This briefing featured presentations by our experts highlighting the trends in Medicare regarding prescription drug pricing, and panelists discussed an array of policy options to align drug prices with value through alternative payment models.
With biosimilar biological products moving from the lab to the marketplace, key policy and regulatory questions are being actively debated, with important implications for industry, patients, and the health care system.
Recent pharmaceutical innovations offer unprecedented possibilities for curing, treating, or preventing a range of diseases. However, patients, providers and payers alike have raised concerns about the affordability and sustainability of these drugs. As a response to price increases of both single-source and generic drugs, some stakeholders are calling for a move towards basing payments on value, and some payers and pharmaceutical manufacturers are exploring ways to base payments on outcomes. However, many challenges remain.
A top Federal Trade Commission official, along with key experts, met with reporters Dec. 15 to discuss the recent surge in health care consolidation; the driving forces behind this trend; and the implications for policymakers and enforcers.
In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. This briefing will discussed the driving forces behind this recent increase in consolidation; the scope and extent of consolidation among doctors, hospitals and insurers; implications for consumers and other stakeholders; and the roles of the Department of Justice and the Federal Trade Commission.
Evidence shows that medication adherence—the extent to which a person takes medications as prescribed by their health care providers—is associated with improved health care outcomes for many costly chronic conditions, including heart disease, diabetes, and asthma. However, only 50% percent of Americans are estimated to take their medications as prescribed, and non-adherence is estimated to result in added direct and indirect costs to the healthcare system of over $300 billion per year. The challenges and policy questions surrounding medication adherence affect Medicare, Medicaid, and the private sector – and offer a window into broader questions surrounding the ability of our health care system to coordinate care, particularly for people with multiple chronic conditions. In this briefing, top experts from the public and private sectors explored key policy, practical, and research questions surrounding medication adherence and management of medications.
Innovative drugs have brought about significant progress in treating costly and complex conditions. While there is agreement among many stakeholders that some of these breakthrough drugs have had a positive impact on Americans’ health and life expectancy, increasing prices have also caused some confusion about the methods by which drug prices are determined. The goal of this briefing was to discuss recent prescription drug price trends, as well as demystify the pricing process. It identified contributors to the rising prices of many drugs, including shareholder interests and R&D costs, in addition to explaining possible future pricing-related challenges for manufacturers, providers, and consumers.
Top congressional health care staff will meet with reporters Wednesday, Sept. 9 to discuss what you need to know to cover health care policy in the fall and into 2016.
The Alliance for Health Reform has released a new toolkit, “Biosimilars: Unpacking Complex Issues.” The Affordable Care Act created an expedited licensure pathway for biosimilars, and, in March 2015, the U.S. approved the first biosimilar, leaving policy makers, regulators, providers and stakeholders to grapple with regulatory and financial questions.
With Congress focused intently on the discovery, development, and delivery pipeline for innovative drugs and devices – and in the wake of the first-ever U.S. approval of a biosimilar medication– key policy and regulatory questions are being actively debated, with important implications for industry, patients, and the health care system
Join us for a special breakfast for reporters, where former FDA Commissioner Andrew von Eschenbach will give you the latest on the fast-moving 21st Century Cures legislation. Karen Riley, deputy director of strategy at the FDA’s Office of External Affairs, will also be available to answer questions. The briefing comes just a week after the House Energy and Commerce Committee unveiled bipartisan draft legislation. The committee may begin voting on the measure as early as next week.
The United States spends more than $125 billion annually on cancer care. By 2022, there will be 18 million people with cancer and by 2030 cancer incidence is expected to rise by 2.3 million new cases per year. The high cost of cancer drugs and the “buy and bill” model of paying for them under Medicare have received significant attention. But other factors, such as highly-variable practice patterns and a lack of meaningful engagement of patients in care decisions, have also been called into question.
According to the Centers for Disease Control and Prevention (CDC), drug overdose is the leading cause of injury death in the United States. In 2010, opioid pain relievers accounted for approximately 17,000 of overdose deaths— more than twice the number of deaths from cocaine and heroin combined. Despite the tremendous importance of prescription drugs in treating pain, some medications have a high risk of being misused or abused. Some researchers have voiced concerns that prescription painkillers could even be a gateway drug for heroin users. With the steady rise in prescription rates and drug overdose deaths, policymakers are coming to a consensus that this national problem must be addressed.
Spending on prescription drugs in the U.S. rose at a faster clip in 2009 than spending for hospital and physician care, a trend that is expected to continue through 2020. By some estimates, prescription drugs account for 15 cents of every health care dollar spent. Thus, federal and state budget cutters – as well as private health plans and hospitals – have a keen interest in restraining drug costs.
Comparative effectiveness research holds out the tantalizing prospect of making it easier for patients and their doctors to choose the best treatment, thus improving quality. At the same time, it could also justify denying or reducing payment for a host of treatments or procedures that may be clinically ineffective or unworthy of their high price.
Close to 24 million Medicare beneficiaries enrolled in Part D coverage for prescription drugs in the first two enrollment cycles. According to the Centers for Medicare and Medicaid Services (CMS), more than 75 percent of beneficiaries are satisfied with the program. However, evidence suggests that seniors who were uncovered in 2005 benefited more than other enrollees in 2006. HHS has announced that more than 90 percent of Medicare beneficiaries in a stand-alone prescription drug plan will have access to at least one plan with a lower premium in 2008; and the third open enrollment period is now upon us – November 15 through December 31, 2007.
There is mounting research highlighting poor quality of care and inefficient spending in our health care system. At the same time, diagnostic and treatment options proliferate at an accelerating pace.
Medicare covers nearly 44 million beneficiaries who are elderly, including 37 million seniors and 7 million younger adults with permanent disabilities, and end stage renal disease. The program cost the federal government approximately $375 billion in 2006, accounting for 13 percent of federal spending. Why is Medicare important for congressional staffers to know about?