The rise of prior authorization

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…

Are generic drug prices too low?

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…

ICER’s updated process for determining unsupported price increases (UPI)

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…

Preferred Pharmacies in Medicare Part D

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…

340B Court Cases

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…