Making Medicines Affordable


Book Description

Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.




Competition and the Cost of Medicare's Prescription Drug Program


Book Description

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization Act, or MMA) substantially expanded the federal Medicare program by creating the prescription drug benefit known as Part D. In FY 2013, Medicare Part D covered 39 million people. The federal government spent $59 billion net of premiums on Part D in that year; after accounting for certain payments from states under the program, the net federal cost was $50 billion, which represented 10% of net federal spending for Medicare. A combination of broader trends in the prescription drug market and lower-than-expected enrollment in Part D has contributed to much lower spending for the program than projected when the MMA became law in 2003. This report examines the federal budgetary cost and competitive design of Medicare Part D and compares Medicare Part D and Medicaid Fee for Service. Figures and tables. This is a print on demand report.




The Medicare Handbook


Book Description







Rare Diseases and Orphan Products


Book Description

Rare diseases collectively affect millions of Americans of all ages, but developing drugs and medical devices to prevent, diagnose, and treat these conditions is challenging. The Institute of Medicine (IOM) recommends implementing an integrated national strategy to promote rare diseases research and product development.




Pharmacy Benefits


Book Description

Pharmaceuticals have become an integral component of medical treatment, with some medications completely transforming health care outcomes and delivery. Drug therapy has been proven to reduce health care costs, increase productivity and enhance the quality of life for many people. When was the last time you examined the prescription drug component of your health care benefits? This primer offers factors to consider when designing or modifying pharmacy benefits, including the pros and cons of carving benefits into a health plan as well as carving them out as a separate prescription drug plan. A practical checklist is provided in almost every chapter to help you focus on important issues, including what questions to ask potential vendors.




PBMs


Book Description

PBMs: Reshaping the Pharmaceutical Distribution Network provides HMOs and other third-party payers with information on the new and increasingly important role of pharmaceutical benefit companies (PBMs) in the health care industry. From this text, you will learn how PBMs can maintain and deliver a quality, cost-effective drug benefit plan to your company while achieving the anticipated market share for the product. PBMs: Reshaping the Pharmaceutical Distribution Network offers you suggestions on how to choose which PBM service is correct for your business, such as what qualifications to look for in a PBM, as well as what questions you should ask a respective company. This text also offers ways on how your company can benefit from becoming a client and may make your business more competitive in the pharmaceutical industry. PBMs: Reshaping the Pharmaceutical Distribution Network also informs you about the controversies that have arisen concerning the new position of PBMs in the industry. Through research and evaluation, this text addresses these issues from many different perspectives and gives you insight into other topics concerning PBMs, including: operating methods that PBMs currently rely on for designing and overseeing a drug benefit plan how the Food and Drug Administration currently views the role of PBMs and why they are contemplating regulatory intervention alerting PBMs, pharmacies, pharmaceutical companies, and managed care organizations to new legal issues involving fraud and abuse affecting pharmacy benefit management and pharmaceutical manufacturers reasons why retail drug chains and pharmacist organizations oppose recent industry developments regarding PBMs whether or not PBMs reflect a move toward greater centralized decisionmaking in the health care systemIn addition, PBMs: Reshaping the Pharmaceutical Distribution Network offers pharmaceutical companies, health care providers, and managed care organizations several suggestions for further research, which may make your business or your business relationships more efficient and productive in the future. If you or your company are considering the services of a pharmacy benefit management, PBMs: Reshaping the Pharmaceutical Distribution Network will guide you in choosing a company that helps you deliver the most cost-effective and efficient pharmaceutical benefits to customers.







Care Without Coverage


Book Description

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.




The Role of NIH in Drug Development Innovation and Its Impact on Patient Access


Book Description

To explore the role of the National Institutes of Health (NIH) in innovative drug development and its impact on patient access, the Board on Health Care Services and the Board on Health Sciences Policy of the National Academies jointly hosted a public workshop on July 24â€"25, 2019, in Washington, DC. Workshop speakers and participants discussed the ways in which federal investments in biomedical research are translated into innovative therapies and considered approaches to ensure that the public has affordable access to the resulting new drugs. This publication summarizes the presentations and discussions from the workshop.