RESUMO
The Inflation Reduction Act of 2022 (IRA) allows the Medicare program to negotiate drug prices beginning in 2024. Based on the guidance in the statute, CMS has selected specific data items to use to adjust initial price offers for 10 drugs in the decision-making process. Although much of the data are publicly available, some of these data items will need to be collected directly from drug companies. A 2019 US House of Representatives Committee on Oversight and Accountability investigative report collected a wide range of data from manufacturers of 12 high-revenue drugs that show what is available from the drug companies, including development costs, marketing, pricing, competition, and patent status. This article focuses on the data obtained for ibrutinib, an oral medication for treating hematologic malignancies, which is one of the only drugs reviewed by the committee that also has been selected for Medicare price negotiation. We examine data that can be obtained only from the drug manufacturer that the IRA has explicitly identified as being used to determine the price and suggest potential negotiation strategies for CMS in response.
Assuntos
Adenina/análogos & derivados , Custos de Medicamentos , Medicare , Piperidinas , Idoso , Humanos , Estados Unidos , Competição Econômica , Indústria FarmacêuticaRESUMO
Physician non-compete agreements may have significant competitive implications, and effects on both providers and patients, but they are treated variously under the law on a state-by-state basis. Reviewing the relevant law and the economic literature cannot identify with confidence the net effects of such agreements on either physicians or health care delivery with any generality. In addition to identifying future research projects to inform policy, it is argued that the antitrust "rule of reason" provides a useful and established framework with which to evaluate such agreements in specific health care markets and, potentially, to address those agreements most likely to do significant damage to health care competition and consumers.
Assuntos
Competição Econômica , Médicos , Humanos , Estados Unidos , Leis Antitruste , Atenção à Saúde , Setor de Assistência à SaúdeRESUMO
This cross-sectional study identifies the prevalence of patents on risk evaluation and mitigation strategies and their association with delaying generic competition.
Assuntos
Medicamentos Genéricos , Patentes como Assunto , Medicamentos sob Prescrição , Avaliação de Risco e Mitigação , Custos de Medicamentos , Indústria Farmacêutica , Medicamentos Genéricos/uso terapêutico , Competição Econômica , Avaliação de Risco e Mitigação/legislação & jurisprudência , Estados Unidos , Patentes como Assunto/legislação & jurisprudênciaRESUMO
This study examined if greater insurer market power was associated with consistently lower negotiated prices within each hospital for 44 shoppable and emergency procedures, using price transparency data disclosed by 1,506 hospitals in metropolitan areas. We used multi-level fixed effects models to estimate the within-hospital variation in plan-level insurer-negotiated prices (from the largest insurer, the second largest insurer, other major insurers, and nonmajor insurers) and cash-pay prices as a function of insurer market power. For shoppable services, relative to nonmajor insurers, the largest, second largest, and other major insurers negotiated 23%, 16%, and 3% lower prices, respectively, while cash prices were 17% higher. For emergency room visits, while the largest insurers paid 5% less than nonmajor insurers, the second largest and other major insurers did not pay lower prices. Stratified analyses by type of shoppable services found varying magnitudes and patterns of price discounts associated with insurer market power.
Assuntos
Comércio , Seguro Saúde , Humanos , Estados Unidos , Competição Econômica , Seguradoras , HospitaisRESUMO
In this latest update, we explore the Inflation Reduction Act (IRA) enacted by the US Congress in August 2022, with the Centers for Medicare and Medicaid Services (CMS) recently releasing the list of the first ten drugs it will negotiate prices on. We also cover the consequences of price controls and rigid value assessment in Germany which have led to the withdrawal of a number of medicines. It will be important to see how the IRA balances cost-saving with holistic value assessment, incentives for innovation and patient access to treatment.
Assuntos
Competição Econômica , Medicare , Idoso , Humanos , Estados Unidos , Alemanha , Custos de MedicamentosRESUMO
This study examines all patents associated with biologic litigation to understand how manufacturers use ancillary product patents to delay biosimilar market entry.
Assuntos
Produtos Biológicos , Medicamentos Biossimilares , Patentes como Assunto , Produtos Biológicos/uso terapêutico , Aprovação de Drogas , Indústria Farmacêutica , Competição Econômica , Estados Unidos , Fatores de TempoRESUMO
This study assesses the frequency of continuation patents on brand-name drugs approved by the US Food and Drug Administration from 2000 to 2015.
Assuntos
Custos de Medicamentos , Competição Econômica , Patentes como Assunto , Aprovação de Drogas/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/uso terapêutico , Estados Unidos/epidemiologia , United States Food and Drug Administration , Patentes como Assunto/estatística & dados numéricosRESUMO
Previous research has demonstrated that the introduction of a new brand-name pharmaceutical competitor does not lower list prices for existing competitive therapies. However, no study has systematically evaluated the impact of new therapeutic competition on net prices of pharmaceutical products. We identified new therapies approved during the period 2013-17 that were competitors for existing treatments. We used a novel peer-reviewed algorithm to estimate the net prices of existing therapies. We implemented regression models to estimate changes in these net prices after the approval of the new therapeutic competition during the period 2011-19. Across twelve therapeutic classes with new drug entrants in 2013-17, the introduction of new therapeutic competition was associated with a 4.2 percent decrease in annual net price growth. The introduction of new brand-name therapies in twelve therapeutic classes reduced net commercial spending on existing therapies by $10.4 billion-an 18.5 percent reduction in projected spending absent therapeutic competition. Our findings demonstrate that new therapeutic competition allows pharmacy benefit managers to use formulary management to decrease net prices and reduce drug spending, contrary to observed trends in list price increases.
Assuntos
Custos de Medicamentos , Medicamentos Genéricos , Humanos , Estados Unidos , Preparações Farmacêuticas , Competição EconômicaRESUMO
Importance: Glucagon-like peptide 1 (GLP-1) receptor agonists were first approved for the treatment of type 2 diabetes in 2005. Demand for these drugs has increased rapidly in recent years, as indications have expanded, but they remain expensive. Objective: To analyze how manufacturers of brand-name GLP-1 receptor agonists have used the patent and regulatory systems to extend periods of market exclusivity. Evidence Review: The annual US Food and Drug Administration's (FDA) Approved Drug Products With Therapeutic Equivalence Evaluations was used to identify GLP-1 receptor agonists approved from 2005 to 2021 and to record patents and nonpatent statutory exclusivities listed for each product. Google Patents was used to extract additional data on patents, including whether each was obtained on the delivery device or another aspect of the product. The primary outcome was the duration of expected protection from generic competition, defined as the time elapsed from FDA approval until expiration of the last-to-expire patent or regulatory exclusivity. Findings: On the 10 GLP-1 receptor agonists included in the cohort, drug manufacturers listed with the FDA a median of 19.5 patents (IQR, 9.0-25.8) per product, including a median of 17 patents (IQR, 8.3-22.8) filed before FDA approval and 1.5 (IQR, 0-2.8) filed after FDA approval. Fifty-four percent of all patents listed on GLP-1 receptor agonists were on the delivery devices rather than active ingredients. Manufacturers augmented patent protection with a median of 2 regulatory exclusivities (IQR, 0-3) obtained at approval and 1 (IQR, 0.3-4.3) added after approval. The median total duration of expected protection after FDA approval, when accounting for both preapproval and postapproval patents and regulatory exclusivities, was 18.3 years (IQR, 16.0-19.4). No generic firm has successfully challenged patents on GLP-1 receptor agonists to gain FDA approval. Conclusions and Relevance: Patent and regulatory reform is needed to ensure timely generic entry of GLP-1 receptor agonists to the market.
Assuntos
Diabetes Mellitus Tipo 2 , Aprovação de Drogas , Medicamentos Genéricos , Receptor do Peptídeo Semelhante ao Glucagon 1 , Hipoglicemiantes , Patentes como Assunto , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Aprovação de Drogas/legislação & jurisprudência , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Preparações Farmacêuticas/economia , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Patentes como Assunto/legislação & jurisprudência , Estados Unidos , Equivalência Terapêutica , Comércio , Competição Econômica/economia , Competição Econômica/legislação & jurisprudência , Fatores de TempoAssuntos
Atenção à Saúde , Reforma dos Serviços de Saúde , Humanos , Países Baixos , Competição EconômicaRESUMO
The FTC ruled on April 3 that Illumina must divest itself of the cancer diagnostics firm Grail, a decision designed to promote competition in the multi-cancer early detection market by providing equal access to essential DNA sequencing technology.
Assuntos
Leis Antitruste , Competição Econômica , Humanos , Estados UnidosRESUMO
The extent to which concentration in the health insurance market affects negotiated prices paid to hospitals is of high interest to policy makers. We examined the association between insurer market share and hospital prices, using a new source of data obtained through the federal Hospital Price Transparency initiative. We found that the market-leading insurer in the least competitive (most concentrated) insurance markets pays 15 percent less to hospitals than the market-leading insurer in the most competitive (least concentrated) markets. We also found the price relationship to be more pronounced for for-profit hospitals than for not-for-profit hospitals. Our results invite the question of whether dominant insurers are passing savings on to employers in the form of lower premiums.
Assuntos
Competição Econômica , Seguradoras , Humanos , Estados Unidos , Seguro Saúde , Hospitais , Negociação/métodosAssuntos
Competição Econômica , Economia Hospitalar , Hospitais , Seguradoras , Reembolso de Seguro de Saúde , Competição Econômica/economia , Competição Econômica/estatística & dados numéricos , Gastos em Saúde , Hospitais/estatística & dados numéricos , Seguradoras/economia , Seguradoras/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia , Economia Hospitalar/estatística & dados numéricos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricosRESUMO
Financial distress among rural hospitals in the US has increased in recent years. Using national hospital data, we investigated how the decline in profitability has affected hospital survival, either independently or with a merger. The answer has direct implications for access to care and competition in rural markets. We assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010-18, focusing on hospitals that were unprofitable at baseline. A minority of unprofitable hospitals (7 percent) closed. A larger share (17 percent) merged, most commonly with organizations from outside of their local geographic market. Most unprofitable hospitals (77 percent) continued to operate through 2018 without closure or merger. About half of these hospitals returned to profitability. At the market level, 22 percent of markets served by unprofitable hospitals lost a competitor to closure or within-market merger. Out-of-market mergers affected 33 percent of markets with an unprofitable hospital. Overall, our results suggest that rural markets are experiencing meaningful rates of hospital closures and mergers, yet many hospitals have survived despite poor financial performance. Policies targeting access to care will continue to be important. Similar attention will be needed to address the competitive effects of hospital closures and mergers on prices and quality.
Assuntos
Fechamento de Instituições de Saúde , Instituições Associadas de Saúde , Humanos , Estados Unidos , Hospitais Rurais , População Rural , Competição EconômicaRESUMO
This Viewpoint discusses how and why cross-market hospital mergers are different than prototypical within-market mergers in their effects on patients and communities, why the trend may be accelerating, and future policy and research directions.
Assuntos
Leis Antitruste , Competição Econômica , Instituições Associadas de Saúde , Competição Econômica/legislação & jurisprudência , Competição Econômica/tendências , Hospitais , Estados Unidos , Instituições Associadas de Saúde/economia , Instituições Associadas de Saúde/legislação & jurisprudência , Instituições Associadas de Saúde/tendênciasRESUMO
Introduction: This study investigated the impact of competition on supplier-induced demand in medical markets theoretically and experimentally. Methods: We employed the framework of credence goods to describe the information asymmetry between physicians and patients, and theoretically derives predictions of physicians' behaviors in monopolistic and competitive markets. Then we conducted behavioral experiments to empirically test the hypotheses. Results: The theoretical analysis revealed that an honest equilibrium would not exist in a monopolistic market, whereas price competition could induce physicians to reveal their types of treatment cost and provide honest treatments; thus, a competitive equilibrium is superior to that of a monopolistic market. The experimental results only partially supported the theoretical predictions, which showed that the cure rate of patients in a competitive environment was higher than that in a monopolistic market, although supplier-induced demand occurred more frequently. In the experiment, the main channel through which competition improved market efficiency was increased patient consultations through low pricing, as opposed to the theory, which stated that competition would lead to physicians' honest treatment of patients through fair prices. Discussion: We discovered that the divergence between the theory and the experiment stemmed from the theory's reliance on the assumption that humans are rational and self-interested, which means that they are not as price-sensitive as predicted by theory.