Unbiased Analysis of Today's Healthcare Issues
When you buy a car, there is the sticker price and what you actually paid after haggling with the dealer over discounts. For pharmaceuticals, the media typically reports on list prices which are analogous to the “sticker price” for cars. However, what really matters is the net price, which is the price after discounts and…
Medicare Part D has had a very odd benefit structure. First, you have a deductible with no coverage; then you get some coverage, then there is a coverage gap or “donut hole” with no coverage and finally there is very generous coverage in the ‘catastrophic phase’. This structure was espeically problematic for patients with high…
In the past, seniors in Medicare had to pay for all their prescription drugs out-of-pocket. For elderly individuals with multiple medical conditions, this lack of coverage was highly burdensome. To address this issue, in 2006, Medicare Part D began which provided some coverage for prescription drugs. To keep the cost of Part D down, however,…
That is the question that a recent study by Tisdale et al. (2021) aim to answer. They first look at the top 250 Medicare Part D drugs in terms 2016 total spending based on the 2016 Medicare Part D Prescriber Public Use File. Drug characteristics were identified from the 2016 FDA Orange Book. The authors…
Medicare Part D covers prescription drugs for largely elderly Americans in the U.S. Those who qualify for both Medicare and Medicaid receive Part D drug coverage with no premiums and reduced copayments through the low-income subsidy program (LIS). Although federal and state government pays for about 6 out of every 7 dollars of the Part…
If you have multiple sclerosis, effective disease modifying therapies (DMTs), can help to reduce relapse rates and slow disease progression. That is, if you can get access to them. A paper by Hartung et al. (2019) found the following when examining 2007-2016 Prescription Drug Plan Formulary files concerning DMT coverage among Part D plans: Among…
Why do Medicare patients choose to stay in their current Part D prescription drug plan or switch to another? Are they rational actors maximizing their their financial benefit or do other factors play a role. A paper by Kate Ho and co-authors (NBER WP version) presented at the 2016 ASSA meetings find the switch rates…
Yesterday, I mentioned that low-income individuals on Medicare can also qualify for Medicaid and, as full-beneift dual eligible beneficiaries, they have significantly lower cost sharing than the typical Part D beneficiary. How does CMS identify these individuals? For currently beneficiaries on Medicaid who ‘age’ into Medicare, this process is fairly easy. CMS can auto-enroll these…
Health insurers face a conundrum. Increased cost sharing helps to reduce patient utilization of medical resources and–at least inititally–lowers the cost of care. Too much cost sharing, however, can lead to decreased patient adherence. In this case, the patients may get sick and require hospitalization, which will actually increase cost. Cost sharing’s affect on adherence…
I will continue reviewing some Medicare reimbursement information as described in a variety of MedPAC reports. Medicare Advantage Medicare Advantage is a program where Medicare beneficiaries can receive private heath insurance, partially or fully funded by CMS. The health insurance must provide coverage at least as generous as Medicare Parts A and B. Private health…