医学系和他的同事。药房支付的价格称为全国平均药品采购成本 (NADAC)，NADAC 价格可通过 Medicaid 数据库公开获得。

但是，当 NADAC 价格下跌时，Alpern 和他的合作研究人员发现平均批发价格——实际上是标价——保持在 44.43 美元。

共付额和共同保险往往使用平均批发价格（或接近它的价格）来计算，而不是 NADAC 或其他价格。

Alpern 和他的同事使用来自健康声明数据库的未识别数据发现，患者购买 30 天仿制药恩替卡韦的平均自付费用从 2014 年的 41 美元增加到 2018 年的 52 美元。在 2018 年增加了 27%。 NADAC 在同一时期下跌了 93%。

参加高免赔额健康计划的人的模式相似：30 天仿制药恩替卡韦供应的平均自付费用从 2014 年的 103 美元增加到 2018 年的 133 美元，增长了 29%。

研究人员指出，每月 133 美元是与 50% 的“放弃处方”率相关的门槛。他们还指出，患有慢性乙型肝炎的人主要出生在美国以外的地区，并且“受到健康的社会决定因素的不成比例的影响”。

他们将平均批发价格描述为“人为的高价”，并称“供应链中介机构，如 PBM 和药品批发商从高价中受益。 Alpern 和他的同事说，他们的发现强调了对仿制药融资和 PBM 实践要求更高透明度的政策和规则的必要性。他们承认，他们的计算没有考虑患者优惠券和药片拆分，这两者都会减少自付费用。他们在恩替卡韦总支出的计算中也没有包括健康计划回扣。

该研究发表在 2022 年 1 月 21 日的 JAMA Network Open 版上。

StephenW

As Price Pharmacies Pay For Generic Entecavir Plummeted, Out-of-Pocket Expenditures for Patients Increased
February 2, 2022
Christine Blank

Findings reported in JAMA Network Open show that patients with chronic hepatitis B didn’t reap the benefits of price competition as the number of generic suppliers of the antiviral increased from one to 11.

Generic drugs are supposed to spur competition on price and that has, in fact,happened with entecavir, a first-line antiviral used to treat chronic hepatitis B.

But a study published in JAMA Network Open shows that patients are not benefiting from the price decline.

As the number of approved generic manufacturers of entecavir increased from one in 2014 to 11 in 2018, the price that pharmacies paid for the drug plummeted from $30.12 per 0.50-mg tablet to $1.93, according to Jonathan Alpern, M.D., an assistant professor in the Department of Medicine, Division of Infectious Diseases at the University of Minnesota, and his colleagues. The price pharmacies pay is called the national average drug acquisition cost (NADAC), and NADAC prices are publicly available through a Medicaid database.

But while the NADAC price fell, Alpern and his co-investigators found that the average wholesale price — in effect, the list price — stayed at $44.43.

Copayments and coinsurance tend to get calculated using the average wholesale price (or something close to it), not the NADAC or other prices.

Using deidentified data from a health claims database, Alpern and his colleagues found that the average out-of-pocket expenditure for patients for a 30-day supply generic entecavir increased from $41in 2014 to $52 in 2018. That is a 27% increase during the same period that the NADAC fell by 93%.

The patterns was similar for people in high-deductible health plans: The increase in the average out-of-pocket expenditure for a 30-day supply of generic entecavir increased from $103 in 2014 to $133 in 2018, a 29% increase.

The researchers note that $133 per month is a threshold associated with 50% rate of “prescription abandonment.” They also note that people with chronic hepatitis B are predominately born outside the U.S. and are “disproportionately affect by the social determinants of health.”

They describe the average wholesale price as “artificially high” and say that “supply chain intermediaries, such as PBMs and drug wholesalers benefit from the high prices. Alpern and his colleagues say their findings underscore the need for policies and rules that require more transparency about generic drug financing and PBM practices. They acknowledge that their calculations don’t factor in patient coupons and pill splitting, both of which would reduce out-of-pocket expenditures. They also didn’t include health plan rebates in their calculations of the total spending on entecavir.

The study was published in the Jan. 21, 2022, edition of JAMA Network Open.