HEALTHCARE SYSTEM REFORM
Update on Massachusetts’ Waiver Request to use a Drug Formulary for Medicaid
Katie Gudiksen, Senior Health Policy Researcher July 9, 2018
On June 27, 2018, the Centers for Medicaid and Medicare Services (CMS) denied Massachusetts’ request to implement a closed drug formulary in its Medicaid program. In a previous post, the Source described the request and explained why it has the potential to save the state millions of dollars every year. In denying the request, CMS said that it would consider the waiver if Massachusetts no longer used the federal Medicaid Drug Rebate Program in which manufacturers give the state rebates when the state purchases a drug to ensure that Medicaid …
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The Source Roundup: July 2018 Edition
Source Fellow July 2, 2018
By: Megan O’Leary, Student Fellow Happy July! In this edition of the Source Roundup, we cover six academic articles and reports from May and June. The topics this month include: (1) the drug rebate system, (2) provider-payer integration as model for healthcare reform, (3) anticompetitive behaviors that delay generic drug competition, (4) short-term insurance plan expansion increases 2019 ACA marketplace premiums, and (5) competition concerns of healthcare consolidation. The Drug Rebate System is Not the Villain in Rising Health Care Costs There are plenty of reasons health care price …
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California Legislative Beat: Transformative Healthcare Bills of 2018 (Pt. 1)
Sammy Chang, Health Policy Researcher June 21, 2018
Year two of California’s 2017-2018 legislative session has been an active one. As lawmakers work diligently, The Source will take a brief look at some 2018 bills that can potentially change the California healthcare landscape. SB 1021: This bill removes the sunset provision for AB 339 (2015), which was enacted to cap cost sharing for a covered outpatient prescription drug at $250/$500 per 30-day supply.[1] Furthermore, the bill codifies the regulation that “prohibits an enrollee or insured from being charged more than the retail price for a prescription drug …
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The Source Roundup: June 2018 Edition
Source Fellow June 1, 2018
By: Megan O’Leary, Student Fellow Happy June! In this edition of the Source Roundup, we cover five academic articles and reports from April and May. The topics this month include: 1) barriers for generics to lower specialty drug prices, 2) a call to reform pharmaceutical systems in the United States and Canada, 3) efforts by states to stabilize the individual market, 4) Vermont’s push for community-driven health care reform, and 5) antitrust lawsuits in the pharmaceutical industry. Barriers for Generics to Lower Specialty Drug Prices The Health Affairs article Generic …
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Will Putting “American Patients First” Result in Lower Drug Prices?
Katie Gudiksen, Senior Health Policy Researcher May 30, 2018
On May 11, 2018, the Trump Administration released American Patients First, a blueprint to lower drug costs (the blueprint). The report details four challenges with the prescription drug market, including high list prices for drugs, high and rising out-of-pocket costs for patients, government programs that overpay for drugs due to the lack of negotiation tools, and foreign governments “free-riding” off of American investment in innovation. To address these challenges, the report also lays out four key strategies for reform, including a list of more than fifty recommendations with both immediate and …
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State Medicaid Programs are a Tool to Address Rising Drug Costs
Katie Gudiksen, Senior Health Policy Researcher May 8, 2018
Rising prescription drug prices concern nearly all Americans, with 80% reporting that drug prices are “unreasonable”. The problem of rising drug expenditures is particularly acute for state Medicaid programs, which provide health coverage for low-income and disabled Americans. 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] Furthermore, Medicaid’s nationwide drug spending increased almost 50% between 2013 and 2016 (from $22.4 billion to $33.4 billion).[2] In a survey of Medicaid programs, 36 states reported increased cost containment efforts for prescription drugs …
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The Source Roundup: May 2018 Edition
Amy Y. Gu, Managing Editor May 1, 2018
Happy May! In this edition of the Source Roundup, we cover four academic articles and reports from March and April. The topics this month include: 1) the unfilled promise of price transparency to encourage price shopping, 2) FDA’s actions on prescription drug prices, 3) the phenomenon of overpayment for prescription drugs, and 4) results of Maryland’s All-Payer global hospital budgeting program. Unfulfilled Promise of Price Transparency to Encourage Price ShoppingIn Promise and Reality of Price Transparency, a health policy report published by the New England Journal of Medicine, authors Ateev Mehrotra, Michael …
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Rate Setting for Health Services: A “Radical” Proposal or A Proven Way to Control Healthcare Costs?
Katie Gudiksen, Senior Health Policy Researcher April 27, 2018
On February 16, 2018, California State Assembly Member Ash Kalra introduced Assembly Bill 3087 – The Health Care Price Relief Act, which calls for a commission to set uniform rates for medical providers, including hospitals and physicians, for the private-insurance market. The bill sets the floor for payment at the Medicare rate and places the onus on providers to apply for adjustments to the base amount.[1] AB 3087 advanced out of committee on April 25, 2018, but faces fierce opposition from doctors and hospitals, among other groups.[2] In this post, The Source …
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Single-Payer vs. Public Option: Can Either System Address Rising Health Care Prices?
Katie Gudiksen, Senior Health Policy Researcher March 29, 2018
In February 2018, the Centers for Medicare and Medicaid Services (CMS) released data that National Health Expenditures accounted for 17.9% of Gross Domestic Product (GPD) and exceeded $10,300 per person. Even more alarming, CMS predicts that health expenditures will increase at an average rate of 5.5%, faster than inflation or increase in GPD, so that by 2026, health care will cost almost 20% of GDP. As a result of escalating costs of health care and increasing cost-sharing and co-pays for individual patients, those on the left of the political spectrum …
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Special California Assembly Hearings Provide Insights and Solutions to Increasing Healthcare Costs
Sammy Chang, Health Policy Researcher February 20, 2018
After the public outcry following last year’s tabling of SB 562 (Lara), which would have created a single-payer program in California, a special California Assembly committee was formed. The Assembly Select Committee on Health Care Delivery Systems and Universal Coverage began hearings in late October 2017 and adjourned on February 7th, 2018. While much of the hearings was a crash course on health insurance, some of them addressed high healthcare prices. This month, we will summarize two of the hearings that focused on understanding the origins of high healthcare pricing …
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