Unbiased Analysis of Today's Healthcare Issues
Do Medicare Advantage enrollees like plans with more prior authorization? On the one han, one would think the answer is a clear ‘no’. However, higher levels of prior authorization could result in lower premiums, a tradeoff many enrollees may prefer. A paper by Marr, Trivedi and Meyers (2026) aims to answer the question using beneficiary…
A paper by Mark Shepard and Jacob Wallace (2026) has a great overview of the Medicaid managed care program. The first question one may have is, how does Medicaid managed care differ from other forms of government procurement. “In standard public procurement—such as contracting for infrastructure projects—the government specifies desired services, solicits bids, selects winners,…
ICER found GLP-1 drugs to be cost effective for treating obesity. If that is the case, why don’t more US payers cover the GLP-1 drugs? Clearly, one reason is the cost given the sheer volume of patients i nthe US that are obese; specifically, >40% of US adults are obese. However, a bigger issue may…
How can we characterize the epidemiology and health care resource utilization of Americans with schizophrenia? This is the question a new paper in JMCP by Parks et al. (2026) aims to answer among patients enrolled in Medicaid. The authors use Transformed Medicaid Statistical Information System (MSIS) Analytic Files from 2016 to 2022 and find that:…
The number of hospitals owned by private equity (PE) firms has increased in recent years. One key question is how increased PE ownership has impact quality of care. To answer the question, a Jiao 2025 Health Services Research paper used claims Medicaid claims data–specifically data from the Transformed Medicaid Statistical Information System (T-MSIS) and Medicaid…
Medicare Drug Price Negotiation aims to reduce the prices paid for high cost pharmaceuticals. Traditionally, biologic drug price reductions after loss of exclusivity (LOE) have occurred due to the introduction of biosimilar competitors. A recent paper by Beinfeld et al. 2025 examines whether Medicare Drug Price Negotiation enacted under the Inflation Reduction Act (IRA) is…
The Trump administration has introduced three most-favored-nation (MFN) drug pricing initiatives designed to link U.S. pharmaceutical costs to prices paid in economically comparable countries. Most-favored-nation pricing requires manufacturers to provide rebates when U.S. prices exceed those in reference nations—a direct response to the persistent gap between U.S. drug prices and those in other developed economies.…
Rural Emergency Hospitals (REHs) are a new Medicare provider type created to preserve essential emergency and outpatient access in rural communities where low inpatient volume makes full-service hospitals financially unsustainable. They receive enhanced outpatient payments and a fixed monthly facility payment in exchange for forgoing acute inpatient care. CMS has an REH fact sheet that…
That is the question asked in a recent Health Affairs Forefront article by Peter Neumann, Josh Cohen, Sean Sullivan and Feng Xie. They compare the CMS negotiated prices for Initial Price Applicability Year (IPAY) 2027 against value-based prices (using QALYs) from the Tufts Cost-Effectiveness Analysis (CEA) Registry. The authors found that cost-effectiveness estimates varied among…
Today, the Centers for Medicare and Medicaid Services (CMS) released the results from the Medicare Drug Price Negotiation Program for Initial Price Applicability Year (IPAY) 2027 (press release). What was the average reduction in drug prices? Across the 15 drugs included in the 2027 negotiation, on average, drug prices fell by 62% (median: 63%); accounting…