Recent months have seen a flood of stories about drug prices, from Martin Shkreli’s dramatic price hikes on generic drugs to Sovaldi's eye-watering introductory price. But woven within these stories are different storylines, each with its own set of complications and policy solutions. Here we present five distinct drug pricing storylines.
Richard "Buz" Cooper, MD, noted LDI researcher and health policy contrarian who died this year, played “hard ball” every day for decades, telling it like he saw it, making observations that made us pause, and questioning assumptions that did not jibe with his clinical experiences and common sense. Typical of his intensity and humor, he was known to say that if the association between the number of surgeons and the number of operations was due to surgeon-induced demand, what might obstetricians be up to that resulted in the birth of more babies in communities with more obstetricians? Eventually this line of thinking led him to wonder if the problem had little to do with the number of doctors and everything to do with the underlying demographics of communities, especially the uneven geographic distribution of the poor. Could their high illness burden, use of expensive healthcare, and poor outcomes be related to preexisting conditions and delayed access to healthcare?
September 16, 2016 [cross-posted from the Health Cents blog on philly.com]
Over the past month, the EpiPen controversy has triggered a national debate on what to do about high drug prices. The enormous public attention stems from a doubling of the price over a three-year period. Families with life-threatening allergies can now end up paying more than $600 for a prescription. Heather Bresch, CEO of the company (Mylan) that makes the EpiPen, blames insurance plans. She says it’s high deductibles that are the root of the problem. I disagree. High deductible health plans are not causing the price hikes – they are just making them visible to consumers and the public.
Sometimes you have to look back to see the path forward. As the Pennsylvania House of Representatives considers legislation to modernize Pennsylvania’s antiquated regulations for nurse practitioners, we might learn something by reviewing the history of the Rendell Administration’s similar battle to expand scope of practice nearly 10 years ago. And if history is a predictor, there is reason to be optimistic.
It seems that every time Obamacare gets a cold, experts call it pneumonia. The high profile withdrawals of a few national insurers from Obamacare exchanges have some experts wondering whether the exchanges are entering a death spiral. The companies’ reports of large losses have led to speculation that the exchanges are unsustainable. If more insurers decide to withdraw, competition will decline and prices could rise to unaffordable levels. So, is there hope that the exchanges will survive? For many reasons, there is.
Pennsylvania Governor Tom Wolf announced the launch of the PA Prescription Drug Monitoring Program (PDMP), PMP AWARxE. With one of the highest overdose rates in the country (3,500 drug overdose deaths in the state in 2015), Pennsylvania’s PDMP is a timely and critical tool to save lives and address this crisis.
In caring for hospitalized patients with serious illnesses, clinicians and researchers often focus on death as the primary outcome to be avoided, but tend to pay less attention to other outcomes that may be equally or more unacceptable to some patients. We asked 180 patients hospitalized with serious illnesses to rate a series of health states on a 5 point Likert scale with options of worse than death, neither better nor worse than death, a little bit better than death, somewhat better than death, or much better than death. We report our findings in a research letter to JAMA Internal Medicine.
In a new paper in the European Journal of Public Health, Harkness Fellow Claudia Maier, and LDI Senior Fellow and Director of Penn Nursing’s Center for Health Outcomes and Policy Research Linda Aiken document the shifting of tasks that reflect expansion of nurses’ scope-of-practice in 39 countries. Their work shows that the current debates on scope-of-practice laws across US states have analogues in Europe, Canada, Australia, and New Zealand, as many countries seek to meet the primary care needs of their populations.
Following approval by the US Food and Drug Administration (FDA), subdermal probuphine will become the latest medication-assisted treatment (MAT) option to treat opioid use disorders in the United States. There are many advantages to probuphine, such as reducing the risk of medication diversion and increased medication adherence, but more research is needed to understand its cost-effectiveness and comparative effectiveness.
This chart on the educational debt level of medical school graduates was tucked away in supplementary material for an excellent article by Ari Friedman and colleagues in the Journal of General Internal Medicine on loan forgiveness programs.
How should social risk factors enter into Medicare’s value-based payments to hospitals? The answer goes beyond an arcane discussion of payment policy; it has a direct impact on hospital bottom lines and the quality of care provided to underserved communities. A new report from the National Academies of Sciences, Engineering, and Medicine—the third in a series of five—lays out criteria and methods to account for social risk factors in Medicare payment.
I just finished reading A Hand to Hold, a moving and powerful JAMA Piece of My Mind by LDI Senior Fellow Chris Feudtner. In it, he details his father’s last hours, and I was reminded of the end of my father’s journey just a few months ago, as I held his hand.