- Prescription drug pricing: Most cost-effectiveness analyses exclude probable end-of-patent, life cycle pricing – and set the initial price too low.
- Private approaches may be the best answer to public health problems.
- Rep Michael Burgess on why the CBO needs to consider the long-term benefits of preventive medicine.
- Looks like there are more deaths by fire than by ice. But there are still more deaths by cold than by warming.
Category: Health Economics & Costs
Congress Wants to Reform Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs) have been portrayed as a boogeyman for quite some time. PBMs manage drug benefits for health plans, including employee health plans, Obamacare, Medicare Advantage, Medicaid managed care and private insurers. PBMs raised the ire of independent pharmacies years ago because PBMs bargain down the fees pharmacists receive from government programs like Medicaid. For instance, most state fee-for-service (FFS) Medicaid programs pay small pharmacies dispensing fees that exceed $10 for a prescription, while some states pay small dispensing fees of more than $13 a prescription, while others pay more than $15. Dispensing fees are the professional fees (basically for counting pills and placing them in a bottle) in addition to the ingredient costs. Keep in mind that Walmart will dispense a month’s supply of certain generic drugs for a total cost of $4, a fee that includes the dispensing fee and the cost of the drugs themselves. Paying $15 to $20 for a Medicaid FFS prescription that Walmart sells to uninsured consumers for $4 seems excessively generous.
Wednesday Links
- How to get more kidney transplants without creating a market for kidneys.
- If new drugs can make it in America, they are developed. If they can’t, they aren’t.
- “A box of fruit or vegetables says ‘Produced in California’ or ‘Origin: Mexico,’ but you have no idea where a container of generic Tylenol came from or whether you can feel confident in the product.”
- Standing in the way of a cure for Parkinson’s disease: the FDA bureaucracy.
Mission Creep: Housing for Homeless is Another Medicaid Expansion
Some states have begun a novel experiment: diverting health care funds for housing assistance.
States are plowing billions of dollars into a high-stakes health care experiment that’s exploding around the country: using scarce public health insurance money to provide housing for the poorest and sickest Americans.
At last count nearly 40% of states – 19 so far – are diverting funds from Medicaid into housing assistance. The Biden Administration is encouraging others to follow.