Unbiased Analysis of Today's Healthcare Issues
New cell and gene therapies offer the promise of revolutionizing care for patients with genetic diseases. Many of these diseases impact kids and about a third of children in the US are insured by Medicaid or the Children’s Health Insurance Program (CHIP). The government faces a challenge: cell and gene therapies are potential breakthrough therapies…
A helpful reminder of what rebates are for drugs covered under State Medicaid Agencies. ICER reports in their California, based on a helpful summary from the Kaiser Family Foundation: For brand name drugs, the [Medicaid] rebate is 23.1% of Average Manufacturer Price (AMP) or the difference between AMP and “best price,” whichever is greater. Certain…
Gaining insurance through Medicaid is likely to have diverse impacts in terms of how likely disabled individuals are to work. On the one hand, having access to health care may improve health outcomes and better enabled disabled individuals to recover (if they are short-term disabled) or better manage their disability (if they are long-term disabled).…
Authorized generics (AGs) are generic drugs that–unlike independent generics–are sold by the brand-name drug manufacturer under a generic label. How big a role do these AGs play among Medicaid beneficiaries. A paper by Rome et al. (2023) aims to answer that using public Medicaid prescription use data between 2014 and 2020. Using these data, they…
Medicare covers largely elderly individuals, the disabled, and individuals with end stage kidney disease. Medicaid covers low-income individuals. So who are dual eligibles, that qualify for both programs? The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) put out a report last year providing a summary of the…
That is what various government bodies are considering. First lets turn to Medicaid via a report by Tyrus Jackson in JD Supra, The Medicaid and CHIP Payment and Access Commission (MACPAC) voted on January 27 to recommend that Congress grant states the ability to limit Medicaid coverage for drugs and biologicals approved under the FDA’s…
According to a recent paper by Wallace (2023), the answer is ‘yes’, but it does so in a highly inefficient manner. Using 2008-2012 Medicaid data from the New York State Department of Health, the author find that: Leveraging the random assignment of over 50,000 Medicaid enrollees in New York, I present causal evidence that narrower…
That is the question asked in a recent paper by Gollu et al. (2022). The study abstract is below: Although people who go through the prison and jail system in the United States have significant health care needs, many leave it with no health insurance and, as a result, they experience gaps in access to…
Are narrow networks a good thing or a bad thing? The first thing you need to know is what is a “narrow network”. Narrow networks is an informal terms which basically means that your health plan either places restrictions over the providers you are able to see and/or you certain providers that are out of…
Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…