Prior authorization and opioid abuse

An interesting article by Cochran et al. (2017) examines whether health plan prior authorization rules can help prevent opioid abuse.  The authors use Pennsylvania Medicaid data from 2010 to 2012.  The data included both fee-for-service and managed care enrollees. The authors measured opioid abuse based on diagnosis codes for opioid use disorder (304.0, 304.00, 304.01,…

Predicting Real-World Effectiveness of Cancer Therapies Using OS and PFS Clinical Trials Endpoints

Clinical trials for cancer treatments aim to demonstrate whether one treatment is better than another. What is of most interest to patients, providers and payers, however, is which treatment works best in the real-world, not in a randomized controlled trial. Further, clinical trials often use progression free survival to measure treatment outcomes rather than overall…

“We are not going to let the fact there are not additional monies right now to prevent us from offering these additional services”

That is what Veterans Affairs Secretary David Shulkin said about his plan to expand urgent mental health care to thousands of veterans.  Specifically, the Shulkin plan would include mental health services for service members with less-than-honorable discharges. As reported in Modern Healthcare, Shulkin testified to Congress that of the 20 veterans who take their lives each day, about 14…

Value Tools in Managed Care Decision Making

Along with co-authors Jeremy Schafer and Dominic Galante, I have a new paper out in JMCP this month.  The abstract is below, but do read the whole piece here. BACKGROUND: Organizations such as the National Comprehensive Cancer Network, American Society of Clinical Oncology, Institute for Clinical and Economic Review, and Memorial Sloan Kettering have created…

Tackling Antimicrobial Resistance

O’Neill Commission has identified a number of recommendations to tackling drug-resistant infections. Seth Seabury and Neeraj Sood have their own thoughts on how to incentivize the development of antibiotics to fight antimicrobial resistance (AMR) which they describe in an interesting article in the Health Affairs blog. They write: The US patent system incentivizes innovation by…