How much does the U.S. federal government pay for pharmaceuticals?

A number of different federal agencies buy prescription drugs. However, the price at which these pharmaceuticals are purchased varies dramatically. To quantify this variation, a 2021 report from the Congressional Budget Office examines the following prices: Medicare Part D: the prescription drug program for Medicare beneficiaries. Prices are set when private insurers (or pharmacy benefit…

Dual Eligibles’ Medicaid Policy Database

Poor, elderly individuals who may qualify for both Medicaid (for being poor) and Medicare (for being elderly, blind, disabled or have ESRD). In these cases, Medicaid serves as a supplemental insurer, covering Medicare coinsurance and deductibles. The generosity of this supplemental coverage for so-called ‘dual-eligibles’ varies across states. These differences in Medicaid payments arise from…

CBO: Healthcare projected to consume increasing share of federal outlays in next decade

Every year, the Congressional Budget Office projects how the federal budget will look over the coming decade. For the coming decade, the numbers look grim. Federal deficits in CBO’s baseline average $1.2 trillion per year and total $11.6 trillion over the 2020– 2029 period…Those deficits would average 4.4 percent of gross domestic product (GDP). Other…

Potential CMS changes to Medicare formulary design

Today at the Academy of Managed Care Pharmacy (AMCP) 2019 Annual Conference, I attended a session titled “Medicare Formulary Updates Impact. How will proposed recent rulemaking affect formulary design? Some answers are below. CMS 2020 draft call letter Improved access to opioid reversal agents. The CMS 2020 draft call letter would place opioid reversal agents…