Gerard F. Anderson, PhD

Using nationally representative data, the authors found that for common physician-administered drugs, hospitals’ unilaterally set cash prices are frequently lower than their median—and sometimes even their lowest—commercial negotiated prices.

Ibrutinib has been selected for Medicare price negotiation under the Inflation Reduction Act. The authors summarize the House Oversight Committee investigation to be considered by CMS during the price negotiation process.

This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.

Expanded coverage under a Medicare-Medicaid partnership to treat all prevalent cases of hepatitis C appears to be cost-effective by saving money and improving patient outcomes.

Out-of-pocket (OOP) spending for specialty drugs is substantially higher in Medicare Part D compared with employer-sponsored insurance because of the Part D benefit design.

The majority of orphan drugs are subject to utilization controls in Medicare Part D plans. The use of utilization controls varies by certain drug characteristics.

A limited distribution network is a pharmaceutical distribution strategy that some drug companies have capitalized upon to obstruct generic and biosimilar competition.

Many programs attempting to effectively treat high-need, high-cost individuals have not been able to lower spending, improve outcomes, or increase satisfaction. This paper suggests 8 attributes that many successful programs share.