RESUMO
PURPOSE OF REVIEW: Cardiovascular medications improve health and prevent early death. However, high drug prices reduce the use of these medications and strain the health system. The Inflation Reduction Act (IRA) of 2022 allows Medicare to negotiate drug prices with manufacturers and reduces out-of-pocket drug costs for Medicare beneficiaries. This article explores the potential impact that the IRA will have on the treatment of cardiovascular disease. RECENT FINDINGS: Cardiovascular disease medications are likely to be selected for price negotiations under the IRA, leading to savings for patients and for Medicare. Recent work suggests that the IRA's reforms to the Medicare Part D drug benefit will meaningfully reduce out-of-pocket costs for important cardiovascular medications. The IRA is expected to impact cardiovascular disease treatments via price negotiations and through the broader access to medications afforded by improvements to Part D coverage design.
Assuntos
Doenças Cardiovasculares , Cardiopatias , Medicare Part D , Idoso , Humanos , Estados Unidos , Negociação , Custos de MedicamentosAssuntos
Betacoronavirus , Centros Comunitários de Saúde/legislação & jurisprudência , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Boston , COVID-19 , Centros Comunitários de Saúde/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Financiamento Governamental/legislação & jurisprudência , Humanos , Patient Protection and Affordable Care Act , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Racismo , SARS-CoV-2 , Estados UnidosRESUMO
This Viewpoint summarizes inefficiencies in the 340B program and provides suggestions for equitable reform that will potentially benefit patients.
Assuntos
Custos de Medicamentos , Programas Governamentais , Medicamentos sob Prescrição , Custos de Medicamentos/legislação & jurisprudência , Estados Unidos , Programas Governamentais/economia , Programas Governamentais/legislação & jurisprudência , Governo FederalAssuntos
Surtos de Doenças/prevenção & controle , Infecções por HIV/prevenção & controle , Redução do Dano , Hepatite C/prevenção & controle , Programas de Troca de Agulhas , Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Humanos , Indiana/epidemiologia , Uso Comum de Agulhas e Seringas/efeitos adversos , Programas de Troca de Agulhas/legislação & jurisprudência , Estados UnidosAssuntos
Infecções por HIV/tratamento farmacológico , Sudorese/fisiologia , Adenina/análogos & derivados , Adenina/uso terapêutico , Adulto , Alanina , Fármacos Anti-HIV/uso terapêutico , Sudeste Asiático , Cobicistat/uso terapêutico , Emtricitabina/uso terapêutico , Humanos , Laos , Masculino , Quinolonas/uso terapêutico , Tenofovir/análogos & derivados , Tailândia , Viagem , Estados UnidosAssuntos
Governo/história , Reforma dos Serviços de Saúde , Política , História do Século XXI , Humanos , Estados UnidosRESUMO
IMPORTANCE: Racial and ethnic disparities in chronic disease are a major public health priority. OBJECTIVE: To determine if the amount of federal grant funding to federally-qualified health centers (FQHCs) was associated with baseline overall prevalence of uncontrolled hypertension and uncontrolled diabetes, as well as prevalence by racial and ethnic subgroup. DESIGN: Cross-sectional multivariate regression analysis of Uniform Data System 2014-2019, which includes clinic-level data from each FQHC regarding demographics, chronic disease control by race and ethnicity, and grant funding. EXPOSURES: Our main exposure were the average values of the prevalence of uncontrolled hypertension and uncontrolled diabetes among the overall population and by racial and ethnic group from 2014-2016. MAIN OUTCOMES: Average federal grant funding per patient from 2017-2019, as measured by annual health center funding from the Bureau of Primary Health Care (BPHC) and overall federal grant funding. RESULTS: We analyzed 1,205 FQHCs from 2014-2019; the average BPHC grant per patient across all FQHCs in 2019 was $168 while the average total federal grant was $184 per patient. Increasing shares of total patients with uncontrolled hypertension or uncontrolled diabetes were not associated with increased total federal grant funding in either unadjusted or adjusted analysis. Increased shares of patients who are American Indian or Alaskan Native (AI-AN) with uncontrolled hypertension and diabetes were associated with increasing total federal grant funding in both unadjusted and adjusted analysis (adjusted beta hypertension $168.3, p <0.001; adjusted beta diabetes 59.44, p = 0.02). However, cardiovascular clinical need among other racial and ethnic groups was not significantly associated with grant funding. CONCLUSIONS: FQHCs with higher overall rates of uncontrolled hypertension or diabetes do not receive more federal funds, and there is no significant association between federal funding levels and rates of uncontrolled blood pressure or diabetes within most racial and ethnic groups, with the exception of AI-AN populations. To narrow inequities in cardiovascular disease, HRSA should consider more explicitly targeting federal grants to clinics with higher levels of clinical need.
Assuntos
Diabetes Mellitus , Financiamento Governamental , Hipertensão , Humanos , Hipertensão/epidemiologia , Hipertensão/economia , Hipertensão/etnologia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Estudos Transversais , Estados Unidos/epidemiologia , Financiamento Governamental/estatística & dados numéricos , Masculino , Feminino , Etnicidade/estatística & dados numéricos , Prevalência , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Equidade em Saúde/economia , Disparidades em Assistência à Saúde/economia , Pessoa de Meia-Idade , Grupos Raciais/estatística & dados numéricosRESUMO
Medicare for All has emerged as a major topic in the national health reform debate. A clear understanding of the policy issues raised by Medicare for All would benefit both public discussion and policy design. In this article we identify key policy design issues for a Medicare for All system: comprehensiveness of coverage, the private sector's role, the payment approach, and financing. We analyze policy options within these domains and show that the Medicare for All bills under consideration in the 116th Congress propose a comprehensive benefit structure with a limited role for supplementary private insurance. We suggest that Medicare for All could adopt payment rates between existing Medicare rates and the average all-payer rate, or it could implement global payment starting at a level similar to current spending. We propose a financing framework that includes repurposing existing public funds, redirecting private health care spending to public spending, and implementing a mix of progressive taxes to replace the regressive financing of private insurance.