Access to clinically indicated genetic tests for pediatric patients with Medicaid: Evidence from outpatient genetics clinics in Texas

PurposeLittle is known about how Medicaid coverage policies affect access to genetic tests for pediatric patients. Building upon and extending a previous analysis of prior authorization requests (PARs), we describe expected coverage of genetic tests submitted to Texas Medicaid and the PAR and diagnostic outcomes of those tests.MethodsWe retrospectively reviewed genetic tests ordered at 3 pediatric outpatient genetics clinics in Texas. We compared Current Procedural Terminology (CPT) codes with the Texas Medicaid fee-for-service schedule (FFSS) to determine whether tests were expected to be covered by Medicaid. We assessed completion and diagnostic yield of commonly ordered tests.ResultsAmong the 3388 total tests submitted to Texas Medicaid, 68.9% (n = 2336) used at least 1 CPT code that was not on the FFSS and 80.7% (n = 2735) received a favorable PAR outcome. Of the tests with a CPT code not on the FFSS, 60.0% (n = 1400) received a favorable PAR outcome and were completed and 20.5% (n = 287) were diagnostic. The diagnostic yield of all tests with a favorable PAR outcome that were completed was 18.7% (n = 380/2029).ConclusionMost PARs submitted to Texas Medicaid used a CPT code for which reimbursement from Texas Medicaid was not guaranteed. The frequency with which clinically indicated genetic tests were not listed on the Texas Medicaid FFSS suggests misalignment between genetic testing needs and coverage policies. Our findings can inform updates to Medicaid policies to reduce coverage uncertainty and expand access to genetic tests with high diagnostic utility.     

Confirmatory versus explorative endpoint analysis: Decision-making on the basis of evidence available from market authorization and early benefit assessment for oncology drugs

The early benefit assessment of pharmaceuticals in Germany and their preceding market authorization pursue different objectives. This is reflected by the inclusion of varying confirmatory endpoints within the evaluation of oncology drugs in early benefit assessment versus market authorization, with both relying on the same evidence. Data from assessments up to July 2015 are used to estimate the impact of explorative in comparison to confirmatory endpoints on market authorization and early benefit assessment by contrasting the benefit-risk ratio of EMA and the benefit-harm balance of the HTA jurisdiction. Agreement between market authorization and early benefit assessment is examined by Cohen’s kappa (k). 21 of 41 assessments were considered in the analysis. Market authorization is more confirmatory than early benefit assessment because it includes a higher proportion of primary endpoints. The latter implies a primary endpoint to be relevant for the benefit-harm balance in only 67% of cases (0.078). Explorative mortality endpoints reached the highest agreement regarding the mutual consideration for the risk-benefit ratio and the benefit-harm balance (0.000). For explorative morbidity endpoints (−0.600), quality of life (−0.600) and side effects (−0.949) no agreement is ascertainable. To warrant a broader confirmatory basis for decisions supported by HTA, closer inter-institutional cooperation of approval authorities and HTA jurisdictions by means of reliable joint advice for manufacturers regarding endpoint definition would be favorable.     

新疆某三甲医院基于岗位胜任力医师资质授权管理体系探索与实践

医师是诊疗活动的主体,新疆医科大学第一附属医院通过规范医师诊疗行为,全面建立医师授权管理的长效机制,对医师处方权、处置权、手术权、报告权等主要权限进行明确授权、全面授权、量化授权、动态授权,实现医师资质准入-授权-考核评价-再授权的闭环管理,保持医院“质量发展、创新发展、安全发展”的动力。     

上市许可持有人制度下非生产企业的药品委托生产质量管理探析

目的：探究上市许可持有人制度下非生产企业的药品委托生产质量管理之有效举措,以供研发机构及科研人员借鉴。方法：阐述上市许可持有人制度出台背景及进展情况,比较现行药品委托生产与上市许可持有人制度下的药品委托生产,通过分析前者的现状及其不足之处,提出上市许可持有人制度下的委托生产中保证药品质量的一系列措施。结果与结论：除详细考察、加强沟通、在委托生产企业配备专职人员外,上市许可持有人还可通过质量源于设计、风险管理等多种手段结合,对委托生产过程进行一体化全面质量管理;设计全面质量体系模型来帮助双方订立详细质量协议。应充分发挥全面质量管理在上市许可持有人制度中的作用。     

药品上市许可持有人制度下药品上市后监管风险分析及监管对策研究

目的：为提升药品上市许可持有人制度下药品上市后监管的效能,本文提出了药品上市后各环节的监管对策,为完善我国药品上市许可持有人制度提供参考。方法：结合上海市试点情况,对药品上市许可持有人制度下药品上市后生产、流通、不良反应监测与评价各环节进行风险识别和风险分析,提出相应的监管策略。结果与结论：在药品上市许可持有人制度下,建议通过制定药品上市许可持有人信息上报制度,建立持有人基础数据库和药品信息追溯体系,在对持有人日常监管中从优化监管资源配置、明确日常监管检查重点、建立跨省监管合作的沟通和协调机制等方面,提升对药品上市后的监管效能。     

我国建立药品上市许可人制度的必要性与可行性分析——基于制度变迁均衡分析模型

目的:探讨我国是否有必要建立药品上市许可人(MAH)制度,及在我国实施该制度是否可行。方法:依托制度变迁理论中的均衡分析模型,分析MAH制度的潜在收益与需求及其建制过程中面临的成本与供给情况,并结合制度弹性进行分析。结果:国内强大的制度需求使建立MAH制度成为必要;政府供给MAH制度的阻力主要在于适应成本和脱序成本;若政府致力于降低这些制度成本,将同时催生更大的内部需求,由此强力推动我国有效实现由合并管理制度向MAH制度的变迁。结论:有必要在我国建立MAH制度,且现阶段允许在我国某些地区先行试点推行MAH制度。