Price, Value, and Access

PORTAL researchers study the high cost of prescription drugs in the US and around the world, and how to ensure essential medicines reach the patients who need them.

Price, Value, & Access

Correlation Between Changes in Brand-Name Drug Prices and Patient Out-of-Pocket Costs

Rome BN, Feldman WB, Desai RJ, Kesselheim AS | JAMA Network Open (2021)

From 2015 to 2017, list prices for brand-name drugs increased by a median of 16.7%, net prices increased by 5.4%, and out-of-pocket (OOP) spending increased by 3.5%, with changes in list prices showing weak correlation with overall out-of-pocket spending but moderate correlation among patients with deductibles or coinsurance. Policies regulating list price increases may be necessary to reduce out-of-pocket spending for patients with high-deductible or coinsurance-based plans, as manufacturer rebates do not appear to translate into reduced patient costs.

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Recent Work in Price, Value, & Access

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Skinny Labels at the Supreme Court—Generic Competition, Patent Inducement, and Affordable Medicines

Tu SS, Tessema FA, Kesselheim AS - JAMA

  • Innovation Incentives and Competition
  • Price, Value, and Access
The skinny label pathway, which allows generic manufacturers to enter the market by omitting patented indications from their labels, is under threat following Federal Circuit decisions in GlaxoSmithKline v. Teva and Amarin v. Hikma, which expanded induced infringement liability to include truthful, FDA-aligned statements and contributed to a sharp drop in skinny labeled generic entries. With Amarin now before the Supreme Court, the authors recommend ways the Court can clarify the skinny label safe harbor, warning that failure to do so risks undermining a cornerstone of the Hatch-Waxman Act and prolonging brand-name drug monopolies.
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Out-of-Pocket Spending for Insulin by Medicare Beneficiaries After Monthly Caps

Hong D, Cantos K, Morgenstern D, Dasgupta S, Kesselheim AS, Song Z, Tong AY, Chadaram R, Potter D, Patorno E, Avorn J, Rome BN - JAMA Internal Medicine

  • Price, Value, and Access
In an interrupted time-series analysis of 4.8 million Medicare beneficiaries with type 2 diabetes from 2019-2023, implementation of a $35 monthly insulin out-of-pocket cap was associated with substantial declines in insulin out-of-pocket spending, modest increases in insulin use, and decreases in patient blood glucose levels. These findings suggest that federal cost-sharing caps can meaningfully improve patient access and adherence to essential medicines like insulin for patients with chronic conditions.
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Industry Payments and Prescribing of Brand-Name Multiple Sclerosis Medications in Medicare

Patel AN, Kesselheim AS, Rome BN - Neurology

  • Innovation Incentives and Competition
  • Price, Value, and Access
  • Regulation and Clinical Evidence
In a cross-sectional study of clinicians who prescribed two multiple sclerosis drugs to Medicare patients, those who received payments from the brand-name drug manufacturers were more likely to prescribe the brand-name version rather than available generic equivalents. This suggests that these industry payments may be undermining generic competition and leading to higher costs for patients and the health care system.
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