Unbiased Analysis of Today's Healthcare Issues
KFF reports on the increased use of copay accumulators: Oscar Health is one of many commercial health insurers that use what are often called copay accumulator programs to keep funds that are meant to defray patients’ out-of-pocket costs for expensive specialty drugs. Over the past decade, more insurers have adopted such strategies to reduce their prescription…
Many policymakers are looking for ways to reduce drug spending. Federal policymakers are not the only ones looking at the issue. In recent years, state Prescription Drug Affordability Boards (PDABs) have formed to reduce drug prices. A paper by Barthold et al. (2026) describes the what PDABs are: As of April 2025, 12 states had…
The answer is provided by FDA’s 2025 Drug Trials Snapshots Summary Report. The report covers 46 novel drug approvals and roughly 26,000 participants across pivotal trials, organized by therapeutic area rather than a single aggregate narrative. Half (23 out of 46) of these approvals were for the treatment of rare or orphan diseases (i.e., diseases…
Today I attended the very interesting ISPOR Health Policy Leadership Exchange (HPLE) in Washington DC on the topic of Most Favored Nation (MFN). There were a number of important points made and I’ll summarize a few of them. First, US drug prices are much higher than in other OECD countries. An ASPE report from 2024…
As online pharmacies have grown in prominence, the German government aim to pass legislation to increase the profits of brick-and-mortar pharmacies in order to keep more physical locations available to Germans. Did it move sales from online to brick-and-mortar pharmacies? Is the law likely to keep brick-and-mortar pharmacies in business? These are the questions asked…
The answer is provided by EFPIA’s annual WAIT indicator (press release, report). First, we see a large decrease in the share of pharmaceuticals fully availbity, drive by a small increase in reduced availability but a much larger increase in the number of drugs that only have a limited availability. Specifically, Historically full availability was the…
If you are a payer or a policymaker, should you except the results of a global clinical trial or require additional evidence that a drug works in your country. There are a few options to consider. Delay approval until local confirmatory trial. Approach enacted in several Asian countries (see Habr et al. 2024). While this…
Let’s say you’re the CEO of a health plan. A new drug just received approval to treat patients with lung cancer. The drug’s clinical trial examined how well the the drug worked on third line (3L) patients and patients with good funcional ability (e.g., performance status ECOG score of 0 or 1). FDA approved the…
Biosimilars aim to be lower cost options for biologic therapies after loss of exclusivity. A key question is whether these cost savings get passed through to patients via lower out-of-pocket costs. A paper by Dayer et al. (2026) aims to answer this question using 2011-2023 Merative MarketScan Commercial claims data. The authors observed: …significant patient…
That is the argument made by Ike Brannon and Anthony Lo Sasso in a recent Health Affairs Forefront article. 340B allows hospitals serving low income communities to purchase pharmaceuticals at discounted rates, but then receive full price reimbursement from payers (e.g., commercial insurers, Medicare). It is not clear that the 340B program even benefits low-income…