Unbiased Analysis of Today's Healthcare Issues
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…
This is the question that a recent AJMCcommentary by William Shrank, Ellen Kelsay, and Mark Fendrick aims to answer. When talking about cell and gene therapies, the authors argue that cost sharing is not being used to avoid unnecessary use of low value care, but rather as a form of rationing that creates disparities in…
Proportion of days covered (PDC) is the most widely endorsed measure of medication adherence. For instance, the Centers for Medicare & Medicaid Services (CMS) uses PDC as its preferred adherence measure for its Quality Rating System for many chronic conditions (e.g., hypertension, diabetes, and hyperlipidemia). However, your PDC measure may be flawed depending on what…
It is not bringing down US prices, but delaying launches in Europe. Reuters reports: Drug launches in EU markets fell by some 35% in the 10 months since Trump’s executive order, compared with the previous 10 months…Delaying launches at lower EU prices could help secure higher U.S. prices for longer. You can read the full…
An NBER working paper by Barwick, Xia and Xia (2026) provides the answer: In 2010, China accounted for less than 8% of global clinical trials; by 2020, it had surpassed the US in annual registered clinical trial volume…We provide strong evidence that China’s rise was primarily driven by the National Reimbursement Drug List (NRDL) reform,…
Treating serious mental illness is not just a good thing to do for altruistic reasons. It also can improve health outcomes and reduce cost for those with comorbid physical conditions as well. Vincent Joralemon writes in Health Affairs Forefront regarding this issue. The article quotes Sherry Rais, CEO of Enthea: Ten percent of patients drive…
After years of legislative debate, Congress has formally codified PBM reform into federal statute. Tucked within the Consolidated Appropriations Act, 2026 (H.R. 7148), signed on February 3, 2026 are structural mandates that will reshape Pharmacy Benefit Manager (PBM) operations in Medicare Part D and the commercial sector by 2028. The legislation targets three primary pillars:…
In a recent report, the Association of the British Pharmaceutical Industry (ABPI) examines the UK’s “translational readiness gap”—the persistent failure to move cutting-edge laboratory models into the actual creation of medicines to treat patients. The Attrition Problem and the Translational Gap Modern drug development is a high risk endeavor. Approximately 90% of drug candidates that…