Unbiased Analysis of Today's Healthcare Issues
A recent paper by Kacerek and Mattingly (2025) aims to answer why certain drugs are defined as “specialty” drugs and others are not. They first cite an Office of the Inspector General (OIG) report: The OIG found that there was no standard definition in Medicaid and that Medicaid programs used more than 100 different characteristics to…
A paper from Guadamuz et al. (2024) examines trends in pharmacy closures between 2010-2021. The authors use data from the National Council for Prescription Drug Programs (to describe US retail pharmacies), National Center for Health Statistics (to describe population characteristics at the county level) and the American Community Survey (to describe populations at the ZIP…
Managing multiple medications is a challenge for many individuals, particularly the elderly. One study by Almodóvar et al. (2019) found that among Medicare beneficiaries eligible for medication therapy management (MTM), 51% had used 11 or more medications. One approach to improving medication management is to use an appointment-based model (ABM) and other forms of medication…
A paper by Kogut (2024) has a nice overview of the organizations that develop pharmacy plan quality metrics. Pharmacy plan quality is vital since approximately 85% of the US population has prescription drug coverage through public (e.g., Medicare , Medicaid) or commercial (e.g., employer-provided) pharmacy plans. A helpful summary table is below. Quality measures are…
A helpful article from Mattingly et al. (2023) describes history, business practices, economics, and policy for pharmacy benefit managers (PBMs). Part of this article explains how PBMs make money. They claim there are three primary avenues. Rebate retention. Plan sponsors pays the list price of the drug net of rebates and discounts received. PBMs are…
That is the subtitle of an NBER working paper by Charles Gray, Abby E. Alpert & Neeraj Sood. The author examine recent mergers between pharmacy benefit managers (PBMs) and health insurers. On the one hand, integration may beneficial to consumers. It could: (i) improve operational efficiencies, and (ii) better align PBM incentives with those of…
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…
How do you get your prescription drugs? For most people, it involves going to your local pharmacy and picking up your pills. But what if the drugs you needs are infused treatments that have to be administered at a physician’s office? Typically, you just show up at a physician’s office and it’ll be ready for…
One reason for worse health outcomes for racial minorities could be reduced access to pharmacies. However, how big a problem is pharmacy access? A recent Health Affairs paper by Guadamuz et al. (2021) uses 2007-2015 data from the National Council for Prescription Drug Programs (NCPDP) to identify pharmacies, which were then geocoded and linked to…