Unbiased Analysis of Today's Healthcare Issues
Prior authorization is a pain. A paper by Howell et al. (2021) found that the total cost of various utilization management schemes is $93.3 billion of which physicians devote $26.7 billion worth of time to navigate utilization management systems. Payers would argue that prior authorization helps to control costs and stop the prescribing of unnecessary…
While many patients and physicians feel that it is increasingly difficult to get insurance to cover new treatments, a JAMA Viewpoint (Resneck 2020) demonstrates this trend numerically. Prior authorization requirements increased from 8% to approximately 24% of covered drugs on Medicare Part D plans between 2007 and 2019.1 In 4 therapeutic classes (including antidepressants, autoimmune disease…
COVID-19 vaccines have had a huge beneficial impact on patient health. One study found that between December 2020 and June 2021, COVID-19 vaccines saved 240,000 lives (Vilches et al. 2022). The figure below shows that as the Delta and Omicron variants spread in the fall of 2021, COVID-19 vaccines prevented significant number of deaths according…
That is part due to the squeeze on generic drug pricing from group purchasing organizations and others. This 60 Minutes report is interesting.
Perhaps the answer is yes, if we want to have a more resilient supply chain. At least that is the argument from a commentary by Mattingly and Conti (2022): Several medications that patients need have been in short supply before and during the COVID-19 pandemic, including low-priced, off-patent generic drugs. The White House recently released…
In recent years, the US government has had a number of proposals which aim to lower drug prices by linking US drug prices to the prices in other developed countries. This process is known as international reference pricing (IRP). A paper by Sullivan et al. (2022) explains: Federal legislative proposals to address global pricing differences…
Last month, ICER updated their protocol for identifying drugs that have unsupported price increases (UPI). Not only is ICER examining rising drug prices, but California and Vermont now have laws tracking substantial drug price increases, requiring drug manufacturers to submit information that might justify increases above a certain threshold. ICER says that the UPI reports…
When new drugs are approved, FDA limits their on-label use to the treatment of specific diseases. A key question is whether the definition of a disease should be narrower or broader. Make the disease definition too broad, then there may not be strong evidence from the clinical trial to support its use among these types…
Medicare Part D plans have begun using preferred pharmacy networks in order to steer their beneficiaries to lower cost pharmacies. A key question is, does this work? A paper by Xu et al. (2022) aims to answer this question using 2011-2016 data. that compares Low Income Subsidy (LIS) Medicare beneficiaries and non-LIS beneficiaries. LIS beneficiaries…
The Public Health Service Act (PHSA) in 1992, created a program to allow hospitals providing care for underserved communities to be able to access discounted drugs. The program–known as the 340B Drug Pricing Program, has been described as follows: …[The] law requires pharmaceutical manufacturers participating in the Medicaid program to enter into a second agreement…