Gerard F. Anderson, PhD

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.