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Innovative Insurance to Improve US Patient Access to Cell and Gene Therapy.
Milbank Q
January 2025
Questrom School of Business, Boston University.
Unlabelled: Policy Points Cell and gene therapies (CGTs) offer treatment for rare and oftentimes deadly disease, but their prices are high, and payers may seek to limit spending. Total annual costs of covering all existing and expected CGTs for the entire US population 2023-2035 to amount to less than $20 per person and concentrate in commercial and state Medicaid plans. Reinsurance fees add to expected costs.
View Article and Find Full Text PDFEconomic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review.
J Mark Access Health Policy
December 2024
Center for Value Based Insurance Design (V-BID), University of Michigan, Ann Arbor, MI 48109, USA;
In health insurance, "moral hazard" describes the concept that coverage without an out-of-pocket cost to consumers could result in health care utilization beyond economically efficient levels. In response, payers in the United States (US) have designed pharmaceutical benefit plans with significant cost exposure (e.g.
View Article and Find Full Text PDFImpact of paramagnetic rim lesions on disability and race in multiple sclerosis: mediation analysis.
Ann Clin Transl Neurol
November 2024
Department of Neurology, Weill Cornell Medicine, New York, New York, USA.
Objective: Black American (BA) multiple sclerosis (MS) patients experience greater disability compared to White American (WA) patients. Here, we investigated the role of paramagnetic rim lesions (PRLs), a subset of chronic active lesions, on race-related disability in MS.
Methods: We conducted a retrospective observational study comparing BA and WA MS patients.
Dual-Eligible Nursing Home Residents: Enrollment Growth In Managed Care Plans That Coordinate Care, 2013-20.
Health Aff (Millwood)
September 2024
Rachel M. Werner, University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system leads to poor quality and inefficient care, particularly for dual-eligible nursing home residents, has led policy makers to test managed care plans that provide incentives for coordinating care across Medicare and Medicaid. We examined enrollment in three such plans among dual-eligible beneficiaries receiving long-term nursing home care.
View Article and Find Full Text PDFIs the price right? Paying for value today to get more value tomorrow.
BMC Med
January 2024
RA Capital Management LP, Boston, USA.
Background: Contemporary debates about drug pricing feature several widely held misconceptions, including the relationship between incentives and innovation, the proportion of total healthcare spending on pharmaceuticals, and whether the economic evaluation of a medicine can be influenced by things other than clinical efficacy.
Main Body: All citizens should have access to timely, equitable, and cost-effective care covered by public funds, private insurance, or a combination of both. Better managing the collective burden of diseases borne by today's and future generations depends in part on developing better technologies, including better medicines.
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