Unbiased Analysis of Today's Healthcare Issues
Last fall, ICER published a white paper titled “Cornerstones of ‘Fair’ Drug Coverage: Appropriate Cost-Sharing and Utilization Management Policies for Pharmaceuticals.” To paraphrase, ICER’s goal is to limit access restrictions (e.g., cost sharing, coverage limitations, prescriber restrictions, step therapy) when a drug is deemed to be cost effective. How will they do this? Their Barriers…
In recent decades, drug prices have risen. To offset this cost, pharmacy benefit managers have negotiated increasingly large rebates which drug manufacturers pay health insurers. PBMs argue that rebates help keep net drug prices down. Manufacturers argue that PBMs want higher list prices so they can negotiate larger rebates. Patients may not like rebates if…
What outcomes should be used to measure if a medicine is a “good” medicine? Improved survival? Improved ability to function? Few side effects? Ability to get back to work? Living to attend your daughter’s wedding? All of the above? Oftentimes, health economists measure value of a treatment for the average person. Preferences for efficacy, safety,…
How do you get your prescription drugs? For most people, it involves going to your local pharmacy and picking up your pills. But what if the drugs you needs are infused treatments that have to be administered at a physician’s office? Typically, you just show up at a physician’s office and it’ll be ready for…
A decade of value-based payment. What caused him to resign from an expert panel. In case you missed it. Do physicians have an “ethical and legal duty” to reinterpret genetic test results? What to do when MCMC fails? Medicare drug price negotiations back on the table?
Healthcare Economist was named one of the top 30 health policy blogs on the web by Feedspot. In fact we came in at #4! The top 5 are: Bill of Health USC-Brookings Schaeffer Initiative for Health Policy The Health Care Blog (Health Policy) Healthcare Economist Health Populi. You can review the full list here.
Medicare Advantage has grown over time. In 2020, nearly four in ten (39%) of all Medicare beneficiaries – 24.1 million people out of 62.0 million Medicare beneficiaries overall – were enrolled in Medicare Advantage (MA) plans. With MA enrollment growing, a key question is who provides higher quality care: Medicare fee-for-service (FFS) or MA? Who…
In an article in Health Affairs, Rick van der Vegte and I argue that in four specific cases, the answer is yes. …the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) developed a “value flower,” which aims to more comprehensively capture all elements of value relevant for measuring the value of a new health technology.…
This is the question posed by a recent article by Lopata et al. (2021). The authors surveyed 26 payers (e.g., leaders of national, regional, local, Medicaid, and Medicare plans; payer components of integrated delivery systems; and pharmacy benefit managers (PBMs) and 11 employers (e.g., large employers, employee benefit consultants, employer coalitions). Respondents were informed that…
Physician compensation during the pandemic. Caring for an aging nation. The debt snowball. Infection rate among the unvaccinated is as high as it was back in January CMS all-in on mandatory pay-for-performance reimbursement. Patients minimize cost by reducing Q, not trying to minimize P.