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.
October 21, 2016 [cross-posted from the Health Cents blog on philly.com]
Along with improving quality, cost containment is vital to redesigning American health care to increase value. For policymakers and health care leaders, accurate “costing” of care is needed to shift towards a more value-based system that patients are able to navigate.
In early 2015, we received pilot funding from LDI to estimate the number of opioid pills left unused following a common outpatient surgery: tooth extraction. We enrolled 79 dental patients over six months. Our results showed that patients used an average of 46% (13/28) of the opioid-containing analgesic pills prescribed for them after surgery, and 1,010 pills remained unused among this group. If generalized to all patients, these results suggest that more than 100 million opioid analgesic pills remain unused following tooth extractions in the United States each year.
Dan Polsky was a bit skeptical when he heard the news that, after a 10-story fall and a week-long coma, construction worker Kal Mathyssen had awakened with the ability to fully understand his health insurance policy. So Polsky decided to give Kal the ultimate test: could he describe the breadth of the provider network in his insurance plan?
As I listened to Gerard Anderson, PhD at recent seminars at the Department of Anesthesiology and Critical Care and the Leonard Davis Institute, I reminisced about many hours sitting on the couch in his office at Johns Hopkins talking about my research career. One of the best pieces of advice he gave me was to always understand your audience.
Prisons and jails in this country are now serving as de facto mental health care institutions. We believe that this represents an ethical and social justice transgression and should be at the center of civic discourse—particularly during an election year. To bring this situation to light and elevate the conversation and debate, we are convening a diverse group of health care providers, law enforcement officials, mental health care advocates, academicians, and bioethicists in Philadelphia on Oct. 20 for “Recovering Inside: Ethical Challenges in Correctional Mental Health Care.”
While a tax on sugary drinks is grabbing the headlines in Philadelphia, several cities and states are exploring other interventions to curb the consumption of sugary drinks, and hopefully reap health benefits. One such proposal is to put warning labels on sugary drinks, or on the advertising for them, calling out adverse health effects, particularly obesity, diabetes and tooth decay. While we can’t yet evaluate the real-world impact of sugary drinks warning labels, recent work by Christina Roberto and colleagues tests the extent to which exposure to warning labels on beverages might influence beliefs and purchasing choices of adolescents and parents.
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.