Paxlovid is startlingly expensive. As with many drugs in the United States, its pricing deserves renewed scrutiny. Among a handful of approved anti-retrovirals, the drug is the go-to prescription medicine to treat mild-to-moderate COVID-19 in adults. It can reduce the likelihood of ending up in the hospital for people at elevated risk. For older people… Read More »
Provider contracting may sound dull, but it can have big impact on patients. Contracting may not be the first thing you think of when choosing a provider or facility. It may also not be something you have a lot of control over. But because of surprise billing, provider contracting can have a big effect on… Read More »
VBID and alternative payment models comprise two approaches to reform with different incentives that influence underlying motives. The underlying principle of Value-Based Insurance Design (VBID) is to align patient out-of-pocket costs, or cost-sharing (deductibles, co-pays, etc.), with clinical value of services. Decreasing cost-sharing for high-value services and increasing cost-sharing for low-value services is the goal of… Read More »
Readers of The Medical Care Blog know that the United States spends more money than any other country on healthcare. Currently, the US spends about 18% of its gross domestic product on health care, and it is predicted to grow to nearly 20% by 2026 [PDF]. While the growth rate in spending remains near historical… Read More »
Alzheimer’s disease and related dementias (ADRD) affect about 5.7 million people in the US. Although most of those affected are covered by Medicare, many of the medical costs are not covered by insurance and must be borne by patients and their families. Total costs of care for ADRD have been estimated at more than $277… Read More »
There’s a box on my mom’s desk. It’s smaller than a shoe box, and unremarkable unless you know what’s in it, how it got there and why it represents several important things that are wrong with how we treat people with terminal cancer. The box contains 28 doses of two drugs, or one “cycle” of… Read More »
Annual routine check-ups, flu shots, and mammograms are among the basic preventive services for which the Patient Protection and Affordable Care Act of 2010 established a mandate for insurance plans: full coverage, with no out-of-pocket costs. In making it a little easier for some parts of the US population to access basic services, did the… Read More »
Ten years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. Individuals over age 65 with incomes below poverty are dually eligible for both Medicaid and Medicare, and full-benefit dual enrollees are automatically enrolled in a subsidized prescription drug plan with minimal co-payments. Turns out, this policy intervention may have played… Read More »
President Obama’s Affordable Care Act (ACA) included provisions to gradually reduce the Medicare part D “doughnut hole” – a much-maligned gap in coverage that was an economizing feature of President Bush’s legislation. So, how have these changes affected drug use and spending by seniors? A new article in Medical Care provides insights. Under the standard part D benefit… Read More »