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Recently, the Office of Management and Budget has released new procedures to assess government regulation (Circular A-4) and economic policies (Circular A-94). What is unique about this guidance is that it weights benefits and costs of new regulations and policies based on the income of the individuals impacted. The goal is to help reduce inequality.…

The time may be fast approaching. A paper by Goh et al. 2024 sampled 50 physicians and examined which was better: physicians alone, physicians with access to GPT-4, or GPT-4 alone. The primary outcome was how well each group diagnosed the case (i.e., diagnostic reasoning score). The authors found that: The median diagnostic reasoning score…

Paxlovid (nirmatrelvir-ritonavir) is effective at preventing hospitalization and death from COVID-19, but few people use it. A paper by SteelFisher et al. (2024) surveyed 1,430 American adults to find out why. Their survey revealed patients had a lack of awareness of the treatment as well as misinformation about the treatment (among those who were aware…

Tyler Cowen on the price of Ozempic. Problems with the OMB’s social welfare function. Link between alcohol and cancer. Disparities in the rural-urban life expectancy. Why will Part D plans “…move drugs that are selected for [MFP] negotiation into a higher cost-sharing tier”?

My FTI colleagues Mark Van Ert and Krunal Patel summarize some of the new quality measures that will be incorporated into the 2025 CMS Star Ratings that are used to evaluate Medicare Advantage (MA) plans. The CMS Star Ratings are very important as CMS payments to MA plans is expected to increase by 3.7% or…

This questions may be harder to answer than it may seem. While some physicians are fully independent, and others are full employees, other physicians can be affiliated with hospitals, without being hospital-employed. There are various approaches for measuring whether a physician is integrated within a hospital system: Basic TIN-based measure. The standard approach to identifying…

Out of more than 50 alternative payment models (APM) that CMS has implemented only six have shown statistically significant cost savings and only four of these met the requirements to be expanded in duration and scope. That is not my opinion, CMS itself states this. We all want higher quality at lower cost; so the…

In the U.S., health insurance premiums are tax deductible–if paid through out of pocket expenses–but out-of-pocket expenses are not. However, there are exceptions to this rule. These include two often-used tax-favored accounts: Flexible savings accounts (FSA). These accounts allow employees to set aside a portion of their pretax income to cover qualified medical expenses; however,…

From the FTC’s press release out today: Today, the Federal Trade Commission brought action against the three largest prescription drug benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and OptumRx—and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’…

Why were drugs not included in Medicare in 1965? And the answer is, because drugs didn’t matter. They were not all that good, and they didn’t do a lot… We now see pharmaceutical care as the heart of treating someone; not so then. Steven Grossman, Executive Director – Alliance for a Stronger FDA It’s amazing…