Unbiased Analysis of Today's Healthcare Issues

Archive for the 'Pharmaceuticals' Category

What does “value” really mean?

An interesting article in Stat makes the important point that although there is much talk about “value” in the media and health policy world, the exact definition of “value” depends on your presepective. But a survey released Wednesday by the University of Utah shows that, in health care, value has no universal meaning — 88 percent of doctors […]

Read the rest of this entry »

Off-label prescribing

How frequently are pharmaceuticals used off label?  Perhaps more than you think.  Although these figures are a bit dated, Tabarrok (2000) details the extent of off-label prescribing in the U.S. as follows: According to a study by the U.S. General Accounting Office, 56 percent of cancer patients have been given non-FDA-approved prescriptions, and 33 percent […]

Read the rest of this entry »

How reimbursement affects innovation

Below are some excerpts from seminal papers examining how changes in reimbursement or market size affect pharmaceutical innovation. Acemoglu and Lin (2004): Our estimates suggest that a 1 percent increase in the size of the potential market for a drug category leads to a 6 percent increase in the total number of new drugs entering the […]

Read the rest of this entry »

Are PBM exclusion lists value-based?

Value-based insurance design (VBID) is a simple concept.  In short, interventions that provide high-value should be covered with little cost sharing; treatments with low-value should be covered with higher rates of cost sharing or in some cases perhaps not even covered at all. A paper by Cohen et al. (2017) aims to see how far […]

Read the rest of this entry »

IVI Model highlights ACR Conference

As reported in a Academy of Managed Care & Specialty Pharmacy newsletter, titled “Mathematical Model Aims to Improve Cost-Effectiveness of Rheumatology Treatment“, the Innovation and Value Initiative’s is highlighted from the American College of Rheumatology conference.  Here is an excerpt: Biological therapies for moderate to severe rheumatoid arthritis have significantly improved treatment and prognosis. However, […]

Read the rest of this entry »

Health plans getting into the PBM game

Bloomberg reports that Anthem is creating is own pharmacy benefits manager (PBM).  Why?  It says it wasn’t getting a good deal from PBMs. Health insurer Anthem Inc. plans to set up its own pharmacy benefits management unit, signaling a final break with Express Scripts Holding Co. after accusing it of overcharging by billions of dollars. […]

Read the rest of this entry »

Outcomes-based contracts: Where are we now?

“Value” is the latest trend in health care.  However, how does value get integrated into reimbursement?  One approach to tying value to prices is through and outcomes based contract (OBC) where the reimbursement for a drug will depend on the real world outcomes experienced by the relevant patient population. A study by Nazareth et al. […]

Read the rest of this entry »

What do drugs cost in the long run?

That is the question that Lakdawalla et al. (2017) attempt to answer in the latest edition of the American Journal of Managed Care (AJMC).  The long-run average cost (LAC) of a pharmaceutical includes not only initial branded drug price, but also subsequent prices increases and decreases, especially those that occur after a treatment’s patent has expired […]

Read the rest of this entry »

Off-label use of cancer drugs

When each drug is approved by the FDA, the drug is not approved to treat all patients.  Each drug receives an “indication” which basically represents the types of patients the drug can treat.  Giving the treatment to patients with said indication is known as “on label” prescribing. Drugs developed to treat one disease may sometimes […]

Read the rest of this entry »

Too many trials, not enough patients

As research in new cancer treatments has grown, scientists may have run into a serious roadblock: there many not be enough patients to fill the needed clinical trials.  As the New York Times reports: There are too many experimental cancer drugs in too many clinical trials, and not enough patients to test them on. The logjam […]

Read the rest of this entry »