Unbiased Analysis of Today's Healthcare Issues
What price does Medicaid pay for drugs? The answer is, the “best price”. What is “best price?” The 1990 Omnibus Reconciliation Act (OBRA) codified that pharmaceutical manufacturers must give Medicaid steep discounts in order to receive coverage by state Medicaid agency. How big are the discounts? The answer is the larger of a fixed percentage of the…
A Health Affairs post by Dana Goldman and Darius Lakdawalla argues that dose-based pricing for pharmaceuticals is suboptimal. They make a clear distinction between typical goods, where cost and benefits are roughly proportional to quantity consumed, and pharmaceuticals. Buying two bunches of bananas naturally costs twice as much as one bunch. Twice as many bananas can…
Outcomes-based risk sharing agreements tie reimbursement for medical goods or services to patient outcomes. Despite the increasing demand from policymakers for value-based payment mechanism, risk-sharing agreements are not that comment. A paper by Garrison et al. (2015) found that there were only 148 risk sharing agreements (RSAs) worldwide between the late 1990s and 2013 and only 18 of the…
The National Institute for Health and Care Excellence (NICE) claims that although cost-effectiveness is highly valued in its health technology appraisal process, it sates that there are other factors considered relevant. However, no explicit weight is assigned to these other factors. Do they matter? A paper by Dakin et al. (2015) tries to answer this question by looking…
There is a belief that providing better care can reduce cost, at least somewhat. For instance, some claim that better primary care can avoid unnecessary hospitalizations. But can increased use of prescription drugs lead to decreased medical spending? This is exactly what a paper by Roebuck et al. (2015) find. They write: We found that a 1…
This is one of the goals of Appointment-based medication synchronization (ABMS). These systems vary in their implementation but they have three common features: All medications refills come due on the same day of the month. Pharmacies place regular call to remind the patient to fill their prescription, typically 5 to 7 days before the scheduled pharmacy visit…
The health care industry should take into account outcomes when weighing the cost of new treatments and technologies and make quality-adjusted life years (QALYs) part of the equation, say the authors of a study in the April issue of Health Affairs. This is the begining of an article in Managed Care Magazine that reviews a…
What is international reference pricing (IRP)? IRP is system whereby a country states that they will pay no more than the price paid by another country or a basket of countries. In theory, countries could also regulate drug prices by saying that they would not pay more than X% of country A’s price or X%…
Oftentimes, prescription pain killers are demonized. Opponents of painkiller are likely to cite statistics like this: The annual number of opioid painkiller prescriptions is now at more than 200 million. In hand with that, overdose deaths have shot up from over 4,000 in 1999 to more than 16,000 in 2013, according to data provided by…
Patients with schizophrenia often require medication—such as antipsychotics—to control the symptoms of their disease. However, adherence to these medications has been poor. Valenstein et al. (2004) estimate that 40% of patients are non-compliant with therapy [i.e., mediation possession ratio (MPR)<0.8]. Why are schizophrenia patients likely to be non-complient to antipsychotic therapy? One key reason is…