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Wouters OJ, Naci H, Papanicolas I. Availability and Coverage of New Drugs in 6 High-Income Countries With Health Technology Assessment Bodies. JAMA Intern Med 2024; 184:328-330. [PMID: 38285561 PMCID: PMC10825779 DOI: 10.1001/jamainternmed.2023.7726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/22/2023] [Indexed: 01/31/2024]
Abstract
This cohort study analyzes review times and approval outcomes of health technology assessments conducted in 6 high-income countries for novel therapeutic agents approved by the US Food and Drug Administration.
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Affiliation(s)
- Olivier J. Wouters
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Irene Papanicolas
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, Rhode Island
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2
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Savova A, Manova M, Tachkov K, Petrova G. The role of insurance policies in the drug pricing landscape. Expert Rev Pharmacoecon Outcomes Res 2024; 24:189-202. [PMID: 38064353 DOI: 10.1080/14737167.2023.2292693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION This overview paper aims at summarizing and analyzing the available literature on healthcare system organization and pricing policies of 11 European countries, comparing them to the Bulgarian pharmaceutical system. The countries were selected based on the reference basket for the pricing of pharmaceuticals in Bulgaria - Belgium, Greece, Spain, Italy, Latvia, Lithuania, Romania, Slovakia, Slovenia, and France. AREAS COVERED In the first part, we explore the health system models in the above-mentioned countries. In the second part we explore the pricing and reimbursement policies, and in the third part we analyze healthcare and pharmaceutical economic indicators, as well as life expectancy. The major focus of the review is the outpatient care. EXPERT OPINION In this work, we attempted to outline differences and similarities between the countries of interest. Despite the differences in their healthcare system organization, health and pharmaceutical expenditures constantly increased during the observed 2 decades. This increase in expenditures, however, has not had a significant impact on life-expectancy. Minor increases were observed - from 2 to 4 years total. No country had an expectancy above 85 years of age. It might be said that other factors are influencing the life expectancy to a greater extent.
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Affiliation(s)
- Alexandra Savova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
- National council of prices and reimbursement of medicines, Sofia, Bulgaria
| | - Manoela Manova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
- National council of prices and reimbursement of medicines, Sofia, Bulgaria
| | | | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofias, Sofia, Bulgaria
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3
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Lin YS, Hsiao FY, Cheng SH. Long-term effects of the global budget program and periodic price adjustment on antibacterial agents: A nationwide decomposition analysis between 2001 and 2016. Am J Infect Control 2024:S0196-6553(24)00051-8. [PMID: 38272312 DOI: 10.1016/j.ajic.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Previous studies have shown that financial strategies are beneficial for improving the appropriate use of antibiotics within a limited period of time. Long-term effects have rarely been explored. METHODS This study evaluated the changes in expenditure and prescription patterns of antibacterial agents under the global budget (GB) program and drug price adjustment of a National Health Insurance scheme. Two structural methods, that is, the Laspeyres method and Fisher's Ideal Index decomposition method, were used to illustrate the impacts of price, volume, and drug change. RESULTS During the first 5 years of the GB program (ie, 2001-2006), the expenses of antibacterial agents increased by 54.1%, while the volume decreased by 11% to 21.3%. Therapeutic choice was the predominant cause of expense growth. In the second and third 5-year periods (ie, 2006-2011 and 2011-2016), the driving force of therapeutic choice gradually decreased. The antibacterial expense remained stable with a slight increase in prescription volume. Periodic price adjustment contributed steadily to cost containment, by 21.9% to 39.9%. CONCLUSIONS The GB program led to a remarkable increase in antibacterial expenses mainly attributed to therapeutic choice, especially in the early stage. In contrast, periodic price adjustment, provided steady benefits to pharmaceutical budget control without a noticeable increase in drug volume.
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Affiliation(s)
- Yu-Shiuan Lin
- Department of Pharmacy, Taipei Veteran General Hospital, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Population Health Research Center, National Taiwan University, Taipei, Taiwan.
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4
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Glaus CEG, Kloeti A, Vokinger KN. Defining 'therapeutic value' of medicines: a scoping review. BMJ Open 2023; 13:e078134. [PMID: 38110384 DOI: 10.1136/bmjopen-2023-078134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES In recent years, discussions on the importance and scope of therapeutic value of new medicines have intensified, stimulated by the increase of prices and number of medicines entering the market. This study aims to perform a scoping review identifying factors contributing to the definition of the therapeutic value of medicines. DESIGN Scoping review. DATA SOURCES We searched the MEDLINE, CINAHL, Embase, Business Source Premier, EconLit, Regional Business News, Cochrane, Web of Science, Scope and Pool databases through December 2020 in English, German, French, Italian and Spanish. ELIGIBILITY CRITERIA Studies that included determinants for the definition of therapeutic value of medicines were included. DATA EXTRACTION AND SYNTHESIS Data were extracted using the mentioned data sources. Two reviewers independently screened and analysed the articles. Data were analysed from April 2021 to May 2022. RESULTS Of the 1883 studies screened, 51 were selected and the identified factors contributing to the definition of therapeutic value of medicines were classified in three categories: patient perspective, public health perspective and socioeconomic perspective. More than three-quarters of the included studies were published after 2014, with the majority of the studies focusing on either cancer disorders (14 of 51, 27.5%) or rare diseases (11 of 51, 21.6%). Frequently mentioned determinants for value were quality of life, therapeutic alternatives and side effects (all patient perspective), prevalence/incidence and clinical endpoints (all public health perspective), and costs (socioeconomic perspective). CONCLUSIONS Multiple determinants have been developed to define the therapeutic value of medicines, most of them focusing on cancer disorders and rare diseases. Considering the relevance of value of medicines to guide patients and physicians in decision-making as well as policymakers in resource allocation decisions, a development of evidence-based factors for the definition of therapeutic value of medicines is needed across all therapeutic areas.
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Affiliation(s)
- Camille E G Glaus
- Academic Chair for Regulation in Law, Medicine, and Technology, Faculty of Law and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Andrina Kloeti
- Academic Chair for Regulation in Law, Medicine, and Technology, Faculty of Law and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Kerstin N Vokinger
- Academic Chair for Regulation in Law, Medicine, and Technology, Faculty of Law and Faculty of Medicine, University of Zurich, Zurich, Switzerland
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5
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Hu X. How to price drugs reasonably? Ann Allergy Asthma Immunol 2023; 131:400. [PMID: 37661174 DOI: 10.1016/j.anai.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Xiaojing Hu
- Human Resources Department, Peking University First Hospital, Beijing, China.
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6
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Egilman AC, Rome BN, Kesselheim AS. Added Therapeutic Benefit of Top-Selling Brand-name Drugs in Medicare. JAMA 2023; 329:1283-1289. [PMID: 37071095 PMCID: PMC10114018 DOI: 10.1001/jama.2023.4034] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/02/2023] [Indexed: 04/19/2023]
Abstract
Importance The Inflation Reduction Act of 2022 authorizes Medicare to negotiate prices of top-selling drugs based on several factors, including therapeutic benefit compared with existing treatment options. Objective To determine the added therapeutic benefit of the 50 top-selling brand-name drugs in Medicare in 2020, as assessed by health technology assessment (HTA) organizations in Canada, France, and Germany. Design, Setting, and Participants In this cross-sectional study, publicly available therapeutic benefit ratings, US Food and Drug Administration documents, and the Medicare Part B and Part D prescription drug spending dashboards were used to determine the 50 top-selling single-source drugs used in Medicare in 2020 and to assess their added therapeutic benefit ratings through 2021. Main Outcomes and Measures Ratings from HTA bodies in Canada, France, and Germany were categorized as high (moderate or greater) or low (minor or no) added benefit. Each drug was rated based on its most favorable rating across countries, indications, subpopulations, and dosage forms. We compared the use and prerebate and postrebate (ie, net) Medicare spending between drugs with high vs low added benefit. Results Forty-nine drugs (98%) received an HTA rating by at least 1 country; 22 of 36 drugs (61%) received a low added benefit rating in Canada, 34 of 47 in France (72%), and 17 of 29 in Germany (59%). Across countries, 27 drugs (55%) had a low added therapeutic rating, accounting for $19.3 billion in annual estimated net spending, or 35% of Medicare net spending on the 50 top-selling single-source drugs and 11% of total Medicare net prescription drug spending in 2020. Compared with those with high added benefit, drugs with a low added therapeutic rating were used by more Medicare beneficiaries (median 387 149 vs 44 869) and had lower net spending per beneficiary (median $992 vs $32 287). Conclusions and Relevance Many top-selling Medicare drugs received low added benefit ratings by the national HTA organizations of Canada, France, and Germany. When negotiating prices for these drugs, Medicare should ensure they are not priced higher than reasonable therapeutic alternatives.
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Affiliation(s)
- Alexander C. Egilman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Program on Regulation, Therapeutics, and Law (PORTAL), Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Benjamin N. Rome
- Division of Pharmacoepidemiology and Pharmacoeconomics, Program on Regulation, Therapeutics, and Law (PORTAL), Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Program on Regulation, Therapeutics, and Law (PORTAL), Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Walsh BS, Kesselheim AS, Rome BN. Medicaid Spending on Antiretrovirals From 2007 Through 2019. Clin Infect Dis 2023; 76:833-841. [PMID: 36268585 DOI: 10.1093/cid/ciac833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antiretroviral (ARV) medications to treat human immunodeficiency virus (HIV) are a major contributor to Medicaid prescription drug spending. Despite having been used for over 3 decades, the first generic ARVs only recently became available, and many newer versions continue to be sold at high prices despite within-class competition. We estimated Medicaid spending on ARVs from 2007 through 2019. METHODS Using public Medicaid State Drug Utilization data, we identified trends in ARV spending and use from 2007 through 2019. We estimated net spending and average prices (spending per 30-day supply), accounting for statutory Medicaid rebates, including a 15%-23% base rebate plus additional rebates if a drug's price increased faster than inflation. RESULTS Among 48 ARVs, estimated net Medicaid spending from 2007 through 2019 was $25 billion for 17 million 30-day supplies. Annual use increased 118%, from 0.7 million 30-day supplies in 2007 to 1.6 million in 2019. During this time, estimated annual net spending increased 178%, from $1.1 billion to $3.0 billion, and average net prices increased 28%, from $1432 to $1830 per 30-day supply. CONCLUSIONS Annual Medicaid net spending on ARVs nearly tripled from 2007 to 2019, due to a combination of expanded use and rising prices. Medicaid did not extract expected benefits from its mandatory inflationary rebates because they were offset by use of newer, more expensive ARVs. To better control spending related to products with incremental innovation, the US government should be authorized to assure that launch prices for new drugs are aligned with the added benefit they offer over existing therapies.
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Affiliation(s)
- Bryan S Walsh
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin N Rome
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Yan VKC, Li HL, Wei L, Knapp MRJ, Wong ICK, Chan EW. Evolving Trends in Consumption of Direct Oral Anticoagulants in 65 Countries/Regions from 2008 to 2019. Drugs 2023; 83:315-340. [PMID: 36840892 DOI: 10.1007/s40265-023-01837-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) have been increasingly utilised over warfarin. However, little is known about the relative consumption trends and costs of each DOAC at the global level. METHODS An ecological study using pharmaceutical sales data from IQVIA-MIDAS database was used to estimate consumption and cost of individual DOACs in 65 countries from 2008 to 2019. Consumption was estimated from the volume of DOACs sold, expressed as defined-daily-dose/1000-inhabitants/day (DDDTID). Compound and absolute annual growth rates were reported to quantify consumption changes over time. Costs were estimated as manufacturer price per day-of-therapy. RESULTS Global consumption of dabigatran, rivaroxaban, apixaban and edoxaban were 0.31, 1.05, 1.08 and 0.78 DDDTID, respectively, in Q2-2019, compared to 0.23, 0.54, 0.21 and 0.03 in Q2-2015, with highest consumption in Western Europe, Northern Europe and Oceania (18.2, 14.07, 13.14 DDDTID). In most countries (46/65, 70%), rivaroxaban contributed to most DOAC consumption (35%-100%), whereas dabigatran accounted for less than one-third. Edoxaban accounted for < 20% of the total in Northern America and Europe but contributed significant proportions in Japan (28.58%) and South Korea (31.37%). Longer median time-to-adoption from FDA approval for apixaban and edoxaban was observed. Costs of all DOACs were ~2-4 times higher in the USA, Puerto Rico and Thailand than in other countries. CONCLUSIONS Regional differences exist in consumption pattern and trends of individual DOACs over the past decade. Consumption of rivaroxaban and apixaban overtook dabigatran in most countries, whereas use of edoxaban remains limited except in East Asian countries. The USA pays higher prices for DOACs than other countries.
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Affiliation(s)
- Vincent K C Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, General Office L02-56, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Hang-Long Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, General Office L02-56, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Division of Cardiology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health, Hong Kong SAR, China
| | - Martin R J Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, General Office L02-56, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK
- Laboratory of Data Discovery for Health, Hong Kong SAR, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, General Office L02-56, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
- Laboratory of Data Discovery for Health, Hong Kong SAR, China.
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Hong Kong SAR, China.
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Rome BN, Nagar S, Egilman AC, Wang J, Feldman WB, Kesselheim AS. Simulated Medicare Drug Price Negotiation Under the Inflation Reduction Act of 2022. JAMA HEALTH FORUM 2023; 4:e225218. [PMID: 36705916 DOI: 10.1001/jamahealthforum.2022.5218] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Importance The Inflation Reduction Act of 2022 gives Medicare the authority to negotiate prices for certain prescription drugs. Which drugs will be selected and how prices will be negotiated remain unclear. Objective To simulate drug selection and the minimum savings that would have been achieved at statutory ceiling prices if Medicare drug price negotiation had been implemented from 2018 to 2020. Design, Setting, and Participants In this cross-sectional study, a policy simulation analysis of high-spending prescription drugs in Medicare Part B and Part D that were eligible for negotiation from January 2018 to December 2020 was performed from August 5 to November 20, 2022. Exposures Eligibility criteria for selection and discounts afforded by the statutory ceiling prices for negotiation. Main Outcomes and Measures The main outcomes were characteristics of drugs subject to negotiation and estimated Medicare savings from 2018 to 2020 that would have been achieved through spending at ceiling prices compared with existing net prices accounting for price concessions. Results Among the 40 selected drugs, 35 were primarily reimbursed through Medicare Part D and 5 through Part B and 10 were biologics. The most common therapeutic classes were endocrine (11), neurologic or psychiatric (5), pulmonary (4), rheumatologic or immunologic (4), and cardiovascular (4). Median time from US Food and Drug Administration approval to selection was 12 years (IQR, 10-14 years). Three drugs faced generic competition in the 2 years between selection and price negotiation. For the remaining 37 drugs, estimated net Medicare spending from 2018 to 2020 was $55.3 billion; spending at ceiling prices would have been reduced by an estimated $26.5 billion, which represented 5% of estimated net Medicare drug spending during those 3 years. Conclusions and Relevance In this cross-sectional study, simulating the drug price negotiation provisions in the Inflation Reduction Act of 2022 revealed important limitations, including strict selection criteria and the potential for drugs to become ineligible for negotiation during the 2 years between selection and prices taking effect. Despite these limitations, the policy still delivered substantial savings because ceiling prices offered steep discounts, in part, by erasing excess spending from price increases faster than inflation.
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Affiliation(s)
- Benjamin N Rome
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sarosh Nagar
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alexander C Egilman
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Junyi Wang
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - William B Feldman
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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10
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Rand LZ, Kesselheim AS. Getting the Price Right: Lessons for Medicare Price Negotiation from Peer Countries. PHARMACOECONOMICS 2022; 40:1131-1142. [PMID: 36348153 DOI: 10.1007/s40273-022-01195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
The USA pays more for brand-name prescription drugs than any other country and new legislation from August 2022 gives Medicare the authority to directly negotiate certain drug prices with manufacturers starting in 2026-something the federal insurer had been prohibited from doing for its prior history. As the USA prepares for negotiations, we therefore surveyed how comparable industrialized countries use statutory requirements and procedures to negotiate brand-name drug prices. Guidance documents, regulations, government and academic publications were reviewed to identify the process of negotiating drug prices in peer countries that have been cited as potential examples for US payment reform: Australia, Canada, France, Germany, and the UK. Processes for arriving at a final price for a drug generally fall under three approaches: statutory rebates, setting a maximum price, and arbitration between national (public) insurers and manufacturers. Each approach to price negotiation could be adopted by Medicare and reduce spending even if Medicare does not adopt an exclusionary or closed formulary. Much remains to be determined about how the new price negotiation authority in the USA will be implemented, and policymakers can learn from comparator countries' statutory and regulatory strategies for price negotiation.
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Affiliation(s)
- Leah Z Rand
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard Medical School Center for Bioethics, Boston, MA, USA.
| | - Aaron S Kesselheim
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA
- Harvard Medical School, Boston, MA, USA
- Harvard Medical School Center for Bioethics, Boston, MA, USA
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Tranvåg EJ, Haaland ØA, Robberstad B, Norheim OF. Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions. JAMA Netw Open 2022; 5:e2219503. [PMID: 35767256 PMCID: PMC9244608 DOI: 10.1001/jamanetworkopen.2022.19503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Rising health care costs are a major health policy challenge globally. Norway has implemented a priority-setting system intended to balance cost-effectiveness and concerns for fair distribution, but little is known about this strategy and whether it works in practice. OBJECTIVE To present and evaluate a systematic drug appraisal method that uses the severity of disease to account for a fair distribution of health in cost-effectiveness analysis, forming the basis for price negotiations and coverage decisions. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study uses confidential drug price information and publicly available data from health technology assessments and logistic and linear regression analyses to evaluate drug coverage decisions for the Norwegian specialized health care sector from 2014 to 2019. MAIN OUTCOMES AND MEASURES Drug coverage decisions by Norwegian authorities and incremental cost-effectiveness and severity of disease measured as absolute shortfall of quality adjusted life years. RESULTS Between 2014 and 2019, a total of 188 drugs were appraised, of which 113 were cancer drugs. The overall coverage rate was 73% (138 of 188). The number of annual appraisals increased during the observation period. Based on 83 chosen decisions, regression analysis showed that incremental cost-effectiveness ratios (ICER) based on negotiated drug prices, adjusted for severity-differentiated cost-effectiveness thresholds, was the variable that best projected drug approvals (OR, 0.60; 95% CI, 0.42-0.86). An increase in the ICER by $10 000 was associated with a reduction in the odds for approval of 40% for drugs assessed from 2018 to 2019. CONCLUSIONS AND RELEVANCE This cross-sectional study demonstrated how concerns for efficiency and fair distribution of health can be implemented systematically into drug appraisals and reimbursement decisions. New, expensive drugs are expected to escalate health care costs in the years to come, and it may be feasible to control costs by negotiating the prices of new drugs while appraising both their cost-effectiveness and how their health benefits are distributed.
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Affiliation(s)
- Eirik Joakim Tranvåg
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Ariansen Haaland
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Research Group in Health Economics, Leadership, and Translational Ethics Research, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ole Frithjof Norheim
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Sorum P, Stein C, Wales D, Pratt D. A Proposal to Increase Value and Equity in the Development and Distribution of New Pharmaceuticals. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:363-371. [PMID: 35546103 PMCID: PMC9203670 DOI: 10.1177/00207314221100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The process of developing and marketing new pharmaceuticals in the United States is driven by a need to maximize returns to shareholders. This results all too often in the production of new medications that are expensive and of marginal value to patients and society. In line with our heightened awareness of the importance of social justice and public health—and in light of our government‘s alliance with private companies in bringing us COVID-19 vaccines—we need to reconsider how new pharmaceuticals are developed and distributed. Accordingly, we propose the creation of a new agency of the Food and Drug Administration (FDA) that would direct the whole process. This agency would fund the research and development of high-value medications, closely monitor the clinical studies of these new drugs, and manage their distribution at prices that are value-based, fair, and equitable.
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Affiliation(s)
- Paul Sorum
- Internal Medicine and Pediatrics, 1092Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | | | - Danielle Wales
- Internal Medicine and Pediatrics, 1092Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | - David Pratt
- 167519Schenectady County Public Health Services, Schenectady, NY, USA
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13
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Naci H, Kyriopoulos I, Feldman WB, Hwang TJ, Kesselheim AS, Chandra A. Coverage of New Drugs in Medicare Part D. Milbank Q 2022; 100:562-588. [PMID: 35502786 DOI: 10.1111/1468-0009.12565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Policy Points Only a small minority of new drugs in "nonprotected" classes are widely covered by Part D plans nationwide in the year after US Food and Drug Administration (FDA) approval. Part D plans frequently apply utilization management restrictions such as prior authorizations to newly approved drugs in both protected and nonprotected classes. Drug price influences both formulary inclusion (in nonprotected classes) and coverage restrictions (in both protected and nonprotected classes), while other drug characteristics such as therapeutic benefits are not consistently associated with formulary design. Plans do not seem to favor the minority of drugs that are determined to offer added therapeutic benefit over existing alternatives. CONTEXT Medicare Part D is an outpatient prescription drug benefit for older Americans covering more than 46 million beneficiaries. Except for mandatory coverage for essentially all drugs in six protected classes, plans have substantial flexibility in how they design their formularies: which drugs are covered, which drugs are subject to restrictions, and what factors determine formulary placement. Our objective in this paper was to document the extent to which Part D plans limit coverage of newly approved drugs. METHODS We examined the formulary design of 4,582 Part D plans from 2014 through 2018 and measured (1) the decision to cover newly approved drugs in nonprotected classes, (2) use of utilization management tools in protected and nonprotected classes, and (3) the association between plan design and drug-level characteristics such as 30-day cost, therapeutic benefit, and the US Food and Drug Administration (FDA) expedited regulatory pathway. FINDINGS The FDA approved 109 new drugs predominantly used in outpatient settings between 2013 and 2017. Of these, 75 fell outside of the six protected drug classes. One-fifth of drugs in nonprotected classes (15 out of 75) were covered by more than half of plans during the first year after approval. Coverage was often conditional on utilization management strategies in both protected and nonprotected classes: only seven drugs (6%) were covered without prior authorization requirements in more than half of plans. Higher 30-day drug costs were associated with more widespread coverage in nonprotected classes: drugs that cost less than $150 for a 30-day course were covered by fewer than 20% of plans while those that cost more than $30,000 per 30 days were covered by more than 50% of plans. Plans were also more likely to implement utilization management tools on high-cost drugs in both protected and nonprotected classes. A higher proportion of plans implemented utilization management strategies on covered drugs with first-in-class status than drugs that were not first in class. Other drug characteristics, including availability of added therapeutic benefit and inclusion in FDA expedited regulatory approval, were not consistently associated with plan coverage or formulary restrictions. CONCLUSIONS Newly approved drugs are frequently subject to formulary exclusions and restrictions in Medicare Part D. Ensuring that formulary design in Part D is linked closely to the therapeutic value of newly approved drugs would improve patients' welfare.
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Affiliation(s)
- Huseyin Naci
- London School of Economics and Political Science
| | | | - William B Feldman
- Program on Regulation, Therapeutics, and Law (PORTAL), Brigham and Women's Hospital and Harvard Medical School
| | - Thomas J Hwang
- Program on Regulation, Therapeutics, and Law (PORTAL), Brigham and Women's Hospital and Harvard Medical School
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Brigham and Women's Hospital and Harvard Medical School
| | - Amitabh Chandra
- John F. Kennedy School of Government and Harvard Business School
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Mamiya H, Igarashi A. Impact of reimbursement restriction on drug market sales under the National Health Insurance in Japan. J Med Econ 2022; 25:206-211. [PMID: 35060813 DOI: 10.1080/13696998.2022.2032096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM National health care expenditures have been increasing each year, although the Japanese government has annually revised official drug prices. Managing the health care system to pay for expensive drugs is a major concern. The reimbursement restriction, which is the only way that a drug can be implemented before market entry in Japan, is crucial for managing expenditures. Therefore, this study identifies the impact of the reimbursement restriction on drug market sales in Japan, particularly in the situation where health technology assessment or other market access regulations are not applicable before market entry. METHOD All new drugs listed in fiscal years 2011-2019, along with their market size forecast, were identified using the materials from the Central Social Insurance Medical Council. We then calculated the percentage rate of reimbursement amounts based on the National Database of Health Insurance Claims relative to the predicted market size as a dependent variable. Using the reimbursement restriction for each drug as an independent variable, we performed descriptive and univariate analyses on each variable, followed by generalized linear mixed-effects model regression analysis. RESULTS We identified 211 drugs. The mean rates of drugs that required physicians, facilities, and patients to meet criteria for use were 30.85% (n = 2), 31.42% (n = 2), and 72.11% (n = 6), respectively. The mean rate of drugs that required diagnostic testing was 22.99% (n = 7), which was 3.7 times lower than the rate of drugs that did not require such testing (p < .05). CONCLUSION Our results indicate that the reimbursement restriction requiring diagnostic testing has a substantial impact on decreasing market sales. As the number of cases for each requirement is small, further study is needed to measure the impact of the other reimbursement restrictions.
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Affiliation(s)
- Hiroaki Mamiya
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, Yokohama, Japan
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15
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Fu M, Naci H, Booth CM, Gyawali B, Cosgrove A, Toh S, Xu Z, Guan X, Ross-Degnan D, Wagner AK. Real-world Use of and Spending on New Oral Targeted Cancer Drugs in the US, 2011-2018. JAMA Intern Med 2021; 181:1596-1604. [PMID: 34661604 PMCID: PMC8524355 DOI: 10.1001/jamainternmed.2021.5983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/20/2021] [Indexed: 01/23/2023]
Abstract
Importance Launch prices of new cancer drugs in the US have substantially increased in recent years despite growing concerns about the quantity and quality of evidence supporting their approval by the US Food and Drug Administration (FDA). Objective To assess the use of and spending on new oral targeted cancer drugs among US residents with employer-sponsored insurance between 2011 and 2018, stratified by the strength of available evidence of benefit. Design, Setting, and Participants In this cross-sectional study, dispensing claims for oral targeted cancer drugs first approved by the FDA between January 1, 2011, and December 31, 2018, were analyzed. The number of patients with drugs dispensed and the total payment for all claims were aggregated by calendar year, and these outcomes were arrayed according to evidence underlying FDA approvals, including pivotal study design (availability of randomized clinical trials) and overall survival (OS) benefit, as documented in drug labels. This study was conducted from July 17, 2019, to July 23, 2021. Main Outcomes and Measures Annual and cumulative numbers of patients who had dispensing events, and annual and cumulative sums of payment for eligible drugs. Results Of 37 348 patients who had at least 1 of the 44 new oral targeted drugs dispensed between 2011 and 2018, 21 324 were men (57.1%); mean (SD) age was 64.1 (13.1) years. Most individuals (36 246 [97.0%]) received drugs for which evidence from randomized clinical trials existed; however, a growing share of patients received drugs without documented OS benefit during the study period: from 12.7% in 2011 to 58.8% in 2018. Cumulative spending on all sample drugs totaled $3.5 billion by the end of 2018, of which 96.8% was spent on drugs that were approved based on a pivotal randomized clinical trial. Cumulative spending on drugs without documented OS benefit ($1.8 billion [51.6%]) surpassed that on drugs with documented OS benefit ($1.7 billion [48.4%]) by the end of 2018. Conclusions and Relevance The findings of this cross-sectional study suggest that drugs used for treatment of cancer without documented OS benefits are adopted in the health system and account for substantial spending.
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Affiliation(s)
- Mengyuan Fu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Christopher M. Booth
- Division of Cancer Care and Epidemiology, Departments of Oncology and Public Health Sciences, Queen’s University Cancer Research Institute, Kingston, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Departments of Oncology and Public Health Sciences, Queen’s University Cancer Research Institute, Kingston, Canada
| | - Austin Cosgrove
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Ziyue Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Anita K. Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Robinson JC, Jarrion Q. Competition From Biosimilars Drives Price Reductions For Biologics In The French Single-Payer Health System. Health Aff (Millwood) 2021; 40:1190-1197. [PMID: 34339240 DOI: 10.1377/hlthaff.2021.00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
France has a single-payer health insurance system that has the authority to impose pharmaceutical price reductions but relies on decentralized market negotiations between hospitals and manufacturers to establish prices for injected and infused biologics. Hospitals rely on biosimilars-less expensive but therapeutically equivalent variants of biologic medications-to stimulate competition. Price reductions negotiated by hospitals subsequently are adopted by the health insurance system, driving hospitals to negotiate a new round of discounts. This article measures 2004-20 trends in prices, price reductions, utilization, and market shares for three prominent biologics-Remicade, Enbrel, and Humira-and their eleven competing biosimilars. Biosimilar launches are associated with a sequence of price reductions for the reference biologic, for other biologics that treat similar conditions, and for all related biosimilars. The French experience provides lessons for the US in its efforts to use competition from biosimilars to drive price reductions and savings from biologics.
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Affiliation(s)
- James C Robinson
- James C. Robinson is the Leonard D. Schaeffer Professor of Health Economics in the Division of Health Policy and Management, School of Public Health, at the University of California Berkeley, in Berkeley, California. He is a Health Affairs contributing editor
| | - Quentin Jarrion
- Quentin Jarrion is a research physician, Health Information Management Department, University Hospitals of Reims, in Reims, France. At the time this research was initiated, he was a visiting scholar at the University of California Berkeley
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17
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Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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18
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Kennedy C, Smith A, O’Brien E, Rice J, Barry M. Prescribers’ knowledge of drug costs: a contemporary Irish study. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yeung K, Dusetzina SB. Prescription Drug Out-of-Pocket Cost Reduction Programs: Incentives and Implications. JAMA Intern Med 2021; 181:765-766. [PMID: 33779700 DOI: 10.1001/jamainternmed.2021.0739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle.,The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee.,Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
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20
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Hartung DM. Economics of Multiple Sclerosis Disease-Modifying Therapies in the USA. Curr Neurol Neurosci Rep 2021; 21:28. [PMID: 33948740 DOI: 10.1007/s11910-021-01118-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Multiple sclerosis (MS) is a prevalent and debilitating neuroinflammatory disease associated with a significant economic burden. Direct healthcare costs, which can average $70,000 a year, have risen rapidly over the last decade and are driven by the escalating cost of disease-modifying therapies (DMTs). Despite a growing number of DMTs, annual increases in price for most DMTs have commonly exceeded 10% over the last 15 years. The high cost of MS DMTs has created economic hardships for patients in terms of high out-of-pocket costs and insurance company-induced barriers. Although generic versions of glatiramer acetate and dimethyl fumarate have provided some lower cost options, the median annual price for branded products currently exceeds $90,000. The goal of this paper is to examine the economic landscape of MS DMTs in the USA. RECENT FINDINGS Recent economic analyses have provided new insights into the relative value of DMTs. Robust economic modeling studies suggest that costs per quality-adjusted life-year for most DMTs exceed commonly endorsed thresholds for what is considered a reasonable value in the USA. Because of higher efficacy and lower net costs, ocrelizumab and alemtuzumab are considered the best value. It is likely that generic versions of dimethyl fumarate and glatiramer acetate are also economically attractive. DMTs provide clinical benefit for patients with MS; however, their high cost can be a financial burden and impede access. High DMT prices are the principal reason why cost-effectiveness studies have indicated the economic value of most DMTs is questionable.
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Affiliation(s)
- Daniel M Hartung
- College of Pharmacy, Oregon State University, 2730 SW Moody Ave CL5CP, Portland, OR, 97201-5042, USA.
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21
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Shortliffe EH, Lyman GH, Amankwah FK. Medications in Single-Dose Vials and Implications of Discarded Injectable Drugs: A National Academies Report. JAMA 2021; 325:1507-1508. [PMID: 33630017 DOI: 10.1001/jama.2021.2414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Edward H Shortliffe
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University in the City of New York
| | - Gary H Lyman
- Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Healthcare Quality and Policy, Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Francis K Amankwah
- Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, DC
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23
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Errors in Wording and a Percentage. JAMA Intern Med 2020; 180:1555. [PMID: 33136127 PMCID: PMC7607439 DOI: 10.1001/jamainternmed.2020.6856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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