About: Katie Gudiksen, Senior Health Policy Researcher
Katie Gudiksen, Ph.D., is the Executive Editor for The Source on Healthcare Price and Competition. Dr. Gudiksen is an expert in healthcare reform and the drivers of healthcare costs, with a special interest in market consolidation and state policies to address market power. She has helped draft model legislation to improve state merger review processes and to prohibit anticompetitive terms in contracts between insurers and health systems. Her current work focuses on evaluating the options states have to restrict excessive provider prices, including cost-growth benchmarks and state public options.Innovations in State Medicaid Programs to Control Prescription Drug Costs
Katie Gudiksen, Senior Health Policy Researcher March 7, 2019
Medicaid serves nearly one in five Americans, including many with chronic conditions, and purchases about 10% of total prescription medications dispensed in the U.S.[1] From 2013 to 2016, Medicaid’s nationwide drug spending increased almost 50%, from $22.4 billion to $33.4 billion.[2] Medicaid programs consume an increasing percentage of state budgets and threaten to overtake funding for other programs like education and infrastructure.[3] In 2018, the National Association of State Budget Officers (NASBO) estimated that Medicaid accounted for nearly 30% of total state spending and is the fastest growing component of …
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Right-to-Shop Programs: Encouraging Patients to Shop for High-Value Health Care
Katie Gudiksen, Senior Health Policy Researcher February 11, 2019
With the share of Gross Domestic Product spent on health care reaching crisis levels,[1] experts on both sides of the political spectrum are demanding better value for the dollars spent on health care. Programs that give patients incentive to choose better value health care get widespread support from both political parties. In the past few years, many states considered enabling or implementing right-to-shop or savings reward programs, in which an insurer creates an incentive program that gives patients financial rewards for choosing providers with lower than average costs. How …
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Trump Administration Issues Proposed Rule to Dramatically Change Drug Rebates
Katie Gudiksen, Senior Health Policy Researcher February 4, 2019
On Thursday, January 31, 2019, the Trump Administration announced a proposed rule to eliminate rebates from drug manufacturers to pharmacy benefit managers (PBMs) in the Medicaid managed care and Medicare Part D programs. The proposed rule accomplishes this aim by removing safe-harbor protection[1] under the federal Anti-Kickback Statute (AKS)[2] for these rebates. In addition, the administration proposed new safe-harbor protections for rebates and other price reductions that will reduce the cost-sharing for patients when they purchase prescriptions and protect some flat PBM service fees (i.e. fees that are not tied …
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DMHC Releases First Annual Prescription Drug Cost Transparency Report
Katie Gudiksen, Senior Health Policy Researcher January 11, 2019
At the end of 2018, California’s Department of Managed Health Care (DMHC) released the first Prescription Drug Cost Transparency Report covering the cost of prescriptions in 2017. The legislature directed DMHC to write this report as part of the provisions of SB 17, which was passed by the legislature in 2017. For more information on SB-17, see The Source’s previous coverage when SB 17 passed, of regulations promulgated by DMHC, and of the lawsuit filed by PhRMA over the law. In this post, we review the report compiled by DMHC …
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Spotlight on 2018 State Drug Legislation Summary: The Year in Review
Katie Gudiksen, Senior Health Policy Researcher December 17, 2018
*Last Updated: February 4, 2019. In 2018, states showed an increasing eagerness to further regulate the pharmaceutical market with the goal of decreasing prices and increasing access to prescription drugs for their residents. This year, forty-four states considered 227 bills to address rising drug costs, of which 55 became laws in thirty-two states. Only two states with active legislative sessions, North Carolina and Alabama, did not consider legislation with the aim of reducing prescription drug costs or ensuring access to prescription.[1] In the first six parts of the “Spotlight on …
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Source Short: CVS Aetna Merger Not a Done Deal
Katie Gudiksen, Senior Health Policy Researcher December 13, 2018
In November 2018, The Source reported that CVS was finalizing its merger with Aetna after getting approval from the Justice Department. In the past two weeks, however, statements by Judge Richard Leon, a judge from the US District Court for the District of Columbia, have made that merger less certain. The approval from the Justice Department is conditional until approved by the courts. As a result, Judge Leon could rule to prevent the merger, but because the transaction already closed,[1] some legal experts have called untangling the companies akin to …
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CVS Health Finalizes Merger with Aetna
Katie Gudiksen, Senior Health Policy Researcher November 30, 2018
On November 28, 2018, CVS Health announced that it had completed its acquisition of the health insurer Aetna. The resulting entity will be a behemoth that includes the third largest health insurer,[1] the largest pharmacy benefit manager (PBM),[2] and the largest pharmacy in the country.[3] The combined, vertically integrated company will likely steer patients to use CVS pharmacies and encourage Aetna members to receive more of their routine care at CVS Minute Clinics. In addition, CVS and Aetna claim that, by merging, they can reduce drug prices by eliminating profits …
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Spotlight on 2018 State Drug Legislation: Part 6 – Pharmacy Benefit Manager Regulation
Katie Gudiksen, Senior Health Policy Researcher November 20, 2018
*Update: This post was written before the end of the 2018 legislative session. For the most recent count of states that passed these legislation, see the Spotlight on 2018 State Drug Legislation Summary: The Year in Review or download our Summary Chart. In the 2018 legislative session, ten states passed fourteen bills to regulate pharmacy benefit mangers (PBMs). In total, 27 states considered 49 bills to regulate PBMs (see map below). This number does not include bills that relate to PBMs only as to gag-clauses in contracts with pharmacists or …
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Spotlight on 2018 State Drug Legislation: Part 5 – Pricing Transparency Laws
Katie Gudiksen, Senior Health Policy Researcher October 10, 2018
*Update: This post was written before the end of the 2018 legislative session. For the most recent count of states that passed these legislation, see the Spotlight on 2018 State Drug Legislation Summary: The Year in Review or download our Summary Chart. Building on the momentum from 2017’s passage of two laws to increase transparency in drug prices, California’s SB 17 and Nevada’s SB 539, in 2018, 22 states considered and 5 states passed legislation to require more transparency of drug pricing (see map and tables below). While transparency laws …
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Revised Draft Regulations for California’s Drug Transparency Law (SB-17)
Katie Gudiksen, Senior Health Policy Researcher September 28, 2018
On September 17, California’s Office of Statewide Health Planning and Development (OSHPD) released a revised set of proposed regulations to implement the California Drug Transparency Law (SB-17) passed in 2017. SB-17 mandates when drug manufacturers must report information to purchasers and to OSHPD, specifically 60 days prior to increasing the price of a drug product more than 16%[1] and when releasing a new drug to the market with a price that exceeds the threshold of a specialty drug under Medicare.[2] (For more details on SB-17 and the lawsuit filed against …
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