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.

Read More

Recent Work in Price, Value, & Access

Talk bubble graphics representing commentary and opinion.

Reforming Payment for Clinician-Administered Drugs — Most-Favored-Nation Pricing in Medicare Part B

Hwang TJ, Clemans-Cope L, Kesselheim AS - New England Journal of Medicine

  • Price, Value, and Access
The Trump administration’s proposed GLOBE model would align Medicare Part B payments for clinician-administered drugs with international pricing benchmarks, with CMS estimating $11.9 billion in Medicare savings and $6.2 billion in reduced beneficiary cost-sharing over seven years. The model would be strengthened by incorporating clinical benefit into rebate determinations, replacing the lowest-available-list-price benchmark with average international prices to reduce manufacturer gaming, and expanding the program nationwide if evidence of improved health outcomes emerges.
View Source
Simple graphic of magnifying glass examining papers to signify reviewing research publications.

Implications of Medicare Negotiation and Most-Favored-Nation Pricing for Cancer Medicine Costs

Hwang TJ, Tibau A, Kesselheim AS, Vokinger KN - JAMA Health Forum

  • Price, Value, and Access
In this cohort study of brand-name cancer drugs in Medicare Part B and Part D, applying most-favored-nation (MFN) pricing tied to international benchmarks in 2024 could have reduced Medicare drug spending by an incremental 28-41% compared to Medicare negotiation alone. However, the long-term sustainability of MFN savings is uncertain given the potential for manufacturer gaming, and policymakers should explore sharing savings with patients by eliminating out-of-pocket costs for highly effective therapies.
View Source
Talk bubble graphics representing commentary and opinion.

Deeming Doesn’t Deliver: Reliance on Foreign Regulators Targets the Wrong Stage of Canadian Drug Access

Eisenkraft Klein D, Kesselheim AS - Health Policy

  • Price, Value, and Access
  • Regulation and Clinical Evidence
The authors argue that Health Canada’s proposal to deem certain drug submission requirements met based on foreign regulatory decisions targets the wrong stage of Canada’s drug access pipeline. The primary drivers of delayed access are manufacturers’ late submissions and prolonged public reimbursement processes, not regulatory review times. More impactful reforms would include incentives for earlier manufacturer filings, enforceable timelines for reimbursement negotiations, and a pan-Canadian listing default to meaningfully accelerate patient access to new therapies.
View Source