Publications by authors named "Sean D Sullivan"

Background: The Centers for Medicare and Medicaid Services (CMS) recently announced the Maximum Fair Price for the first 10 Medicare Part D drugs selected for price negotiation. By February 2025, CMS should announce the list of Part D drugs to be negotiated with implementation of the negotiated prices in 2027.

Objective: To identify up to 15 Medicare Part D single-source drugs anticipated to be selected by CMS for price negotiation in 2025.

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Article Synopsis
  • By September 2024, the Centers for Medicare and Medicaid Services (CMS) will disclose the Maximum Fair Prices for the first 10 drugs involved in price negotiation, using various pricing benchmarks and effectiveness data.
  • The study analyzed net prices and therapeutic alternatives to estimate initial price offers, considering regulatory guidelines and available clinical effectiveness data.
  • Initial price offers will likely be influenced by statutory price ceilings and net prices, with generics prompting potential discounts, while some drugs may need stronger negotiation strategies due to similar pricing among alternatives.
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Background: Approximately one-half of all heart failure (HF) consists of heart failure with preserved ejection fraction (HFpEF) or heart failure with mid-range ejection fraction (HFmrEF). Although several recent trials have investigated treatments for HFpEF/HFmrEF, there is limited insight on the long-term clinical trajectory of this population.

Objectives: The purpose of this study was to model clinical outcomes in patients with symptomatic (NYHA functional class II-IV) HFpEF/HFmrEF over 10 years.

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Biologic therapies play a critical role in modern medical practice but also present challenges for payers, patients, and other stakeholders because of their high cost. Biosimilars can mitigate the cost pressures of reference biologic therapy because they are typically priced at least 25% lower, providing a means to administer cutting-edge biologic therapy while also managing cost of care. In fact, the US health care system has saved an estimated $23.

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Drug shortages threaten patients' access to medications and are associated with adverse health outcomes and increased costs. Drug shortages disproportionately occur among generic drugs of limited profitability, most notably drugs administered by injection. In this perspective, we discuss how reimbursement and purchasing practices that were meant to create an efficient marketplace for generics have generated strong price pressure that threatens profitability in certain markets.

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Background: The Centers for Medicare and Medicaid Services (CMS) are currently negotiating prices with pharmaceutical manufacturers for the first 10 Part D drugs selected for Medicare drug price negotiation. Non-publicly available data, including the net prices of selected drugs and their therapeutic alternatives, will play a central role in the determination of the maximum fair prices (MFPs).

Objective: To estimate price benchmarks involved in the derivation of the starting point of the CMS initial price offer for the 10 drugs selected for Medicare price negotiation.

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Background: Larotrectinib is approved for patients with advanced gene fusion-positive solid tumors. Prior studies demonstrated promising results with larotrectinib compared with other systemic therapy. However, comparisons to checkpoint inhibitors, such as nivolumab or pembrolizumab, have not been done.

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Article Synopsis
  • Health technology assessment (HTA) for pharmaceuticals, especially rare disease treatments, involves complexities and uncertainties due to faster approval processes.
  • Real-world evidence (RWE) is being proposed to support HTA decisions, but its collection and application come with significant methodological challenges.
  • The paper emphasizes the importance of rigorous study design and analysis in using RWE, and offers suggestions to enhance its effectiveness in HTA, highlighting its growing role in determining coverage and pricing.
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Objective: Glucagon-like peptide-1 receptor agonists (GLP1s) are effective antiobesity drugs and the subject of intense debate around insurance coverage due to the large prevalence of obesity and overweight. The estimation of the budget impact associated with GLP1 insurance coverage requires estimates of GLP1 prices that account for manufacturer discounts. The authors applied a peer-reviewed method to estimate the net prices of GLP1s after manufacturer discounts.

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  • The 2022 Inflation Reduction Act allows CMS to negotiate prices for top-selling drugs in Medicare programs by comparing their prices and benefits to alternatives.
  • CMS's guidance lacks detail on how they will select therapeutic alternatives, which is crucial for pricing negotiations.
  • The study used Medicare claims data and FDA indications to identify drug use and suggest relevant alternatives, while also highlighting potential challenges CMS might encounter in this selection process.
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  • Nirmatrelvir/ritonavir (NMV/r) is a treatment for mild-to-moderate COVID-19 in high-risk adults and has also been approved for certain pediatric patients by the FDA.
  • The study aims to evaluate the annual budget impact of NMV/r within a US commercial health plan during the Omicron variant's prevalence.
  • Results show that NMV/r could potentially reduce hospitalizations significantly, leading to a total budget impact of approximately $2.7 million, with additional cost savings when considering various post-COVID conditions.
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In the rapidly evolving landscape of biotechnologies, cell and gene therapies are being developed and adopted at an unprecedented pace. However, their access and adoption remain limited, particularly in low- and middle-income countries (LMICs). This study aims to address this critical gap by exploring the potential of applying a hub and spoke model for cell and gene therapy delivery in LMICs.

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The National Academy of Medicine has called for value-based drug formularies to address health plan prescription drug spending while maintaining access to high-value medicines. Thirty employer-sponsored plans implemented a "Value-Based Formulary-essentials" (VBF-e) program that uses cost-effectiveness evidence to inform cost-sharing and coverage exclusion. To evaluate if the VBF-e was associated with changes in medication use and patient out-of-pocket spending and health plan spending on prescription drugs and other health care.

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Hemophilia A (HA) is a rare, inherited, serious bleeding disorder characterized by a deficiency of blood clotting factor VIII (FVIII). HA is associated with considerable economic burden. To identify, review, and summarize published studies on the health care resource use and costs of managing HA in the United States using a targeted literature review.

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To compare efficacy outcomes for all approved and investigational first-line (1L) treatment regimens for locally advanced or metastatic urothelial carcinoma (la/mUC) with standard of care (SOC), a network meta-analysis (NMA) was conducted. A systematic literature review (SLR) identified phase 2 and 3 randomized trials investigating 1L treatment regimens in la/mUC published January 2001-September 2021. Three networks were formed based on cisplatin (cis) eligibility: cis-eligible/mixed (cis-eligible patients and mixed populations of cis-eligible/ineligible patients), cis-ineligible (strict; exclusively cis-ineligible patients), and cis-ineligible (wide; including studies with investigator's choice of carbo).

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Objective: No consensus exists on the ideal methodology to evaluate the economic impact and value of new, potentially curative gene therapies. We aimed to identify and describe published methodologic recommendations for the economic evaluation of gene therapies and assess whether these recommendations have been applied in published evaluations.

Methods: This study was conducted in three stages: a systematic literature review of methodologic recommendations for economic evaluation of gene therapies; an assessment of the appropriateness of recommendations; and a review to assess the degree to which the recommendations were applied in published evaluations.

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  • The study examines the cost-effectiveness of next-generation sequencing (NGS) compared to sequential single-gene testing (SGT) for identifying patients with actionable genomic alterations in various cancers.
  • A cost calculator was developed using sensitivity and specificity data to estimate the cost per correctly identified patient (CCIP) for both testing methods.
  • Results show that NGS was generally more cost-effective than SGT for most cancers, suggesting that NGS may become the preferred approach in precision oncology as prices decrease and targeted therapies expand.
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Objectives: The healthcare expenditure for managing diabetes with glucose-lowering medications has been substantial in the United States. We simulated a novel, value-based formulary (VBF) design for a commercial health plan and modeled possible changes in spending and utilization of antidiabetic agents.

Methods: We designed a 4-tier VBF with exclusions in consultation with health plan stakeholders.

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