RESUMEN
This cohort study quantifies the rejections that patients with new-to-class claims face when attempting to initiate therapy with PCSK9 inhibitors and explores the association of rejection with subsequent behavior.
Asunto(s)
Lípidos , Inhibidores de PCSK9 , Humanos , Estudios RetrospectivosRESUMEN
This cohort study uses a longitudinal access and adjudication data set to evaluate prescription out-of-pocket costs and filling behaviors of commercially insured individuals with chronic obstructive pulmonary disease (COPD).
Asunto(s)
Gastos en Salud , Enfermedad Pulmonar Obstructiva Crónica , Estudios de Cohortes , Humanos , Prescripciones , Enfermedad Pulmonar Obstructiva Crónica/terapia , Estudios RetrospectivosRESUMEN
New oncology therapies can contribute to survival or quality of life, but payers and policy makers have raised concerns about the cost of these therapies. Similar concerns extend beyond cancer. In seeking a solution, payers are increasingly turning toward value-based payment models in which providers take financial risk for costs and outcomes. These models, including episode payment and bundled payment, create financial gains for providers who reduce cost, but they also create concerns about potential stinting on necessary treatments. One approach, which the Centers for Medicare and Medicaid Services adopted in the Oncology Care Model (OCM), is to partially adjust medical practices' budgets for their use of novel therapies, defined in this case as new oncology drugs or new indications for existing drugs approved after December 31, 2014. In an analysis of the OCM novel therapies adjustment using historical Medicare claims data, we found that the adjustment may provide important financial protection for practices. In a simulation we performed, the adjustment reduced the average loss per treatment episode by $758 (from $807 to $49) for large practices that use novel therapies often. Lessons from the OCM can have implications for other alternative payment models.