Audience - Policy Makers
Are the Benefits of Newer Drugs Worth Their Cost? Evidence From the 1996 MEPS, by Frank R. Lichtenberg, Health Affairs, Vol. 20, No.5,
September/October 2001
Critics of pharmaceutical spending point to the increase in the pharmaceutical “line item” in our overall health spending as cause for alarm. Lichtenberg's research examines the value of this spending in its complete context by exploring whether there are cost offsets associated with using newer and, most often, more expensive drugs. Lichtenberg finds that we are paying more, but we are getting a bigger “bang for our buck.”
Annotated PowerPoint slides related to this article are available.
Clinical and Economic Advantages of Modern Dosage Forms: Improving Medication Adherence, by Albert Wertheimer, MBA, PhD, 2006
A substantial source of waste and inefficiency in health care is patient non-adherence with medications. Modern drug delivery technology can help improve adherence by simplifying the dosing regimen, and/or decreasing side effects. Other advantages include steadier drug concentrations in the bloodstream and targeted delivery of medication to its site of therapeutic action in the body.
A Closer Look at Allergies, 2001
Allergies are the sixth leading cause of chronic disease in the U.S., and cost the health care system over $18 billion annually. In this publication, a joint project between the Asthma and Allergy Foundation of America and NPC, we take a closer look factors influencing drug spending for allergies.
A Closer Look at Arthritis, 2002
One in six Americans suffers from arthritis, and the CDC projects that number will grow to one in five by 2020. In this six-page brochure, a collaborative project between the Arthritis Foundation and NPC, we take a closer look at the factors influencing drug spending for treating arthritis.
A Closer Look at Asthma, 2001
Asthma results in approximately 5,000 deaths annually in the U.S. and accounts for nearly half a million hospitalizations, 1.6 million emergency room visits, and over 10 million physician office visits. In this six-page brochure, a joint project between the Asthma and Allergy Foundation of America and NPC, we take a closer look at the factors influencing drug spending for the treatment of asthma.
A Closer Look at Depression, 2002
Clinical depression is a widespread and debilitating illness that cost Americans $44 billion in 1990, making it one of the nation's ten most costly diseases. In this six-page brochure, a collaboration between the National Alliance for the Mentally Ill and NPC, we take a closer look at the factors that influence
drug spending for treating depression.
A Closer Look at Diabetes, 2002
The number of Americans diagnosed with diabetes jumped 49 percent from 1990 to 2000. Diabetes is the main cause of kidney failure, new cases of blindness, and lower limb amputations, and is a major risk factor for heart disease and stroke. In this six-page brochure, a joint project between the American Diabetes Association and NPC, we take a closer look at the factors that influence drug spending for the treatment of diabetes.
A Closer Look at High Blood Pressure, 2001
Roughly 50 million Americans ages six and older have high blood pressure. Left untreated, high blood pressure can lead to heart disease, kidney disease, and stroke. In this six-page brochure, a joint project between the American Heart Association and NPC, we take a closer look at the factors influencing drug spending for the treatment of high blood pressure.
A Closer Look at High Cholesterol, 2001
High cholesterol is a major risk factor in heart disease, the leading cause of death in the U.S., which claims the lives of nearly 460,000 Americans each year. In this six-page brochure, a joint project between the American Heart Association and NPC, we take a closer look at the factors influencing drug spending for the treatment of high cholesterol.
Consumer Reports on the Health Effects of Direct-to-Consumer Advertising of Prescription Drugs, by Joel S. Weissman, et al., Health Affairs Web Exclusive, February 2003
This paper reports the results of a study of the health behaviors and outcomes that result when patients initiate discussions with their doctors as a result of seeing a prescription drug ad. Consumers reported that DTCA-motivated discussions with physicians frequently result in new diagnoses for clinically important conditions, and the survey found no evidence to support concerns about adverse health consequences.
Costs and Benefits of Pharmaceuticals: The Value Equation for Older Americans, by Richard Levy, PhD, Care Management Journals, Vol. 3, No. 3, Spring 2002
Benefits from new pharmaceuticals far outweigh their costs for many key diseases of the elderly. Even incremental improvements in drug therapies contribute substantially to improved care. Chronic illness, disability, and an aging population will drive future health care spending. Pharmaceutical innovation will be an integral part of effective strategies to address this challenge.
Cultural and Genetic Diversity in America: The Need for Individualized Pharmaceutical Treatment, by Valentine J. Burroughs, et al., 2002
Pharmacogenetic research in the past few decades has uncovered significant differences among population groups in the metabolism, clinical effectiveness, and side effect profiles of many clinically important drugs. In addition, differences in how various populations view and respond to medicines underscores the need for an individualized approach to pharmaceutical therapy. Cost management policy design must take these differences into
account in order to ensure that they are broad and flexible enough to enable rational choices and individualized treatment for all patients, regardless of racial or ethnic origin. Fact Sheet available.
Annotated PowerPoint slides related to this report are available.
Disease Management for Asthma, 2004
Asthma, one of the first disease management targets, is often selected for managed intervention because high-cost patients can be easily identified via their frequent medication refills, consistent clinical practice guidelines and validated outcome measures are available that can help assess the effectiveness of the interventions, and educational interventions have been
developed to help improve the behavior of both patients and health care practitioners. This bibliography presents 69 studies demonstrating the impact of educational interventions on asthma treatment and management. Fact sheet available.
Disease Management for Depression, 2003
This monograph provides an introduction to disease management along with an analysis of penetration, trends and growth. Disease management strategies have great potential to improve therapeutic outcomes for patients with depression. Although there can be some challenges in managing depression through a disease management program, many programs have had success. While not every program included in the literature search represents a comprehensive disease management program, examples of specific educational interventions for depression are included and discussed.
Disease Management for Diabetes, 2004
This monograph presents 65 studies detailing the impact of educational interventions on diabetes treatment and management as well as information
on diabetes disease management programs in development. It is intended to serve as a guide for those interested in developing disease management programs for the treatment of diabetes. Fact sheet available.
Disease Management for Heart Failure, 2004
This bibliography presents 68 studies concerning the impact of educational interventions on heart failure treatment and management. It is intended to serve as a guide for those interested in developing disease management programs for the treatment of congestive heart failure. Fact sheet available.
Disease Management for Schizophrenia, 2004
Disease management efforts for schizophrenia are less well established than are efforts for other chronic illnesses such as asthma and diabetes. Managing schizophrenia poses more of a challenge than many other chronic diseases because it usually causes greater disability than other mental and physical illnesses. However, disease management strategies have the potential to improve therapeutic outcomes for patients with schizophrenia. This monograph provides an introduction to disease management as well as examples of interventions for schizophrenia.
DM LitFinder™ Database
The Disease Management Association of America offers a query tool to search the peer-reviewed literature available on disease management for eight conditions (asthma, congestive heart failure, diabetes, COPD, coronary artery disease, end-stage renal disease, high risk pregnancy, and depression). Updated quarterly, this tool helps users identify programs that have reported medical cost savings and demonstrated improvements in clinical processes and outcomes of care such as drug compliance, reduced absenteeism and better quality of life, and what patient and physician interventions were used to achieve these outcomes.
Drug-Related Adverse Events: A Readers' Guide to Assessing Literature Reviews and Meta-Analyses, by Susan D. Ross, MD, Archives of Internal Medicine, Vol. 161, April 23, 2001
The objective of this article is to provide readers with a practical guide to critically appraising reviews and meta-analyses of source studies of drug-related adverse events. A critique of a highly publicized meta-analysis is used as a case study to highlight several contentious issues.
The Effect of New Drugs on Mortality from Rare Diseases and HIV, by Frank R. Lichtenberg, NBER Working Paper W8677, December 2001
This article examines the effects of two important government policies designed to provide incentives for the development of pharmaceuticals—the Orphan Drug Act and the FDA fast track for drugs for AIDS and other diseases where current therapies are inadequate. Following implementation of these policies, introduction of new drugs for orphan diseases and HIV/AIDS was found to increase substantially and there was a dramatic, time-lagged reduction in mortality from these diseases. These results suggest that government policy can be an effective lever for stimulating innovation of pharmaceuticals having significant effects on longevity.
Ethnic Disparities in the Burden and Treatment of Asthma, 2005
In the United States the burden of asthma falls disproportionately on the black and Hispanic—largely Puerto Rican—populations, especially children. Much of this disparity has been attributed to unequal access to preventive care. Black and Puerto Rican children characteristically under-use routine health care services and overuse emergency care services for asthma. This report, developed in partnership with the Asthma and Allergy Foundation of America, discusses: disparities in the burden of asthma; possible hereditary, environmental, and behavioral causes of these disparities; and ways in which these asthma disparities may be lessened.
Annotated PowerPoint slides related to this report are available.
Explaining Drug Spending Trends: Does Perception Match Reality? by Robert Dubois, et al., Health Affairs, Vol. 19, No. 2, March/April 2000
Using large claims databases from managed care and employer-sponsored health benefit plans, this study found increased volume, not rising pricing, accounted for drugs’ higher levels of spending. For more information about the methodology used for this study, see Measuring the Costs and Benefits of Pharmaceutical Expenditures, Expert Review of Pharmacoeconomics and Outcomes Research, October 2002.
Annotated PowerPoint slides related to this article are available.
Follow the Dollar: Understanding Drug Prices and Beneficiary Costs Under Medicare Part D, by Lindy Hinman, John Richardson, and Jennifer Snow, 2006
This snapshot of the Medicare drug benefit supply chain by Avalere Health emphasizes that Medicare beneficiaries’ out-of-pocket costs are a product of negotiations that occur between many players and at multiple points along the supply chain. The report considers out-of-pocket costs as a whole – including cost-sharing via premiums, deductibles, and coverage gaps – not just the final price at the pharmacy counter. Flowcharts in the report illustrate at what point prices are negotiated and by whom.
Genes, Culture, and Medicines: Bridging Gaps in Treatment for Hispanic Americans, by Carolina Reyes, MD, et al., 2004
This report brings together for the first time a growing body of scientific research demonstrating substantial disparities in pharmaceutical therapy for Hispanic Americans. These disparities in pharmaceutical treatment are substantial and often persist even after adjustment for differences in income, age, insurance coverage, and coexisting medical conditions. Emerging research demonstrates that genetic variations affect Hispanic Americans and may require dosage adjustments to achieve an optimal therapeutic effect.
Fact Sheet available.
Annotated PowerPoint slides related to this report are available.
Genetic Variations in Response to Medications: Looking at the Implications for Minority Elders, by Richard Levy and Jean Polatsek, Healthcare and Aging, Vol. 9, No. 1, Spring 2002
Genetic, environmental and cultural factors influence variations in drug response among elders from different racial and ethnic backgrounds. Racial and ethnic heritage can be an indicator of special medical needs and differing drug responses; if ignored these differences in treatment response, can lead to compromised care and greater health risks. In addition, substantial dosing
adjustments may be necessary to avoid overdosing or underdosing. Reprinted with permission from Healthcare and Aging, Vol. 9, No. 1, Spring 2002. Copyright © 2002 American Society on Aging San Francisco, California. Also published in Diversity Currents, Vol. 4, No. 2, Spring 2002.)
Growth in Use of Lipid-Lowering Therapies: Are We Targeting the Right Patients? by Robert W. Dubois, MD, PhD, et al., American Journal of Managed Care, Vol. 8, October 2002
This article looks at the appropriateness of statin use in 1997 (pre-DTCA guidance) and in 1999 (post-DTCA guidance). The conclusion is that although the number of people being treated with statins rose considerably from 1997 to 1999, there did not appear to be any shift towards less appropriate treatment.
Health Care Budgeting: Tools & Techniques for State Budget Officers, May 2005
Health care is the second-largest and fastest growing item in state budgets. State health care spending includes Medicaid, state employees health benefits program, public mental health services, and public health. Many states have reached the point of cutting eligibility or benefits in order to balance their revenue deficient budgets. In a rapidly changing environment, it is essential that state budget officers keep abreast of the innovations in developing health budgets and ensure that all the many options have been considered.
This webcast captures the executive fellowship held at the College of William & Mary in May 2005.
A History of Creating the Medicare Prescription Drug Benefit: Striking Compromises, Avoiding Past Mistakes, and Minding Budgetary Constraints, by Jonathan Blum, 2006
The Medicare Modernization Act of 2003 introduced new terminology that has now become commonplace among politicians, health policy analysts, and Medicare beneficiaries, including donut holes, PDPs, risk corridors, and low-income subsidies. This commentary by Avalere Health examines the confounding forces that influenced the development of this technically complex piece of legislation.
The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients, by Louis F. Rossiter, et al.,
Inquiry, Vol. 37, No. 2, Summer 2000
This article chronicles how concerns about the health outcomes and costs of care for Medicaid recipients with chronic diseases has led to development of a model program to enhance the quality of care and reduce overall cost of care for Medicaid patients enrolled in Virginia's primary care case management program. Fact
sheet available.
The impact of increased utilization of HIV drugs on longevity and medical expenditure: an assessment based on aggregate US time-series data, by Frank R. Lichtenberg, Expert Review of Pharmacoeconomics & Outcomes Research, Vol. 6, No. 4, August 2006
The objective of this Special Report is to estimate the medical cost per
life-year gained from increased utilization of HIV drugs by estimating
the impact of increased drug utilization on the life expectancy and drug
and hospital expenditure of HIV/AIDS patients, using aggregate (US
national-level) data for the period 1982-2001.
The Impact of Tiered Co-Pays: A Survey of Patients and Pharmacists, 2003
Employers increasingly have adopted strategies to reduce prescription drug expenditures, including cost-sharing arrangements that require employees to pay a greater share of the costs. In 2002, approximately 57% of people with employer-sponsored health benefits were enrolled in multi-tier co-pay plans. The growing use of tiered benefit plans and increasing co-pay levels has prompted concern that higher co-pays may lead patients, particularly those with chronic illnesses, to reduce prescription drug compliance and,
consequently, experience negative health outcomes that result in increased utilization of other health care services. To view the study instruments, click here.
The Impact on States of the Medicare Drug Benefit: Information for State Administrators, 2005
As administrators work to integrate Medicaid and state prescription assistance programs with the new drug benefit established by Part D of the Medicare Modernization Act, there will be significant savings opportunities as well as significant costs. The decisions states make must not only reflect budget considerations, but must also recognize the lead role that states have in providing a safety net to the poorest, frailest, and most vulnerable of our citizens. This issue brief identifies key decision points and factors that must be taken into consideration as states prepare for the January 1st, 2006 implementation of the new Medicare drug benefit.
The Impact on States of the Medicare Drug Benefit: Information for State Legislators, 2005
The new drug benefit established by Part D of the Medicare Modernization Act assures that all older and disabled persons have access to affordable prescription drug coverage and will subsidize many low-income persons who previously had no access to drug benefits through Medicaid or state pharmaceutical assistance programs. States have numerous policy decisions to
make in implementing the Part D drug benefit, including several options to enhance the Part D program. These decisions must be made quickly in order to be ready for the January 1st, 2006 implementation date. As the safety net provider for many vulnerable individuals, the state's choices on these matters are important to the future well-being of the elderly and disabled.
Information for Consumer Groups about the NAIC's Model Act on Prescription Drug Benefit Management, 2002
This six-page fact sheet examines the National Association of Insurance Commisioners' (NAIC) model act currently in development regarding pharmacy benefit management. A four-page table compares the consumer protections offered by the draft model act with the provisions offered by the insurance industry in an alternate model act, and the provisions desired for optimum consumer protection.
Intended and Unintended Consequences of HMO Cost Containment Strategies: Results from the Managed Care Outcomes Project, by Susan D. Horn, PhD, et al., The American Journal of Managed Care, Vol. 2, No. 3,
1996
Contrary to common assumptions, greater formulary restrictions may result in decreased quality of patient care, increased use of services and higher medical costs. This 1996 study by Susan Horn, PhD, disputed widely held beliefs that formularies reduce pharmaceutical and overall health care costs.
Is Technological Change in Medicine Worth It? by David M. Cutler and Mark McClellan, Health Affairs, Vol. 20, No. 5, September/October 2001
Cutler and McClellan's research explores the relationship between spending and health benefits. They examine several different disease areas and find that, indeed, there are tremendous benefits to be had from the use of pharmaceuticals. In four of five disease areas examined, benefits outweighed costs, and in the fifth disease costs and benefits were equal. Putting a price on life is a difficult task, but Cutler and McClellan calculate that the true cost of some types of care is actually falling because of medical innovation.
View "Measuring the Value of Health Innovations: The Policy Implications of New Medical Technologies," a briefing by the Alliance for Health Reform featuring Mark McClellan, September 7, 2001,
Washington, DC
Annotated PowerPoint slides related to this article are available.
The Link Between Gross Profitability and Pharmaceutical R&D Spending, by F.M. Scherer, Health Affairs, Vol. 20, No. 5, September/October 2001
Scherer points out that the new pharmaceutical discoveries benefiting consumers are being driven by the gross profit margins that pharmaceutical companies make. As profits increase, so does research and development. This ultimately yields new and promising options for consumers. In addition, Scherer finds that medical innovations are leading to longer life and improved quality of life.
View "Measuring the Value of Health Innovations: The Policy Implications of New Medical Technologies," a briefing by the Alliance for Health Reform featuring F.M. Scherer, September 7, 2001, Washington, DC
Measuring the Costs and Benefits of Pharmaceutical Expenditures, by William H. Crown, Davina Ling, and Ernst Berndt, Expert Review of Pharmacoeconomics and Outcomes Research, Vol. 2, No. 5, October 2002
This paper presents a methodological approach for analyzing growth in pharmaceutical expenditures, enabling researchers to disaggregate growth into price and volume components. Research using this methodology (see Explaining Drug Spending Trends: Does Perception Match Reality?) has found increased volume, not price, is the primary driver of pharmaceutical spending growth.
Medicaid 101 - Overview of Policies, Expenditures, Current Trends, and Initiatives
Medicaid 101 for State Legislators is designed to help legislators and their staffs:
- Understand the history and mission of Medicaid
- The drivers behind Medicaid budget growth (e.g., aged, blind, disabled eligibility expansions)
- The part that drugs play in the budget.
The presentation explains how barriers to care that delay effective treatment can add to long-term costs and reduce quality; examines a range of alternatives (along with their pros and cons) for managing drug expenditures; highlights extensive state-specific data on the Medicaid population.
Medicaid Disease Management Programs: Findings from Three Leading U.S. State Programs, by Jeann L. Gillespie and Louis F. Rossiter, Disease Management & Health Outcomes, Vol. 11, No. 6, June 2003
A growing number of states are beginning legislative and administrative studies, piloting disease management programs, and expanding existing programs. There is no single, correct way to implement programs across patient populations. Results will depend upon the way the program is implemented, the model used, the diseases selected, and the ability to implement purely voluntary efforts or programs with strong incentives and outcome-driven approaches.
The Medicare Drug Benefit: Impact on States, and Cost Containment
This presentation outlines key MMA issues for Medicaid, State Pharmaceutical Assistance Programs (SPAPs), other state agencies, and state employee retiree benefit plans. It also reviews Medicaid cost-containment options being considered in the states related to eligibility, benefits, unit cost, utilization, managed care, revenue enhancement and cost avoidance, and administrative
efficiencies.
National Health Spending In 2004: Recent Slowdown Led By Prescription Drug Spending, by Cynthia Smith, Cathy Cowan, Stephen Heffler, Aaron Catlin the National Health Accounts Team, Health Affairs, Vol. 25, No. 1,
Jan./Feb. 2006
U.S. health care spending rose 7.9 percent to $1.9 trillion in 2004, or $6,280 per person. Health spending accounted for 16 percent of gross domestic product (GDP), nearly the same as in 2003. The pace of health spending growth has slowed, compared with the 2000–2002 period, for both public and
private payers. Hospital spending accounted for 30 percent of the aggregate increase between 2002 and 2004, and prescription drugs accounted for an 11 percent share—smaller than its share of the increase in recent years and much
slower in absolute terms.
Noncompliance with Medications: An Economic Tragedy with Important Implications for Health Care Reform, 1994
The economic and medical consequences of noncompliance to the U.S. health care system are examined in this 32-page NPC publication. Understand how noncompliance accounts for up to $100 billion in health care and productivity costs.
An Overview of Two Monographs on Pain Management, 2003
In 2001, the Joint
Commission on Accreditation of Healthcare Organizations and the National Pharmaceutical Council began a collaborative effort to facilitate improvements in pain management. To date, this effort has produced a set of
monographs intended for those involved in pain management activities, including clinicians, quality management professionals, and others involved in pain management performance, assessment, improvement, education, and policy making.
Perspectives on the Pharmaceutical Industry, by Uwe E. Reinhardt, Health Affairs, Vol. 20, No. 5, September/October 2001
Reinhardt's research shows that our nation can indeed afford spending on drugs that help us live longer, more productive lives. Spending on
pharmaceuticals accounts for only a small fraction of our Gross Domestic Product (GDP). In fact, Americans spend more per capita on alcohol, tobacco, and entertainment combined than on pharmaceuticals.
Annotated PowerPoint slides related to this article are available.
Pharmaceutical Benefits Under State Medical Assistance Programs, 2005/2006 and Previous Editions
The 2005-2006 edition of Pharmaceutical Benefits Under State Medical Assistance Programs marks the 40th year that NPC has compiled and published one of the largest sources of information on pharmacy programs within the State Medical Assistance Programs (Title XIX) and expanded pharmacy programs for the elderly and disabled. Over the years, this collection of statistical data has become a standard reference in government offices, research libraries, consultancies, and numerous businesses. It incorporates information on each State pharmacy program from an annual NPC Survey of State Medicaid program administrators and pharmacy consultants, statistics from the Centers for Medicare and Medicaid Services (CMS), and information from other Federal agencies and organizations.
Pharmaceuticals and Productivity: Investing in Human Capital, 2001
(Note: ~20mb)
New therapies have the potential to produce economic savings and benefits both outside of the health care system (indirect savings) and within the system (direct savings). This report explores the question of whether spending on pharmaceuticals has a positive payoff.
Pharmaceuticals for Elders: Why Innovation Matters, by Albert Wertheimer, Healthcare and Aging, Vol. 9, No. 1 Spring 2002
The current policy debate over drug-benefit reform and improved access to needed medicines for elders has generated considerable confusion and many
misperceptions regarding the nature and value of incremental pharmaceutical innovation. Cumulatively, these new medicines allow for precision treatment of the individual needs of diverse patients, which is especially important for
optimal treatment of older patients, because age-related physiological changes and individual differences may produce markedly diverse responses to medications in older adults. (Reprinted with permission from Healthcare and Aging, Vol. 9, No. 1, Spring 2002. Copyright © 2002 American
Society on Aging San Francisco, California.)
CD-ROM Prescription Medicines: Returning Value to Patients, Payers and Society, 2003
Studies confirm that indeed, medicines are one of the fastest growing areas of health care spending. And while few can imagine life without the life improving medicines that patients with diabetes, heart disease, cancer, HIV/AIDS, and many others have come to depend on, some have questioned the value of that spending – to the health care system overall and to consumers. In this compilation of materials – much of it peer-reviewed research – we hope to help answer some of the critical questions in this debate.
The Price of Progress: Prescription Drugs in the Health Care Market, by J.D. Kleinke, Health Affairs, Vol. 20, No. 5, September/October 2001
Kleinke's research tells us that increased spending on pharmaceuticals does not explain the insurance premium increases that many consumers are seeing.
He points out that pharmaceuticals are a small fraction of the total equation, and that even though spending on pharmaceuticals is increasing, that rise in expenditures amounts to a small percentage of the premium increases.
View "Measuring the Value of Health Innovations: The Policy Implications of New Medical Technologies," a briefing by the Alliance for Health Reform featuring J.D. Kleinke, September 7, 2001, Washington, DC
The Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs (Report to Funders), February 2003
This report contains more detailed findings from the report "Consumer Reports on the Health Effects of Direct-to-Consumer Advertising of Prescription Drugs" (see above) and includes the survey questionnaire.
Q's and A's for State Officials, Physicians and Patients
Find out the benefits of disease management for Medicaid officials, providers and patients. State officials are briefed on how to determine high quality services and utilization management to chronically ill Medicaid patients. Other fact sheets explain how disease management benefits physicians and their patients.
The Silver Book: Chronic Disease and Medical Innovation in an Aging Nation
The Silver Book, a project of the Alliance for Aging Research is an almanac of hundreds of facts, statistics, graphs, and information from close to 100 agencies, organizations and experts. It is a searchable database that is constantly updated and expanded in order to highlight the latest research and data on the burden of chronic disease and the value of investing in medical research. The Silver Book database is searchable by specific terms or by sections. The database is also interactive, allowing users to submit data from additional studies and reports.
Sources of U.S. Longevity Increase 1960-2001, by Frank R. Lichtenberg, The Quarterly Review of Economics and Finance, Vol. 44,
No. 3, July 2004
This empirical analysis provides support for the hypothesis that both medical innovation (in the form of new drug approvals) and public health expenditure contributed to longevity increase during the period 1960–2001. Longevity is viewed as the output of the health production function, and output fluctuations as the consequence of fluctuations in medical inputs (expenditure) and technology. The estimates imply that the public health expenditure needed to gain one life-year is about $9640, and that the pharmaceutical R&D expenditure needed to gain one life-year is about $926.
State Medicaid Program Issues: Preferred Drug Lists, 2003
This issue brief identifies issues, requirements and considerations relating to preferred drug lists (PDLs). Developed for state audiences, the brief addresses policy, operational and procedural issues; federal provisions for patient protection; specific case studies; provisions of the Florida Medicaid patient suit settlement agreement; evaluation methodologies; and principles
to consider.
State Medicaid Resource Kit: Maintaining Quality and Patient Access to Innovative Pharmaceuticals in Challenging Economic Times, 2006
This resource kit, modeled on NCSL's "Managing Medicaid Costs: A Legislator's Toolkit," is designed to help states better identify the needs of their populations and to develop patient-focused cost management interventions while maintaining quality care. Sixteen specific strategies are addressed, providing the pros and cons, states' experiences, design and policy issues, and Federal and State involvement/constraints.
Executive Summary: Too Many Drugs? The Clinical and Economic Value of Incremental Innovations, by Albert Wertheimer, Richard Levy and Thomas O'Connor, 2001
Some believe that incremental advances within the pharmaceutical industry are too costly and do not ultimately benefit the consumer. This is a misconception. The new agents resulting from this evolutionary process can offer advantages in terms of improved efficacy, better patient satisfaction and compliance and, in some cases, greater cost effectiveness.
Annotated PowerPoint slides related to this report are available.
The Value of Disease Management: Balancing Cost and Quality in the Treatment of Asthma, by Jeann Lee Gillespie, PharmD, MS, Disease Management, Vol. 5, No. 4, 2002
Asthma is often selected for disease management programs because of its high prevalence and large economic impact and the frequent failure to provide appropriate patient care and achieve optimal outcomes. The article examines the value of disease management in both improving the quality of care received and managing costs associated with the treatment of asthma. Case studies from state Medicaid initiatives and private sector HMO programs are provided.
The Value of Disease Management: Balancing Cost and Quality in the Treatment of Congestive Heart Failure, by Jeann Gillespie, PharmD, MS, Disease Management, Vol. 4, No. 2, 2001
This article reviews the literature to identify reports concerning the impact of educational interventions on heart failure treatment and management. It also
discusses why heart failure is often selected for disease management, outlines the management and treatment of heart failure, and provides a review of heart failure disease management literature.
The Value of Disease Management: Balancing Cost and Quality in the Treatment of Diabetes Mellitus, by Jeann Lee Gillespie, PharmD, MS, Disease Management, Vol. 5, No. 1, 2002
The article examines the value of disease management in both improving the quality of care received and managing costs associated with the treatment of diabetes. Case studies from state Medicaid initiatives and private sector HMO programs are provided, as well as a bibliography of 56 studies citing disease management interventions and outcomes for further reference.
The Value of Incremental Pharmaceutical Innovation for Older Americans, by Albert Wertheimer, PhD, MBA, Thomas W. O'Conner, Jr., PharmD, MBA, and Richard Levy, PhD, 2001
This monograph explains that small incremental improvements within drug classes provide important health benefits, especially for elderly patients. The monograph illustrates therapeutic advantages of these newer drugs in a class including: fewer side effects, improved safety and greater effectiveness; easier use, which facilitates compliance with prescribed regimens; and better tailoring to fit individual patient needs. Fact sheet available.
Executive Summary: The Value of Investment in Health Care: Better Care, Better Lives, 2004
Over the past few decades, significant advances in the U.S. health care system have helped people live longer and better lives. Both mortality and disability rates have fallen consistently since the 1970's. This report endeavors to examine costs in the context of benefits received by focusing on overall improvements in health, as well as taking a specific look at four conditions (heart attack, type 2 diabetes, breast cancer, and stroke) that are among the most common causes of death and disability.
Annotated PowerPoint slides related to this report are available.
CD-ROM The Value of Medical Innovation
This collection of materials on the increasingly important role of pharmaceuticals in health care delivery includes selected research from the Health Affairs September/October 2001 issue, video highlights from the September 7, 2001, Capitol Hill symposium held to discuss research featured in the issue, key points from the research, illustrative charts, and selected news articles covering the research and its implications.
The Virginia Health Outcomes Partnership: A Demonstration Project, 1997
Learn how to select diseases for Medicaid disease management from this 18-page NPC booklet written by Judith Jones, the Degge Group. See what Virginia considered before selecting asthma as its first targeted intervention. Fact sheet available.
Why the Elderly Need Individualized Pharmaceutical Care, by David Nash, MD, MBA, et al., April 2000
A “one drug fits all” approach does not work for elderly patients because they are exposed to unique health variables that are rare in younger patients. This 18-page report explains the pharmacological, physiological and epidemiological reasons why therapy for this population must be personalized.
Annotated PowerPoint slides related to this report are available.
Fact sheet available.
Your Pharmacy Benefit: Make it Work for You!
This 16-page booklet, available through the Federal Citizen Information Center offers helpful advice for those with prescription drug coverage through and employer, union, or other group plan, or who are eligible for prescription drug coverage under Medicare. The booklet guides readers through important questions to ask and things to consider when choosing a plan, and offers tips for troubleshooting problems filling prescriptions once enrolled in a plan. Includes a sample appeal letter. Also available in Spanish.
Surveys
Survey of States re Impact of MMA (UPDATED!)
Surveys of state pharmeutical assistance programs were conducted in 2005 and 2006 to provide a timely snapshot for NPC member companies on state activities regarding supplemental drug coverage. The initial SPAP survey in 2005 was conducted to ascertain the states’ plans for adapting their SPAPs to the Medicare Part D benefit. SPAPs were re-surveyed in 2006 in order to gauge their actual experience in providing financial assistance, benefits offered, difficulties experiences, etc. (Click here for the presentation on the 2006 survey's preliminary results.)
SPAPs were re-surveyed more briefly in 2007, focus on best practices for maximizing federal coverage through Part D plan and LIS enrollment.
Click here for the report and here for the presentation of the 2007 survey findings.
Aggregate Findings from 2006 SPAP Surveys. For individual survey results, please click on the state below:
Aggregate Findings from 2006 Medicaid Surveys. For individual survey results, please click on the state below:
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