Unbiased Analysis of Today's Healthcare Issues
Public reporting of hospital quality of care could improve the care patients receive through at least two pathways. First, patients (or their physicians) could send patients to higher quality hospitals (i.e., the selection pathway). Alternatively, hospitals themselves could have behavioral responses to the metrics and may improve quality of care in response to public reporting…
Gaining insurance through Medicaid is likely to have diverse impacts in terms of how likely disabled individuals are to work. On the one hand, having access to health care may improve health outcomes and better enabled disabled individuals to recover (if they are short-term disabled) or better manage their disability (if they are long-term disabled).…
That is the summary takeaway I had form reviewing the 91 page CMS guidance on the Inflation Reduction Act (IRA) maximum fair price (MFP) negotiation released about 10 days ago. Below, I summarize some of the key findings. SELECTING DRUG FOR PRICE NEGOTIATION Unsurprisingly, CMS is looking for the highest cost drugs among the 10…
Authorized generics (AGs) are generic drugs that–unlike independent generics–are sold by the brand-name drug manufacturer under a generic label. How big a role do these AGs play among Medicaid beneficiaries. A paper by Rome et al. (2023) aims to answer that using public Medicaid prescription use data between 2014 and 2020. Using these data, they…
A Health Affiairs Forefront article by DiGiorgio (2023) argues the 340B has outlived its purposes. He writes: By mandating that drug companies give a large discount to covered entities, the majority of which are hospitals with disproportionate share or critical access designations, the 340B program was intended to provide a financial buffer for institutions such as the…
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 covers largely elderly individuals, the disabled, and individuals with end stage kidney disease. Medicaid covers low-income individuals. So who are dual eligibles, that qualify for both programs? The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) put out a report last year providing a summary of the…
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…
That is what various government bodies are considering. First lets turn to Medicaid via a report by Tyrus Jackson in JD Supra, The Medicaid and CHIP Payment and Access Commission (MACPAC) voted on January 27 to recommend that Congress grant states the ability to limit Medicaid coverage for drugs and biologicals approved under the FDA’s…
According to a recent paper by Wallace (2023), the answer is ‘yes’, but it does so in a highly inefficient manner. Using 2008-2012 Medicaid data from the New York State Department of Health, the author find that: Leveraging the random assignment of over 50,000 Medicaid enrollees in New York, I present causal evidence that narrower…