本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMsa2306609

摘要内容如下：

背景

医院可以利用其在药品最终买家和卖家之间的地位，保留保险公司药品支出的很大份额。

方法

在这项研究中，我们使用了2020-2021年国家蓝十字蓝盾索赔数据，这些数据是关于美国因肿瘤疾病、炎症或血细胞缺乏疾病而进行药物输注的患者。报销价格的加价是根据蓝十字蓝盾计划（Blue Cross Blue Shield Plans）支付给医院和医师诊所的金额相对于这些供应商支付给药品制造商的金额来衡量的。根据联邦340B药品定价计划，医院支付给药品制造商的收购价格降低是根据折扣来衡量的。我们估计了药品制造商收到的蓝十字蓝盾药品支出的百分比和供应商组织保留的百分比。

结果

该研究纳入了美国404，443名患者，他们接受了4，727，189次药物输注。有资格获得340B折扣的医院的中间价格加价（定义为报销价格与收购价格的比率）为3.08（四分位间距为1.87至6.38）。在对药物、患者和地理因素进行调整后，符合340B折扣条件的医院的加价是独立医师诊所的6.59倍（95%可信区间[CI]，6.02-7.16），不符合条件的医院的加价是医师诊所的4.34倍（95%CI，3.77-4.90）。有资格享受340B折扣的医院保留了64.3%的保险公司药品支出，而没有资格享受340B折扣的医院保留了44.8%，独立执业医师保留了19.1%。

结论

这项研究表明，医院实行大幅加价，并在保险公司为私人保险患者支付的医生管理药物的总支出中保留了相当大的份额。对于根据联邦340B药品定价计划有资格享受支付给制造商的采购成本折扣的医院来说，这种影响尤其大。（由阿诺德风险投资公司和国家卫生保健管理研究所资助。）。

英文原文如下：

Abstracts

BACKGROUND  Hospitals can leverage their position between the ultimate buyers and sellers of drugs to retain a substantial share of insurer pharmaceutical expenditures.

METHODS  In this study, we used 2020-2021 national Blue Cross Blue Shield claims data regarding patients in the United States who had drug-infusion visits for oncologic conditions, inflammatory conditions, or blood-cell deficiency disorders. Markups of the reimbursement prices were measured in terms of amounts paid by Blue Cross Blue Shield plans to hospitals and physician practices relative to the amounts paid by these providers to drug manufacturers. Acquisition-price reductions in hospital payments to drug manufacturers were measured in terms of discounts under the federal 340B Drug Pricing Program. We estimated the percentage of Blue Cross Blue Shield drug spending that was received by drug manufacturers and the percentage retained by provider organizations.

RESULTS  The study included 404,443 patients in the United States who had 4,727,189 drug-infusion visits. The median price markup (defined as the ratio of the reimbursement price to the acquisition price) for hospitals eligible for 340B discounts was 3.08 (interquartile range, 1.87 to 6.38). After adjustment for drug, patient, and geographic factors, price markups at hospitals eligible for 340B discounts were 6.59 times (95% confidence interval [CI], 6.02 to 7.16) as high as those in independent physician practices, and price markups at noneligible hospitals were 4.34 times (95% CI, 3.77 to 4.90) as high as those in physician practices. Hospitals eligible for 340B discounts retained 64.3% of insurer drug expenditures, whereas hospitals not eligible for 340B discounts retained 44.8% and independent physician practices retained 19.1%.

CONCLUSIONS  This study showed that hospitals imposed large price markups and retained a substantial share of total insurer spending on physician-administered drugs for patients with private insurance. The effects were especially large for hospitals eligible for discounts under the federal 340B Drug Pricing Program on acquisition costs paid to manufacturers. (Funded by Arnold Ventures and the National Institute for Health Care Management.).

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。

现在购买可享受最大优惠（买一年送三个月，买两年送一年），2024年2月10日起将不再享有该优惠。