Unbiased Analysis of Today's Healthcare Issues
Last month, ICER released their 2023 “Assessment of Barriers to Fair Access” . The report concludes the following regarding 18 drugs evaluated. ICER defines “fair access” based on the following criteria: Cost sharing Cost sharing based on net price. Patient cost sharing should be based on the net price to the plan sponsor, not the…
Now that 51% of Medicare beneficiaries are enrolled in Medicare Advantage (MA), one key question is how restrictive are MA narrow networks? While beneficiaries enrolled in Medicare fee-for-service can choose any provider, MA plans can impose restrictions on enrollee’s provider choices. Measuring how restrictive an MA plan is, however, is difficult because “restrictiveness” is a…
According to a recent paper by Doshi et al. (2023), the answer is ‘yes‘! Why do people think otherwise? Many people are concerned that there may not be a sustainable way for the private group insurance market, particularly in small self-insured firms, to cover gene therapies? If a firm—particularly a smaller, self-insured firm—gets one or…
That is the news according to a report in Healthcare Dive. Blue Shield of California…will drop CVS Caremark as the sole manager of its pharmacy benefits. In Caremark’s place, Blue Shield of California will contract out the job to five separate companies…Blue Shield of California, or BSCA, expects to save $500 million a year from…
If you guessed manufacturers, you would be incorrect. At least that is according to a new study by Mattingly et al. (2023) in JAMA Health Forum. Using a sample of the 45 generic drugs with >$100m in Part D and used by >1m beneficiaries, the authors found that: …Medicare Part D spent $11.8 billion for…
Form Kaiser Health News: That’s why desperate patients like Nix — and even some physicians — say they have turned to publicly shaming insurance companies on social media to get tests, drugs, and treatments approved.“Unfortunately, this has become a routine practice for us to resort to if we don’t get any headway,” said Shehzad Saeed,…
Copay cards are somewhat controversial. These cards or coupons are used to help patients afford copayments and deductible payments patients owe when using pharmaceuticals. On the one hand, these programs are highly beneficial for patients. Patient out-of-pocket costs have risen dramatically in recent years, even among the insured. For instance, whereas only 7% of workers…
What is the impact of being insured on health outcomes? This is a difficult question to answer in part because of adverse selection (e.g., sicker patients may choose to be insured). But even absent adverse selection, the ability to diagnosis a disease may vary between the insurer and uninsured. Consider this example from Kaliski (2023):…
That is the title from a recent N.Y. Times article. Here is an excerpt: There’s a general sense that all that unpaid labor required to get medical care is increasing. This is in part because as health costs spiral upward, health plans have tried to find incentives to steer treatment to reduce costs. These incentives…
From Einav and Finkelstein (2023): …while 12.5% of individuals under 65 are uninsured at a point in time, twice as many—one in four—are uninsured at some point over a 2-y period. Moreover, the risk of losing insurance remained virtually unchanged with the introduction of the landmark ACA. Risk of insurance loss is particularly high for…