Main >> Kamfanin >> Ta yaya Medicaid ke tsara farashin magunguna da rarrabawa a Amurka

Ta yaya Medicaid ke tsara farashin magunguna da rarrabawa a Amurka

Kamfanin

Amurkawa suna biyan kusan kusan $ 1,200 a shekara don takaddun magani - kuma wannan adadi yana wakiltar kuɗin aljihu shi kaɗai.

Sauran alamar farashin takardar sayan ta faɗi ga ma'aikata da masu ba da inshora, gami da shirye-shiryen tarayya da na jihohi kamar su Medicaid , wanda ya shafi fiye da mutane miliyan 70. Wasu sun dage cewa dole ne masu kula da Medicaid su yi hakan yi shawarwari tare da masu kera magunguna , ta amfani da ikon siyan su don rage farashin. A taƙaice, kashe kuɗin Medicaid a kan magungunan ƙwayoyi duk suna da rikici da rikitarwa. Mun tashi yin nazarin bayanan da ke bayan mahawarar.

Mun bincika Medicaid's Bayanin Amfani da Magungunan Jiha , cikakken rikodin yadda masu cin gajiyar Medicaid a duk faɗin ƙasar ke sayen takardun magani. Abubuwan da muka gano sun nuna waɗanne shirye-shiryen jihohi ne ke kashe kuɗi mafi yawa kuma waɗanne irin kwayoyi ne aka fi amfani da su. Don fahimtar yadda Amurka ke amfani da takaddun tsada mai tsada, ci gaba da karantawa.

Farashin takardar magani na Medicaid da shahara

Smallananan adadin magunguna suna asusun ajiyar kuɗi mai yawa na kuɗin Medicaid, gami da takaddun magani waɗanda ke haɗuwa da maganin cututtukan yau da kullun. Tsakanin 2009 da 2018, Medicaid ya rufe takardun magani 212,663,453 don amoxicillin , maganin rigakafi da ake amfani dashi don magance yanayi tun daga cutar huhu zuwa cututtukan fitsari. Rubutun Ibuprofen sun kasance kamar na kowa, kodayake ana samun wannan maganin a saman kan kari. Hydrocodone, magani ne da ake amfani dashi don magance ciwo, an tsara shi sau 191,159,584 a lokacin karatun.

jimlar-watsawa

Game da yawan kuɗin sake dawowa, duk da haka, mafi yawan kuɗin Medicaid sun fito ne daga magunguna masu tsada waɗanda aka tsara don magance cututtukan da ke ci gaba. Truvada, wanda ke danne alamomin cutar kanjamau kuma yana hana yaduwar kwayar, ya lakume Medicaid dala biliyan 5.8 (masu sukar sun yi iƙirarin cewa likitan ya caje shi farashin amfani don samfurin ta). Hakanan, Suboxone ya kashe Medicaid dala biliyan 6.7 tsakanin 2009 da 2018, kodayake wannan kuɗin ya biya ƙasa da takardun magani miliyan 30. Magungunan, wanda aka tsara don magance dogaro da opioid, ya kasance mai tsari sosai.

Wani fashewar rajistar Medicaid

A cikin shekarun da suka gabata bayan zartar da Dokar Kulawa Mai Amfani, Jihohi 37 da aka zaba don karba Shirye-shiryen Fadada Medicaid , yana faɗaɗa ɗaukar hoto ga miliyoyin Amurkawa waɗanda ba su cancanci ba a baya. A sakamakon haka, shigar Medicaid ya karu sosai tsakanin 2013 da 2017, daga mutane 56,533,472 zuwa 74,775,710. A wannan lokacin, farashin sake biyan kuɗin shirin ya tashi da dala biliyan 17 kuma. Duk da haka, duka matakan biyu sun faɗi kaɗan a cikin 2018, ci gaban da wasu ke yi masana sun danganta ga tattalin arziƙi mai ƙarfi. Yayinda ma'aikata ke samun ƙarin, suna wucewa ƙofar samun kuɗin shiga na Medicaid, rage rage shirin. Wani abin da ke haifar da ragin shiga shi ne wasu sabbin bukatun aiki, wadanda gwamnatin Trump ta bukaci jihohi da su aiwatar a shekarun baya.

sake biyan kuɗi

Yawancin jama'ar kasar jihohi mafi yawan jama'a yana da mafi yawan kuɗin dawo da kuɗin jimla. A zahiri, bambance-bambancen farashi daga jihohi zuwa ƙasa suna da girma: New York, California, da Texas sun kashe fiye da sauran jihohi 47 da aka haɗu yayin lokacin karatun. Amma game da kashe kuɗin Medicaid ta kowane mutum, New York da Kalifoniya suna da mafi ƙarancin kuɗin ƙasa-ƙasa da cent 15 a kowace mai rajista. Sabanin haka, wasu Newan jihohin New England sun zama kamar masu karimci: Vermont, Maine, da New Hampshire sun biya sama da $ 3 a kowace rajista a cikin kuɗin da aka sake biya.

Surari a cikin rubutun don mahalarta Medicaid

Yayinda shigar Medicaid ya karu tsakanin 2013 da 2017, yawan takardun da aka samu ta hanyar Medicaid suma sun karu sosai. Har ila yau, waɗannan binciken suna da ilhama: Yayin da yawancin mutane ke shiga cikin shirin, buƙatar magani yana ƙaruwa daidai. Duk da haka, bayanan jihar yana ƙara matakan rikitarwa ga wannan sauƙi mai sauƙi. Wasu daga cikin wuraren da suka fi yawan al'umma, ciki har da California, New York, Texas, da Florida, sun kai kimanin kasa da kaso 0.3 na kowane mai rajista 1,000. A wani gefen bakan, shirin Medicaid na Vermont ya rufe kusan magunguna shida don kowane mahalarta 1,000. Me zai iya bayyana waɗannan bambancin yanayin ƙasa game da buƙatar magani?

an cika rajista

Explanationaya daga cikin bayani game da waɗannan tsarin rubutun yana iya danganta da shekaru: Maine, New Hampshire, da Vermont suna da cikin tsofaffin jama'ar jihar ta yawan yawan jama'a, don haka matsakaita mazauna na iya buƙatar ƙarin magunguna a sakamakon. Amma a cikin jihohin da ke kan iyakoki biyu na keɓaɓɓun tsarin bambance-bambance, 'yan majalisun yankin sun fahimci tasirin farashin magunguna kan shirye-shiryen su na Medicaid. A cikin 2018, Vermont ya zama jiha ta farko don halatta shigo da magungunan ƙwaya daga Kanada, tare da cin gajiyar farashi mai rahusa a kan iyakar. A California, Gov. Gavin Newsom ya umarci Medicaid zuwa yi shawarwari farashin takardar sayan magani kai tsaye tare da masana'antun magunguna a cikin yarjejeniyar neman ingantattun sharuɗɗa.

Magungunan maganin Medicaid

Yawancin magungunan da aka fi ba da izini ga masu rajistar Medicaid ba su fitar da kuɗaɗen dawo da su ba. Amma Ventolin HFA (albuterol), inhaler mai ceto da ake amfani da shi don magance asma, ya ba da wannan yanayin: Kamar yadda aka fi ba da magani, yawan kuɗin ya kai dala biliyan 10.5. Yawancin magungunan asma da ba su da mashahuri sun tabbatar da tsada ga Medicaid, gami da Fluticasone da Symbicort. Wasu bincike ya nuna cewa asma ta fi zama ruwan dare tsakanin yara da manya waɗanda ke zaune a cikin iyalai masu ƙarancin kuɗi - kuma an tsara Medicaid a bayyane don hidimtawa waɗannan rukunin.

na kowa-da tsada

Magungunan ciwon sukari uku suma sun kashe shirye-shiryen Medicaid sama da dala biliyan 4 kwatankwacin kuɗin ragowa. Wannan binciken na iya nuna yanayin lafiyar Amurkawa masu ƙarancin kuɗi, waɗanda ke da su mafi girma yawan ciwon sukari fiye da sauran kungiyoyin tattalin arziki. Harvoni, wani magani ne da aka tabbatar ya magance hepatitis C, ya kai sama da dala biliyan 5 a cikin kudaden. Masu gudanarwa na Medicaid sun damu ƙwarai da gaske cewa sake biyan kuɗin magani na iya tabbatar da rashin ci gaba. Da matsakaici 12 mako na Harvoni halin kaka $ 94,500 , ragin da zai iya ɗaukar nauyin shirye-shiryen Medicaid na ƙasa idan duk masu rajista tare da hepatitis C sun sami wannan maganin.

Kudin biyan kuɗin Medicaid mafi girma

Don magunguna shida, rarar kuɗin Medicaid ya wuce $ 1,000 a kowane kashi a kan matsakaita. Mafi tsada gabaɗaya shine Synagis, wanda zai iya taimakawa hanawa numfashi syncytial , yanayi na yau da kullun a cikin jarirai da tsofaffi. Epogen, maganin rashin jini, yana cin dala 1,857 a kowane kashi - tsada musamman tsada idan aka yi la’akari da cewa karancin jini ne sau da yawa sakamako mai illa na wasu magunguna masu tsada, kamar su chemotherapy. Magungunan antipsychotic guda biyu, Invega da Risperdal, suma sun tabbatar da tsada a kowane fanni.

hi-kashi

Kamar yadda aka tattauna a sama, Harvoni na daga cikin magunguna masu tsada a kowane fanni, kamar yadda wasu magungunan hepatitis C su uku suka samu. Masu rigakafi biyu, Humira da Remicade, suma sun sanya wannan jeren (Humira kuma zata iya yin allurar kai tsaye, mai yuwuwar rage farashin). A halin yanzu, Mirena, na'urar da ke cikin mahaifa da aka ƙera don hana ɗaukar ciki, ta kashe dala 758 a matsakaita - kodayake wannan farashin a zahiri na iya zama ƙasa da kuɗin da ake tarawa na ƙwayoyin hana haihuwa a cikin lokaci. Medicaid takardar sayan magani don hana haihuwa ya kasance mai kawo rigima a wasu jihohin, amma masu ba da shawara sun ce yana rage tsadar shirin a cikin dogon lokaci ta hana daukar ciki ba tare da tsari ba.

Taswirar taswira

A kusan kowace jiha, takamaiman magunguna suna rufewa sosai ta hanyar Medicaid. Sau da yawa, amfani da ba daidai ba na takamaiman magani yana haifar da shirye-shiryen kiwon lafiya na jihar. A cikin Vermont, alal misali, takaddun magani na Suboxone sun kasance 805% mafi girma fiye da matsakaita na ƙasa: Maganin ya zama muhimmin ɓangare na hub kuma yayi magana samfurin don magance dogaro da opioid. New Jersey, wanda yake da ya jaddada yaki da ciwon sukari ta hanyar Medicaid, an rufe magungunan alogliptin kusan sau tara fiye da na ƙasa. A wasu lokuta, manufofin jihohi sun zama kamar gata ne ga takamaiman nau'in magani na yau da kullun. Oklahoma, alal misali, ya rufe 562% ƙarin umarnin Tamiflu fiye da matsakaicin ƙasa. Indiana, yayin haka, ya kasance mafi kusantar rufewa 738% oseltamivir , daidai gwargwado.

Hanyoyin bayar da umarni na wasu jihohi na iya haifar da damuwa akan dalilan haɗarin jaraba, kodayake. A Arewacin Carolina, alal misali, Medicaid ya rufe ƙarin kashi 178% na maganin morphine fiye da matsakaicin ƙasa. Hakazalika, shirin Medicaid na Louisiana ya rufe Soma, mai narkar da jijiyoyin da za a iya cin zarafin su, 216% fiye da matsakaicin ƙasa. A Kentucky, takardun magani na benzodiazepine Ativan sun zama gama gari. Masana da yawa sun yi imanin cewa wannan rukunin magani na iya wakiltar babbar barazanar lafiyar jama'a ta gaba, tare da farashin farashi yana ƙaruwa sosai a cikin decadesan shekarun nan.

Arin ambaliyar Naloxone (Narcan) wanda ke tsarawa

Yayinda rikice-rikicen opioid ke ci gaba da lalata al'ummomin Amurka, gwamnatin tarayya tana ƙara juyawa hanyoyin magani-taimakon magani a matsayin wata hanya ta hana yawan mutuwa. Kuma yayin da wasu shirye-shiryen Medicaid na ƙasa ba su biya kai tsaye don magungunan da aka tsara don magance karɓar opioid, yawancin wurare da yawan waɗanda suka mutu fiye da kima suna yin hakan. Buprenorphine, sinadarin farko a cikin Suboxone, an biya shi kai tsaye ta duk yankin arewa maso gabas, Appalachia, da kuma manyan ɓangarori na Midwest-yankuna sun fi fuskantar matsala ta kowane fanni.

opioid-gani

Biyan kuɗin Methadone ya ɗan zama ba gama gari ba fiye da ɗaukar hoto don buprenorphine, kodayake bincike ya nuna duka magunguna suna da tasiri wajen rage yawan zafin rai tsakanin tsoffin masu amfani da opioid. Duk da haka, wani magani na iya ceton rayuka da yawa a cikin 'yan shekarun nan: naloxone , antagonist mai maganin opioid wanda aka yi amfani dashi don juyar da overdoses. A tarihi, yawan takaddun naloxone tsakanin masu rajistar Medicaid ya karu a mataki tare da yawan maye. Duk da haka, a cikin 2016, yawan adadin naloxone da aka rufe ta Medicaid a zahiri ya ɗan faɗi kaɗan, duk da cewa yawan zafin rai ya kai matakin da ba a taɓa gani ba a waccan shekarar. Wannan ci gaban da aka samu zai iya samun bayani mai sauki: A wurare irin su Pennsylvania, wanda ke da mafi yawan adadin yawan shan kwaya a 2017, hukumomi sun fara rarraba naloxone kyauta.

Kiwan lafiyar Amurka: Babban farashin da za'a biya

Abubuwan da muka gano suna gabatar da bambance-bambance masu ban sha'awa game da amfani da magungunan likitanci tsakanin masu rajistar Medicaid a duk faɗin ƙasar. A kowane yanayi, tsarin rubutun daban-daban na iya samo asali ne daga dalilai da dama, gami da barazanar kiwon lafiya na yanki, hanyoyin gudanar da mulki, da kuma yanayin yawan kowace jiha. Amma yayin da sakamakonmu na iya bambanta sosai, jigogi masu mahimmanci guda biyu suna ci gaba koyaushe.

Na farko, babu wata jiha da ba ta da hauhawar farashin magunguna, amma wasu wurare suna samun ƙimar takaddama musamman ƙalubale. Na biyu, magungunan da suka fi tsada da kuma wajabta sune buƙatu — ba kayan alatu ba — ga waɗanda suke buƙatar su. Ga wadanda suka yi rajistar Medicaid da duk sauran Amurkawa, waɗannan abubuwan da ke rikice-rikice suna da mahimmanci a yi watsi da su.

Idan kuna da ɗaukar magungunan Medicaid amma kuɗin ku har yanzu ya yi yawa, koyaushe kuna iya bincika SingleCare don takardar sayan ku. Anan ga kadan daga cikin dubunnan kwayoyi da zamu iya bayarda ragi akan:

Amoxicillin
Ibuprofen
Albuterol
Loratadine
Ventolin HFA
Lisinopril
Omeprazole
Azithromycin
Fluticasone
Cetirizine
Metformin
Gabapentin
Amlodipine
Levothyroxine

Hanyar

Duk bayanan wannan aikin an samo su ne daga gwamnatin Amurka Bayanin Amfani da Magungunan Jihar Medicaid ta hanyar shiga API. Bayanan da aka tattara sun rufe Janairu. 2009 zuwa Jul. 2018 (ƙarshen Q2). Yawancin bambance-bambancen da ke cikin wannan hadadden sinadaran da aka rarraba kuma aka rarraba su azaman abubuwa daban-daban a cikin bayanan Medicaid an haɗa su (alal misali, Suboxone, Suboxone 1, Suboxone 2, Suboxone 4, Suboxone 8, da Suboxone S duk an haɗa su). Don bayanan 2018 wanda aka taƙaita (maimakon aƙalla), mun samar da keɓaɓɓen ƙididdigar gani don ƙididdigar ƙarshe dangane da lissafin tazarar tazara. Bayanai don zane-zane na ƙarshe (a kan tsauraran matakai) an samo su ne daga Cibiyoyin Kula da Rigakafin Cututtuka (CDC) da Cibiyar Nazarin Magunguna ta Nationalasa.