The end of Medicaid work requirements?

Last week, a federal judge blocked Arkansas and Kentucky from requiring individuals to work in order to receive Medicaid benefits. Prior to that decision, 9 states had been approved to implement Medicaid work requirements. At first glance, a work requirement does not make a lot of sense. If you are very sick and on Medicaid,…

Potential CMS changes to Medicare formulary design

Today at the Academy of Managed Care Pharmacy (AMCP) 2019 Annual Conference, I attended a session titled “Medicare Formulary Updates Impact. How will proposed recent rulemaking affect formulary design? Some answers are below. CMS 2020 draft call letter Improved access to opioid reversal agents. The CMS 2020 draft call letter would place opioid reversal agents…

How easy is it for ICER to predict budget impact?

The answer–according to a recent study by Thornton Snider et al. (2019)–is not that easy. Using case studies of ICER report’s predictions of unmanaged uptake of new medications before 2016, the paper estimates how well these reports predict price, uptake, and overall spending. The authors find: ICER’s uptake estimates exceeded real-world estimates by factors ranging…

Medicaid expansion and prescription drug use

How did Medicaid expansion affect prescription drug use? At first glance, one would think that prescriptions increased; more insurance lowers patient out-of-pocket cost so we would expect more prescriptions. Medicaid insurance may crowd out other forms of insurance; if those other forms of insurance covered more drugs, then perhaps utilization would go down. A study…