Journal of Health Politics Policy and Law最新文献_第5页

Reduction in Medicaid Rebates Paid by Pharmaceutical Manufacturers for Outpatient Infused, Injected, Implanted, Inhaled, or Instilled Drugs: The 5i Loophole. 减少药品制造商为门诊病人注射、注射、植入、吸入或灌注药物支付的医疗补助回扣:第51个漏洞。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041219

Sean Dickson, Nico Gabriel, Walid Gellad, Inmaculada Hernandez

{"title":"Reduction in Medicaid Rebates Paid by Pharmaceutical Manufacturers for Outpatient Infused, Injected, Implanted, Inhaled, or Instilled Drugs: The 5i Loophole.","authors":"Sean Dickson, Nico Gabriel, Walid Gellad, Inmaculada Hernandez","doi":"10.1215/03616878-10041219","DOIUrl":"https://doi.org/10.1215/03616878-10041219","url":null,"abstract":"Context: When nonretail pharmacy sales exceed 70% of sales, manufacturers of infused, injected, implanted, inhaled, or instilled (5i) drugs are required to calculate average manufacturer price (AMP) under a different methodology than that used for drugs predominantly distributed through retail channels. Specifically, the modified methodology includes pharmacy benefit manager (PBM) rebates in the calculation of AMP for 5i drugs. The modified methodology reduces manufacturers' Medicaid rebate liability and increases net costs to the Medicaid program.Methods: The authors identified 15 5i drugs predominantly dispensed through the nonretail setting. Using 2013-2017 data from Medicaid, Medicare, SSR Health, and 340B program eligibility, they estimated differences in AMP, Medicaid rebates, and net Medicaid costs under both the standard and 5i AMP methodologies.Findings: AMP was 42% lower, on average, under the 5i methodology than under the standard methodology. From 2013-2017, Medicaid rebates under the 5i methodology were 82% lower than under the standard methodology, resulting in manufacturers of these 15 drugs reducing their Medicaid rebate liability by $1.1 billion in five years.Conclusions: Inclusion of PBM rebates in the calculation of AMP for 5i drugs significantly reduced Medicaid rebates, resulting in higher Medicaid spending. This may incentivize manufacturers to shift sales to nonretail channels. To remove this incentive, policy makers should consider excluding PBM rebates from the calculation of AMP for 5i drugs.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":"47 6","pages":"835-851"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

The Contribution of Price Growth to Pharmaceutical Revenue Growth in the United States: Evidence from Medicines Sold in Retail Pharmacies. 价格增长对美国药品收入增长的贡献：来自零售药店销售的药品的证据。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041079

Pragya Kakani, Michael Chernew, Amitabh Chandra

{"title":"The Contribution of Price Growth to Pharmaceutical Revenue Growth in the United States: Evidence from Medicines Sold in Retail Pharmacies.","authors":"Pragya Kakani, Michael Chernew, Amitabh Chandra","doi":"10.1215/03616878-10041079","DOIUrl":"10.1215/03616878-10041079","url":null,"abstract":"Context: To what extent does pharmaceutical revenue growth depend on new medicines versus increasing prices for existing medicines? Moreover, does using list prices, as is commonly done, instead of prices net of confidential rebates offered by manufacturers, which are harder to observe, change the relative importance of the sources of revenue growth?Methods: This study uses data from SSR Health LLC to address these research questions using decomposition methods that analyze list prices, prices net of rebates, and sales for branded pharmaceutical products sold primarily through retail pharmacies.Findings: From 2009 to 2019, retail pharmaceutical revenue growth was primarily driven by new products rather than by price increases on existing products. Failing to account for confidential rebates creates a more prominent role for price increases in explaining revenue growth, because list price inflation during this period was 10.9%, whereas net price inflation was 3.3%.Conclusions: Policies that restrict price growth on existing medicines likely need to be coupled with policies that reduce launch prices to have a meaningful long-term impact on pharmaceutical revenue growth. Using pharmaceutical list prices is often an inadequate approximation for net prices because the role of rebates has increased and varies by drug class.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":"47 6","pages":"629-648"},"PeriodicalIF":3.3,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Insulin Shocks. 胰岛素的冲击。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041149

Joseph White, Nicholas Corwin

引用次数: 0

Assessing US Pharmaceutical Policy and Pricing Reform Legislation in Light of European Price and Cost Control Strategies. 参照欧洲价格和成本控制策略评估美国药品政策和价格改革立法。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041163

Marc A Rodwin

{"title":"Assessing US Pharmaceutical Policy and Pricing Reform Legislation in Light of European Price and Cost Control Strategies.","authors":"Marc A Rodwin","doi":"10.1215/03616878-10041163","DOIUrl":"https://doi.org/10.1215/03616878-10041163","url":null,"abstract":"This article compares the pharmaceutical pricing policies employed by public and private insurers in the United States with seven price and spending control strategies employed in the United Kingdom, France, and Germany. Differences between American and European policies explain why American pharmaceutical prices and per capita spending are higher than in European nations. The article then analyzes two recent bills as examples of significant American reform ideas-H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act (introduced in 2019) and the Build Back Better Act (BBBA, introduced in 2021)-and compares them with European cost control strategies. Key drug price provisions of the BBBA were incorporated into the recently enacted Inflation Reduction Act (IRA). H.R. 3 would have used an international (mostly European) price index to cap U.S. prices; the BBBA would cap Medicare prices at a discount from average U.S. market prices. Neither bill would employ the key cost control strategies that European nations do. Both bills would have significantly less impact on prices than legislation that employs European-style cost controls. This article proposes steps that Congress could take in line with European strategies to lower purchase prices and costs for patients. These measures would have to overcome political obstacles that currently stymie reform.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":"47 6","pages":"755-778"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

The Price of Progress: Managing Prescription Drug Spending. 进步的代价:管理处方药支出。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041065

Stacie B Dusetzina, Jonathan Oberlander

引用次数: 0

International Reference Pricing in the Context of US Drug Policy. 美国药物政策背景下的国际参考定价。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041177

Richard Frank, Rena M Conti, Jonathan Gruber

引用次数: 1

Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress. 追求药物公平:决定因素、驱动因素和进步途径。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041135

Rohan Chalasani, Sudarshan Krishnamurthy, Katie J Suda, Terri V Newman, Scott W Delaney, Utibe R Essien

{"title":"Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress.","authors":"Rohan Chalasani, Sudarshan Krishnamurthy, Katie J Suda, Terri V Newman, Scott W Delaney, Utibe R Essien","doi":"10.1215/03616878-10041135","DOIUrl":"https://doi.org/10.1215/03616878-10041135","url":null,"abstract":"The United States pays more for medical care than any other nation in the world, including for prescription drugs. These costs are inequitably distributed, as individuals from underrepresented racial and ethnic groups in the United States experience the highest costs of care and unequal access to high-quality, evidence-based medication therapy. Pharmacoequity refers to equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions. Herein the authors describe the urgent need to prioritize pharmacoequity. This goal will require a bold and innovative examination of social policy, research infrastructure, patient and prescriber characteristics, as well as health policy determinants of inequitable medication access. In this article, the authors describe these determinants, identify drivers of ongoing inequities in prescription drug access, and provide a framework for the path toward achieving pharmacoequity.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":"47 6","pages":"709-729"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10451488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

Reforming the Medicare Part D Benefit Design: Financial Implications for Beneficiaries, Private Plans, Drug Manufacturers, and the Federal Government. 改革医疗保险D部分福利设计:对受益人、私人计划、药品制造商和联邦政府的财务影响。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041233

Erin Trish, Katrina M Kaiser, Jeanai Celestin, Geoffrey Joyce

{"title":"Reforming the Medicare Part D Benefit Design: Financial Implications for Beneficiaries, Private Plans, Drug Manufacturers, and the Federal Government.","authors":"Erin Trish, Katrina M Kaiser, Jeanai Celestin, Geoffrey Joyce","doi":"10.1215/03616878-10041233","DOIUrl":"https://doi.org/10.1215/03616878-10041233","url":null,"abstract":"Context: Reforming the Medicare Part D program-which provides prescription drug coverage to 49 million beneficiaries-has emerged as a key policy priority.Methods: The authors evaluate prescription drug claims from a 100% sample of Medicare Part D beneficiaries to evaluate the current spending distribution across different payers for different types of beneficiaries across different benefit phases. They then model how these estimates would change under a proposal to redesign the Medicare Part D standard benefit.Findings: Spending patterns differ for beneficiaries who do and do not qualify for low-income subsidies. Part D plans face limited liability for total spending under the current standard benefit design, amounting to 36% of total spending for beneficiaries who do not receive low-income subsidies and 28% of total spending for those who do. Proposed reforms would increase plan liability and significantly change the distribution of liability across plans, drug manufacturers, and the federal government.Conclusions: Though the original goal of the Part D program was to create a market of competing private plans that provide prescription drug coverage to Medicare beneficiaries, the standard benefit design that was included in the original legislation reflected significant political compromises. Reforming the standard benefit design to give plans more skin in the game could significantly affect competition in the market, with differential impact across drug classes and types of beneficiaries.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":"47 6","pages":"853-877"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Industry Payments to Physicians Are Kickbacks. How Should Stakeholders Respond? 行业向医生支付的费用属于回扣。利益相关者应如何应对？

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041205

Aaron Mitchell, Ameet Sarpatwari, Peter B Bach

{"title":"Industry Payments to Physicians Are Kickbacks. How Should Stakeholders Respond?","authors":"Aaron Mitchell, Ameet Sarpatwari, Peter B Bach","doi":"10.1215/03616878-10041205","DOIUrl":"10.1215/03616878-10041205","url":null,"abstract":"Payments from the pharmaceutical industry to US physicians are common. In determining which payments rise to the level of an illegal kickback under the Anti-Kickback Statute (AKS), the Department of Health and Human Services' Office of Inspector General (OIG) has stated in nonbinding guidance that influencing or \"swaying\" physician prescribing is key. OIG has highlighted as a compliance standard the Pharmaceutical Research and Manufacturers of America Code on Interactions with Health Professions, which stipulates that permissible payments are those that do not interfere with prescribing. However, recent evidence has shown that most payments influence physician prescribing, driving higher prescription drug costs by increasing use of brand-name and low-value drugs. This evidence implies that many payments that are currently commonplace could be subject to prosecution under AKS. Given that these payments increase costs to patients and the health care system, there is a public interest in curtailing them. This article proposes a range of actions available to stakeholders-including industry, providers, regulators, and payers-to mitigate the cost-increasing effect of industry payments to physicians.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":"47 6","pages":"815-833"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11107028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10451487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Trends in the Quality of Evidence Supporting FDA Drug Approvals: Results from a Literature Review. 支持FDA药物批准的证据质量趋势:来自文献综述的结果。

IF 4.2 3区医学

Journal of Health Politics Policy and Law Pub Date : 2022-12-01 DOI: 10.1215/03616878-10041093

Beatrice L Brown, Mayookha Mitra-Majumdar, Krysten Joyce, Murray Ross, Catherine Pham, Jonathan J Darrow, Jerry Avorn, Aaron S Kesselheim

{"title":"Trends in the Quality of Evidence Supporting FDA Drug Approvals: Results from a Literature Review.","authors":"Beatrice L Brown, Mayookha Mitra-Majumdar, Krysten Joyce, Murray Ross, Catherine Pham, Jonathan J Darrow, Jerry Avorn, Aaron S Kesselheim","doi":"10.1215/03616878-10041093","DOIUrl":"https://doi.org/10.1215/03616878-10041093","url":null,"abstract":"Context: New drug approvals in the United States must be supported by substantial evidence from \"adequate and well-controlled\" trials. The Food and Drug Administration (FDA) has flexibility in how it applies this standard.Methods: The authors conducted a systematic literature review of studies evaluating the design and outcomes of the key trials supporting new drug approvals in the United States. They extracted data on the trial characteristics, endpoint types, and expedited regulatory pathways.Findings: Among 48 publications eligible for inclusion, 30 covered trial characteristics, 23 covered surrogate measures, and 30 covered regulatory pathways. Trends point toward less frequent randomization, double-blinding, and active controls, with variation by drug type and indication. Surrogate measures are becoming more common but are not consistently well correlated with clinical outcomes. Drugs approved through expedited regulatory pathways often have less rigorous trial design characteristics.Conclusions: The characteristics of trials used to approve new drugs have evolved over the past two decades along with greater use of expedited regulatory pathways and changes in the nature of drugs being evaluated. While flexibility in regulatory standards is important, policy changes can emphasize high-quality data collection before or after FDA approval.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":"47 6","pages":"649-672"},"PeriodicalIF":4.2,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10817508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3