Correction: Pharmacy Benefit Managers, Brand-Name Drug Prices, and Patient Cost Sharing

2018 ◽  
Vol 168 (12) ◽  
pp. 904
Keyword(s):  
Cost Sharing ◽  
Brand Name ◽  
Pharmacy Benefit ◽  
Patient Cost ◽  
Drug Prices

Pharmacy Benefit Managers, Brand-Name Drug Prices, and Patient Cost Sharing

2018 ◽  
Vol 168 (6) ◽  
pp. 436 ◽  
Author(s):  
Ge Bai ◽  
Aditi P. Sen ◽  
Gerard F. Anderson
Keyword(s):  
Cost Sharing ◽  
Brand Name ◽  
Pharmacy Benefit ◽  
Patient Cost ◽  
Drug Prices

Proposed Solutions for Rising Drug Prices

2021 ◽  
pp. 38-61
Author(s):  
Neumann Peter J. ◽  
Cohen Joshua T. ◽  
Ollendorf Daniel A
Keyword(s):  
Collective Bargaining ◽  
Generic Drug ◽  
New Drugs ◽  
Patient Access ◽  
Brand Name ◽  
Pharmacy Benefit ◽  
High Drug ◽  
Drug Prices ◽  
Market Protection ◽  
Drug Companies

This chapter explores proposed solutions for high drug prices. They include measures to rein in “middlemen” pharmacy benefit managers who may artificially inflate prices; increase generic drug competition to prevent price spikes for older, off-patent drugs; enhance competition for new drugs after brand-name products reach the intended period of market protection; align US drug prices with the lower prices available in other wealthy countries; and leverage the collective bargaining power of government payers to compel drug companies to accept lower prices for their products. Policies that force drug prices down can save money but risk choking off the development of important new advances, limiting patient access to their health benefits. Moreover, the policy solutions typically offered are incremental solutions that will likely put a modest dent in the nation’s $500 billion annual drug bill. Most important, they fail to link a drug’s price to its value.

scholarly journals Temporal trends and variation in out-of-pocket expenditures and patient cost sharing: evidence from a Chinese national survey 2011–2015

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Vicky Mengqi Qin ◽  
Yuting Zhang ◽  
Kee Seng Chia ◽  
Barbara McPake ◽  
Yang Zhao ◽  
...  
Keyword(s):  
Prescription Drugs ◽  
Cost Sharing ◽  
Temporal Trends ◽  
Absolute Amount ◽  
Financial Protection ◽  
Patient Cost ◽  
Older Chinese ◽  
Using Data ◽  
Reported Data ◽  
The Relationship

Abstract Objectives This study aims to examine: (1) temporal trends in the percentage of cost-sharing and amount of out-of-pocket expenditure (OOPE) from 2011 to 2015; (2) factors associated with cost-sharing and OOPE; and (3) the relationships between province-level economic development and cost-sharing and OOPE in China. Setting A total of 10,316 adults aged ≥45 years from China followed-up from 2011 to 2015 were included in the analysis. We measured two main outcome variables: (1) patient cost sharing, measured by the percentage of OOPE as total healthcare expenditure, and (2) absolute amount of OOPE. Results Based on self-reported data, we did not find substantial differences in the percentage of cost sharing, but a significant increase in the absolute amount of OOPE among the middle-aged and older Chinese between 2011 and 2015. The percentage of cost-sharing was considerably higher for outpatient than inpatient care, and the majority paid more than 80% of the total cost for prescription drugs. Provinces with higher GDP per capita tend to have lower cost-sharing and a higher OOPE than their counterparts, but the relationship for OOPE became insignificant after adjusting for individual factors. Conclusion Reducing out-of-pocket expenditure and patient cost sharing is required to improve financial protection from illness, especially for those with those with chronic conditions and reside in less developed regions in China. Ongoing monitoring of financial protection using data from various sources is warranted.

scholarly journals The Impact of Patient Cost-Sharing on the Poor: Evidence from Massachusetts

2012 ◽  
Author(s):  
Amitabh Chandra ◽  
Jonathan Gruber ◽  
Robin McKnight
Keyword(s):  
Cost Sharing ◽  
Patient Cost ◽  
The Poor ◽  
The Impact

scholarly journals Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review

2018 ◽  
Vol 44 (5) ◽  
pp. E6 ◽  
Author(s):  
Seungwon Yoon ◽  
Michael A. Mooney ◽  
Michael A. Bohl ◽  
John P. Sheehy ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Financial Burden ◽  
Vascular Lesions ◽  
Annual Growth Rate ◽  
Model Case ◽  
Patient Cost ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Insured Patients

OBJECTIVEWith drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.METHODSFor 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors’ institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time.RESULTSIn the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016).CONCLUSIONSEven after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

scholarly journals RxLegal: Pharmacist Gag Clauses

2018 ◽  
Vol 53 (6) ◽  
pp. 376-377 ◽  
Author(s):  
Michael Gabay
Keyword(s):  
Prescription Medication ◽  
Insurance Companies ◽  
Right To Know ◽  
Drug Pricing ◽  
Pharmacy Benefit ◽  
Drug Prices

Much publicity has surrounded the use of gag clauses in contracts between insurance companies or their pharmacy benefit managers (PBMs) and pharmacies. These clauses prohibit pharmacists from voluntarily informing patients that their prescription medication may cost less if paid for directly by them instead of through their insurance. By concealing the least expensive way to purchase a medication, critics state that gag clauses reduce transparency and medication affordability for patients and appear to be counterintuitive to one of the major activities of a PBM—negotiation of drug pricing. Due to the uproar surrounding these clauses, the bipartisan Patient Right to Know Drug Prices Act was recently introduced in Congress to effectively ban the practice.

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