Trends in Obamacare plans: 2019 edition

The Robert Wood Johnson Foundation conducted case study interviews of health insurance exchange marketplace (i.e., Obamacare marketplaces) in 10 states (i.e., California, Florida, Georgia, Indiana, Maryland, Minnesota, Ohio, Virginia, Washington, and West Virginia) to determine trends in the available plans. One general trend was that large commercial insurers were leaving the marketplace. Marketplace participation is…

Payer coverage of FDA-approved drugs

Many people think that once a treatment is approved, your insurance automatically covers the treatment.  However, that is no longer the case.  Some health plans may keep certain drugs off of formularies.  Others health plans have drugs on formulary but may require step edits (failing another drug first before moving to the novel treatment) and…

Can single payer systems work?

Much of the discussions of the pros and cons of single payer systems are ideological.  Single payer advocates will say they are fair, potentially can leverage economies of scale, and more equitable.  Single payer opponents will argue that they are inefficient, and restrict choice. An interesting paper from Tomoki Fuji (2018), shows that the answer…

Estimating the price elasticity of demand through value-based formulary designs

In 2010, Premera Blue Cross (Premera), a large nonprofit health plan in the Pacific Northwest implemented a value-based formulary design for its beneficiaries.   In essence, enrollees could purchase high-value treatments for low copayments and low-value treatments for higher copayments.  Can we use this change from more standard to value-base formulary designs to estimate the price elasticity…