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…

Pharmacists as health care providers

Pharmacists are often seen as individuals who just dispense drugs.  However, pharmacists are increasingly considered as providers that are part of the broader health care team. My own research has shown that pharmacists are a more cost-effective and safe approach to getting vaccinations compared to primary care providers (see Fontanesi et al. 2009).  A Health Affairs Entry…

Competition matters

While the high price of branded drugs often gets a lot of attention in the public, few realize that after patent expiration, prices often plunge dramatically and high quality treatments are available for extremely affordable prices.  Granlund and Bergman (2018) estimate the size of this price reduction using data from Sweden. In the long term,…

Healthcare Economist on President Trump’s plan to lower Medicare drug prices

A recent report from Assistant Secretary for Planning and Evaluation (ASPE) found that for about 30 physician administered drugs, prices are 8 times as high as those charged in other developed countries. To address the high prices, President Trump unveiled a three-part plan to reduce drug prices.  Under the “international pricing index” proposal, U.S. drug…

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…

Does physician knowledge of patient non-compliance change prescribing behavior in the real world?

This is the topic of a recent publication with co-authors Kata Bognar, Katie Everson, Michelle Brauer, Darius Lakdawalla and Felicia Forma.  The full title is Does knowledge of patient non-compliance change prescribing behavior in the real world? A claims-based analysis of patients with serious mental illness.  The abstract is below, but do read the whole thing…