Links
Rise in reported US maternal mortality rates largely due to change in measurement ChatGPT 4o and Khan Academy. FDA clinical trial snapshots: 2023. Do some Medicaid beneficiaries even know they are insured? Do PBMs reduce prices?
Month: May 2024
Risk compensation after COVID-19 vaccination
Could COVID-19 be more efficacious than effective? This could be the case if individuals receiving COVID-19 engaged in ‘risk compensation’. In short, without a COVID-19 vaccine, individuals may have refrained from travel and engaged in social distancing. After a COVID-19 vaccine, these same individuals could have been more likely to travel and less likely to…
CMS Guidance on IRA Price Negotiation: Part 3
See my previous posts on IRA price negotiation on drug selection (Part 1) and manufacturer data submission (Part 2). Today we will talk about the negotiation process and how CMS will set the maximum fair price (MFP) How will CMS price across dosages? “CMS will base the single price on the cost of the selected…
CMS Guidance on IRA Price Negotiation: Part 2
What data do drug manufacturers need to submit to CMS as part of the IRA price negotiation? What data elements can they electively submit? The recent CMS guidance released May 3, 2024 outlines these elements. What mandatory data are manufacturers required to submit? On the mandatory side, drug manufacturers are required to provide CMS with…
CMS Guidance on IRA Price Negotiation: Part 1
CMS released guidance on IRA price negotiation last week. Below are some highlights regarding how drugs will be selected. Which drugs are eligible for negotiation? For small molecules, drugs have to be (i) FDA-approved, (ii) be FDA-approved at least 7 years ago, and (iii) have no generic equivalent on the market. For biologic molecules, drugs…
The world is relying on the United States to get value-based drug pricing right
That is the title of my article with Melanie Whittington and Louis Garrison in STAT News. An excerpt is below: The changing landscape of drug pricing policy in the U.S. has implications for the global pace and direction of innovation. Drug policy changes are being influenced by perceptions of the value of novel medicines relative…
Risk Adjustment and Incentives for Upcoding in Medicare
To account for differences in disease burden across a Medicare Advantage (MA) plans patient population, uses risk adjustment based on patient disease burden. Specifically, MedPAC notes that: Medicare uses beneficiaries’ characteristics, such as age and prior health conditions, and a risk-adjustment model—the CMS hierarchical condition categories (CMS– HCCs)—to develop a measure of their expected relative…
Friday Links
ISPOR is next week…IRA is a hot topic. Spending on AI vs. the Manhattan Project. Competition and dating apps. Coverage of UnitedHealth cyberattack Good news Friday.
Impact of Medicare Advantage on skilled nursing facility profitability
How does Medicare Advantage market share impact skilled nursing facility (SNF) profitability? That is the question asked by Marr and Shen (2024). Using data from Medicare SNF cost reports, LTCFocus.org data, and county MA penetration rates, the authors use an ordinary least squares regression with SNF and year fixed effects examining how MA penetration impacts…
Bryan Perry joins FTI’s Center for Healthcare Economics and Policy
In some exciting news, Bryan Perry has joined FTI Consulting’s Center for Healthcare Economics and Policy. Below is an excerpt from the press release. Washington, D.C., May 1, 2024 — FTI Consulting, Inc. (NYSE: FCN) today announced the appointment of economics and litigation expert Bryan Perry as a Senior Managing Director in the Center for Healthcare Economics and Policy…