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Abstract：
UNASSIGNED: The 2022 Inflation Reduction Act authorizes Medicare to negotiate the prices of 10 drugs in 2026 and additional drugs thereafter. Understanding the sociodemographic and spending characteristics of beneficiaries taking these specific drugs could be important describing the impact of the legislation.
UNASSIGNED: To describe sociodemographic and spending characteristics of Medicare beneficiaries who use the 10 prescription drugs (\"negotiated drugs\") that will face Medicare drug price negotiations in 2026.
UNASSIGNED: A 20% sample of Medicare Part D beneficiaries from 2020 (n = 10,224,642) was used. Sociodemographic and spending characteristics were descriptively reported for beneficiaries taking the negotiated drugs, including subgroups by low-income subsidy (LIS) status and by drug, and for Part D beneficiaries not taking negotiated drugs.
UNASSIGNED: Part D beneficiaries taking a negotiated drug compared with Part D beneficiaries not taking a negotiated drug overall had similar sociodemographic characteristics, more comorbidities (3.9 vs 2.2) and higher mean [median] Medicare ($33,882 [$18,251] vs $12,366 [$3,429]) and out-of-pocket (OOP) spending ($813 [$307] vs $441 [$160]). There was variation in characteristics by LIS status. The mean age was highest among non-LIS beneficiaries taking a negotiated drug compared with LIS beneficiaries taking a negotiated drug and beneficiaries not taking a negotiated drug (76.2 vs 69.9 vs 71.4). Among beneficiaries using negotiated drugs, a higher percentage of LIS beneficiaries compared with non-LIS was female (59.7% vs 48.0%), was Black (20.9% vs 6.6%), and resided in lower-income areas (39.1% vs 20.3%). Mean [median] annual Part D OOP spending for negotiated drugs was $115 [$59] for beneficiaries with LIS and $1,475 [$1,204] for beneficiaries without LIS. There were also differences depending on which negotiated drug was used. Drugs for cancer and blood clots had the highest proportions of White users, whereas type 2 diabetes and heart failure drugs had the highest proportions of Black users and beneficiaries residing in lower-income areas. Annual Part D OOP costs were lowest for sitagliptin (LIS: $104 [$60], non-LIS: $1,391 [$1,153]) and highest for ibrutinib (LIS: $649 [$649], non-LIS: $6,449 [$6,867]). Among non-LIS beneficiaries, 24% (22% to 76%) had more than $2,000 in OOP costs.
UNASSIGNED: Inflation Reduction Act OOP spending caps and LIS expansion will lower prescription drug costs for beneficiaries with OOP costs exceeding $2,000 who are mostly White and live in higher-income areas, insulin users who are disproportionately Black with multiple chronic conditions, and beneficiaries with low incomes. However, these provisions will not impact the 76% of non-LIS beneficiaries using negotiated drugs who have OOP costs that are still substantial but below $2,000. Negotiations could reduce OOP costs through reduced coinsurance payments for this group, which is older and has more chronic conditions compared with beneficiaries not taking negotiated drugs. Part D plan design, spending, and utilization changes should be monitored after negotiation to determine if further solutions are needed to lower OOP costs for this group.
UNASSIGNED: To describe sociodemographic and spending characteristics of Medicare beneficiaries who use the 10 prescription drugs (\"negotiated drugs\") that will face Medicare drug price negotiations in 2026.
UNASSIGNED: A 20% sample of Medicare Part D beneficiaries from 2020 (n = 10,224,642) was used. Sociodemographic and spending characteristics were descriptively reported for beneficiaries taking the negotiated drugs, including subgroups by low-income subsidy (LIS) status and by drug, and for Part D beneficiaries not taking negotiated drugs.
UNASSIGNED: Part D beneficiaries taking a negotiated drug compared with Part D beneficiaries not taking a negotiated drug overall had similar sociodemographic characteristics, more comorbidities (3.9 vs 2.2) and higher mean [median] Medicare ($33,882 [$18,251] vs $12,366 [$3,429]) and out-of-pocket (OOP) spending ($813 [$307] vs $441 [$160]). There was variation in characteristics by LIS status. The mean age was highest among non-LIS beneficiaries taking a negotiated drug compared with LIS beneficiaries taking a negotiated drug and beneficiaries not taking a negotiated drug (76.2 vs 69.9 vs 71.4). Among beneficiaries using negotiated drugs, a higher percentage of LIS beneficiaries compared with non-LIS was female (59.7% vs 48.0%), was Black (20.9% vs 6.6%), and resided in lower-income areas (39.1% vs 20.3%). Mean [median] annual Part D OOP spending for negotiated drugs was $115 [$59] for beneficiaries with LIS and $1,475 [$1,204] for beneficiaries without LIS. There were also differences depending on which negotiated drug was used. Drugs for cancer and blood clots had the highest proportions of White users, whereas type 2 diabetes and heart failure drugs had the highest proportions of Black users and beneficiaries residing in lower-income areas. Annual Part D OOP costs were lowest for sitagliptin (LIS: $104 [$60], non-LIS: $1,391 [$1,153]) and highest for ibrutinib (LIS: $649 [$649], non-LIS: $6,449 [$6,867]). Among non-LIS beneficiaries, 24% (22% to 76%) had more than $2,000 in OOP costs.
UNASSIGNED: Inflation Reduction Act OOP spending caps and LIS expansion will lower prescription drug costs for beneficiaries with OOP costs exceeding $2,000 who are mostly White and live in higher-income areas, insulin users who are disproportionately Black with multiple chronic conditions, and beneficiaries with low incomes. However, these provisions will not impact the 76% of non-LIS beneficiaries using negotiated drugs who have OOP costs that are still substantial but below $2,000. Negotiations could reduce OOP costs through reduced coinsurance payments for this group, which is older and has more chronic conditions compared with beneficiaries not taking negotiated drugs. Part D plan design, spending, and utilization changes should be monitored after negotiation to determine if further solutions are needed to lower OOP costs for this group.
摘要：
■《2022年降低通货膨胀法案》授权Medicare在2026年谈判十种药物的价格，此后再谈判其他药物的价格。了解服用这些特定药物的受益人的社会人口和支出特征可能对描述立法的影响很重要。
■描述使用将在2026年面临Medicare药品价格谈判的十种处方药（“谈判药物”）的Medicare受益人的社会人口统计学和支出特征。
■使用了2020年的医疗保险D部分受益人的20%样本（n=10,224,642）。描述性报告了服用谈判达成的药物的受益人的社会人口统计学和支出特征，包括按LIS状态和药物划分的亚组，以及D部分受益人不服用谈判达成的药物。
■服用谈判药物的D部分受益人与未服用谈判药物的D部分受益人相比，总体上具有相似的社会人口统计学特征，更多的合并症(3.9比2.2)和更高的平均[中位数]医疗保险(33,882美元[18,251美元]比12,366美元[3,429美元])和自付支出(813美元[307美元]比441美元[160美元])。LIS状态的特征存在差异。与服用谈判药物的LIS受益人和不服用谈判药物的受益人相比，服用谈判药物的非LIS受益人的平均年龄最高（76.2vs69.9vs71.4）。在使用谈判药物的受益人中，与非LIS相比，LIS受益人中女性比例更高(59.7%对48.0%)，黑色（20.9%对6.6%），居住在低收入地区（39.1%对20.3%）。拥有LIS的受益人的年度D部分谈判药物的平均[中位数]自付费用为115美元[59美元]，没有LIS的受益人为1,475美元[1,204美元]。根据使用的谈判药物也存在差异。治疗癌症和血栓的药物在白人使用者中比例最高，而2型糖尿病和心力衰竭药物在低收入地区的黑人使用者和受益人比例最高。西格列汀的年度D部分自付费用最低(LIS：104美元[60美元]，非LIS：1,391美元[1,153美元])，伊布替尼最高(LIS：649美元[649美元]，非LIS：6,449美元[6,867美元]）。在非LIS受益人中，24%(22%至76%)的自付费用超过2000美元。
《降低通货膨胀法》的自付支出上限和低收入补贴扩大将降低自付费用超过2,000美元的受益人的处方药成本，这些受益人大多是白人，生活在较高收入地区，胰岛素使用者不成比例的黑人患有多种慢性疾病，和低收入的受益者。然而,这些规定不会影响使用谈判药物的76％的非LIS受益人，这些受益人的自付费用仍然很高，但低于2,000美元。谈判可以通过减少该群体的共同保险金来降低自付费用，与不服用谈判药物的受益人相比，年龄更大，慢性病更多。D部分方案设计,消费,应在谈判后监测利用率的变化，以确定是否需要进一步的解决方案来降低该组的自付费用。
■描述使用将在2026年面临Medicare药品价格谈判的十种处方药（“谈判药物”）的Medicare受益人的社会人口统计学和支出特征。
■使用了2020年的医疗保险D部分受益人的20%样本（n=10,224,642）。描述性报告了服用谈判达成的药物的受益人的社会人口统计学和支出特征，包括按LIS状态和药物划分的亚组，以及D部分受益人不服用谈判达成的药物。
■服用谈判药物的D部分受益人与未服用谈判药物的D部分受益人相比，总体上具有相似的社会人口统计学特征，更多的合并症(3.9比2.2)和更高的平均[中位数]医疗保险(33,882美元[18,251美元]比12,366美元[3,429美元])和自付支出(813美元[307美元]比441美元[160美元])。LIS状态的特征存在差异。与服用谈判药物的LIS受益人和不服用谈判药物的受益人相比，服用谈判药物的非LIS受益人的平均年龄最高（76.2vs69.9vs71.4）。在使用谈判药物的受益人中，与非LIS相比，LIS受益人中女性比例更高(59.7%对48.0%)，黑色（20.9%对6.6%），居住在低收入地区（39.1%对20.3%）。拥有LIS的受益人的年度D部分谈判药物的平均[中位数]自付费用为115美元[59美元]，没有LIS的受益人为1,475美元[1,204美元]。根据使用的谈判药物也存在差异。治疗癌症和血栓的药物在白人使用者中比例最高，而2型糖尿病和心力衰竭药物在低收入地区的黑人使用者和受益人比例最高。西格列汀的年度D部分自付费用最低(LIS：104美元[60美元]，非LIS：1,391美元[1,153美元])，伊布替尼最高(LIS：649美元[649美元]，非LIS：6,449美元[6,867美元]）。在非LIS受益人中，24%(22%至76%)的自付费用超过2000美元。
《降低通货膨胀法》的自付支出上限和低收入补贴扩大将降低自付费用超过2,000美元的受益人的处方药成本，这些受益人大多是白人，生活在较高收入地区，胰岛素使用者不成比例的黑人患有多种慢性疾病，和低收入的受益者。然而,这些规定不会影响使用谈判药物的76％的非LIS受益人，这些受益人的自付费用仍然很高，但低于2,000美元。谈判可以通过减少该群体的共同保险金来降低自付费用，与不服用谈判药物的受益人相比，年龄更大，慢性病更多。D部分方案设计,消费,应在谈判后监测利用率的变化，以确定是否需要进一步的解决方案来降低该组的自付费用。
