美國醫療補助計劃:減肥藥物覆蓋限制原因揭秘

**美國Medicaid計劃因成本因素影響減肥藥覆蓋,調查顯示**

根據健康研究機構KFF的調查,大多數美國州份目前並未在其Medicaid健康計劃中,為低收入人群提供Novo Nordisk(NYSE:NVO)和Eli Lilly(NYSE:LLY)的熱門減肥藥,原因主要是成本問題。

調查顯示,截至2024年7月,50個州和哥倫比亞特區中,只有12個Medicaid計劃涵蓋了治療肥胖的藥物,並對使用設有一定限制。

沒有覆蓋的州份中,一半表示他們正在考慮或評估是否加入覆蓋這些藥物。

這類藥物屬於GLP-1激動劑,最初是為治療2型糖尿病而開發,但也能通過抑制食慾促進減肥。Novo的Wegovy和Lilly的Zepbound每月定價約為1,000美元,但大多數人通過健康保險或其他藥廠折扣支付較少。

商業計劃對這些藥物的覆蓋也有限。針對65歲以上人群的Medicare計劃已表示,GLP-1藥物可以因應糖尿病和心血管疾病而覆蓋,因研究顯示其對心臟有益。

調查發現,各州的Medicaid計劃預計在2025財年的健康計劃支出將增加7%,較今年19%的增幅有所放緩,原因是會員數量減少。調查中大多數州的財年於6月30日結束。

與去年相比,支出增幅下降是因為COVID-19疫情期間要求保險公司保持會員登記的政策終止及部分聯邦資金到期。

Medicaid的費用由各州和美國聯邦政府共同承擔。2024財年Medicaid總支出增長5.5%,預計2025財年將增長3.9%。

Medicaid會員資格重新認定使得登記人數從2023年4月的9400萬高峰減少。截至8月,仍有四個州在重新確定Medicaid資格。

KFF指出,2025年各州Medicaid計劃預計會員數量將下降約4.4%,而2024年則下降了7.5%。

根據調查結果,提供者成本、管理護理、醫療福利和處方藥是支出的主要驅動因素。

KFF發現,四分之三的州正在探索至少一項新的或擴大的計劃,以在2024年或2025年控制處方藥成本。

**評論與分析**

這篇報道揭示了美國醫療保險系統中一個持續的挑戰,即如何在成本控制與醫療覆蓋之間取得平衡。減肥藥的高成本對於資源有限的Medicaid計劃來說是一個巨大的挑戰,特別是在疫情後期的經濟壓力下。這不僅涉及到醫療支出的直接影響,還關乎到公共健康政策的長期策略。

Medicaid計劃在面對減肥藥的覆蓋問題時,反映出一個更廣泛的醫療保健議題:如何合理分配有限資源以達到最大的公共健康效益。隨著肥胖問題的日益嚴重,這類藥物的需求可能會持續增加,這將進一步考驗各州的財政能力和政策制定能力。

未來,可能需要創新的解決方案來緩解這類藥物的成本壓力,例如推動公私合作,優化藥物定價機制,或尋求更多的聯邦支持。這不僅對美國有重要意義,對其他面對類似問題的國家和地區也具有借鑒價值。

以上文章由特價GPT API根據網上資料所翻譯及撰寫,過程中沒有任何人類參與 🙂

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