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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Cost-Effectiveness Thresholds: Overvaluing Innovation, Undervaluing Health

Rand LZG, Paulden M, Raymakers AJN - Health Affairs Forefront

  • Price, Value, and Access
Standard cost-effectiveness thresholds used in the US and other high-income countries already exceed the marginal cost of a unit of health, building in an “innovation premium” that allows new drugs to be deemed cost-effective even when adopting them produces a net population health loss. Rather than abandoning thresholds, policymakers should fund research to identify the true opportunity-cost threshold, use it as a primary result in analyses, and acknowledge this premium for “newness” as a deliberate policy choice rather than a hidden default.
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Changes in the Use of Montelukast for Asthma After a US Food and Drug Administration Boxed Warning

Shanmugam H, Kesselheim AS, Liu ITT, Feldman WB, Rome BN - JAMA Network Open

  • Price, Value, and Access
  • Regulation and Clinical Evidence
After the FDA added a boxed warning to montelukast, a widely used asthma drug, over potential neuropsychiatric adverse effects in March 2020, incident prescriptions fell nearly 30% and prevalent use declined across all age groups, with the steepest drop among children. These findings indicate that boxed warnings can meaningfully shift prescribing even when causal evidence is mixed and should be carefully tailored to the strength of available data.
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Geographic Variation in Pharmacy Competition and Social Vulnerability Proximate to Walgreens

Kissi-Twum K, Anderson KE, Mattingly TJ - Research in Social and Administrative Pharmacy

  • Price, Value, and Access
With Walgreens planning to close more than 1,200 stores nationwide, this analysis of 8,743 locations found that 85.3% of counties with a Walgreens had low-competition (i.e., fewer nearby alternative pharmacies per capita than the national average), and 334 counties were both low-competition and highly socially vulnerable (based on the CDC Social Vulnerability Index). Because the closure of a Walgreens in these counties could leave residents with few alternatives and longer travel times to access medications, they should be prioritized for contingency measures like telepharmacy or mail-order delivery. Regulators should also incorporate local competition and vulnerability metrics into pharmacy network adequacy standards.
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