Unbiased Analysis of Today's Healthcare Issues
How does formulary restrictions impact health outcomes for patients with multiple sclerosis (MS)? To answer this question, Blaylock, Van Nuys and Joyce (2025) use data 100% Medicare claims data from 2018-2022 covering patients with both prescription drug plans (PDPs) and Medicare Advantage Prescription Drug plans (MA-PDs). Individuals were categorized as above vs. below average formulary…
Does Medicare Part B increase or decrease the prices of physician-administered drugs relative to physician-administered drugs covered by private insurance? That is the question a paper by Acquatella, Ericson and Starc (2023) aim to answer. Before we answer that question, we first need to understand how Part B works, how physicians are reimbursed, and how…
According to a recent Health Affairs Perspective from Michael Chernew, the answer is ‘no’. In fact, physician and hospital prices may be too low. Although much has been made of high prices contributing to high spending in the US, 5 spending growth in Medicare is not driven by price growth. In fact, inflation-adjusted Medicare physician…
There were lots of very interesting sessions at ISPOR 2025 in Montreal. One of my favorites that I was able to attend was titled “Medicare Price Negotiation of Part B Drugs: Implications for Provider Reimbursement and Commercial Spillover“. The session was moderated by Sean Sullivan of University of Washington, with Kristi Martin from the Centers…
How does a hospital’s participation in a health plan’s Medicare Advantage (MA) provider network impact their commercial rates? Since many insurers offer both MA plans and commercial plans, there could be spillovers with respect to negotiating. How would MA network participation impact commercial rates? Marr et al. (2025) offers some hypotheses: On the one hand,…
The answer is ‘yes’ according to a paper by Borrelli et al. (2025). The authors use annual Medicare Star Rating health plan performance for Medicare Advantage-Part D (MAPD) plans over the past decade (2015 to 2024). They find that: For plans achieving at least 4 stars on the medication adherence measures, 70%-74% of them also…
How did Medicaid expansion under the Affordable Care Act impact health insurance coverage, cost and mental health? That is the question asked by Andreyeva, Rochford and Marthey (2025). They use 2011-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine outcomes for Americans aged 26–54 with at least one child living in the…
One reason are the administrative obstacles and frictions that eligible individuals have to overcome to receive the public services. A paper by Herd and Moynihan (2025) in the Journal of Economic Perspectives provides an overview of the literature. Such burdens are the experience of policy implementation as onerous, and arise via learning costs (knowing about…
In a statement today, CMS confirmed that Elon Musk and the Department of Government Efficiency (DOGE) has been given access to CMS payment systems: CMS has two senior Agency veterans – one focused on policy and one focused on operations – who are leading the collaboration with DOGE, including ensuring appropriate access to CMS systems…
Chuanzi Yue and Marisa Miraldo argue in a recent Health Affairs Forefront piece that the answer is ‘yes’, but I am highly skeptical of their claim. Will IRA cause firms to allocate funds from marketing to R&D? One point they make is that the IRA’s Medicare Drug Price Negotiation program will reduce pharmaceutical expenses on…