Latest Blog Posts & Articles

Thoughtful Discussion of Trump Administration Drug Pricing Plans

The Trump administration is thinking of requiring pharma companies to include price information in their ads. Here is a quick thoughtful article exploring a few reasons that information might not work as intended. It includes a summary of some of the things I’ve written about copay assistance programs, that essentially make patients insensitive to the (often extremely) high price of their medications.

A proposal by the Trump administration to address the high prices of drugs by making drugmakers include list price information in direct-to-consumer advertising received renewed attention in Congress this week. But while a recent study indicates that high list prices can indeed diminish interest in a drug, it also indicated that drugmakers can get around that by promising copay assistance and coupons.

On Tuesday, Sen. Chuck Grassley, R-Iowa, advocated inclusion of list prices in the television commercials for drugs. “I am confident in the ability of Americans to use this information to make the best decision for themselves,” he said in remarks in a hearing on drug pricing.

Some experts have already called the wisdom of that proposal into question, saying that it is more likely to cause confusion, misinformation and oversimplification of how drug pricing actually works than to create consumers well-informed and equipped to make smart decisions about their therapy.

But the new study adds an additional wrinkle, indicating that information about financial assistance may undercut the sticker shock from high prices. The study, published as a research letter last week in the Journal of the American Medical Association, was conducted by researchers at Johns Hopkins University, Clemson University and Brigham Young University.

To read the rest of this piece, please visit MedCityNews.

Posted in Health Policy

Colon Cancer Screening Controversy. Here’s What All The Debate Is About.

Tablet with the text Colonoscopy on the display photocredit: Getty

Here’s what most medical experts agree on: People 50 and older should be screened for colon cancer.
Here’s what is more controversial: Whether that screening should start, routinely, at age 45.
Recently, the American Cancer Society (ACS) recommended that colon cancer screenings start at age 45. Their recommendation was based in large part on an uptick in the number of people 45-50 years old who are being diagnosed with colon cancer in the last couple of decades, a 22% increase.
But the ACS recommendation might be recommending more cancer screening than the American public needs. In an op-ed in the Annals of Internal Medicine, three physicians raise important concerns about this new screening recommendation.
(To read the rest of this article, please visit Forbes).
Posted in Behavioral Economics and Public Policy

How Great HIV Medicines Are Now (In Two Pictures)

HIV positive test result with blood sample tube photocredit: Getty

In 1991, I remember where I was walking when I learned that Magic Johnson was HIV positive. I shuffled along in a daze, distraught at the thought of such a young and magnificent man facing imminent death. Back then, you see, an HIV diagnosis was practically a death sentence. Of course, Magic Johnson is still alive. But he was one of the minority of people in 1991 who were able to get the virus under control with the medications of that time. For the vast majority of people, the medications weren’t effective at suppressing the virus. Their days were numbered.

Boy have times changed! Medications are so good today that the majority of people under treatment for HIV have no virus detectable in their blood.

(To read the rest of this article, please visit Forbes).

Posted in Behavioral Economics and Public Policy

Think Generics Will Lower the Cost of Chemo? Think Again

photocredit: Getty

Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance rate, typical for basic Medicare coverage, leaves patients responsible for more than $20,000 of chemotherapy costs, an often crippling burden.

Fortunately, many expensive cancer drugs are going off patent soon, raising hopes that generic alternatives will significantly lower patients’ expenses.

Time to dash those hopes. Or at least generate some caution about just how much generic medications will lower chemo prices. The source of my hope dashing is a study done by Ashley Cole, a PhD student at UNC (a school that has dashed would the hopes of people like me, at Duke, more than a few times).

Posted in Critical Decisions

Physician Burnout — These Characters Are To Blame

photocredit: Getty

Physician burnout in the U.S. is reaching epidemic levels, affecting the majority of physicians in some specialties. Practicing medicine is, of course, a stressful job. Make a mistake and you might end someone’s life. But physicians are not usually burned out by such life and death matters. Instead, it’s the most mundane part of their jobs that’s driving them away from the profession.

They’re getting burned out one keystroke at a time.

(To read the rest of the article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy

Hospital Price Transparency

The US is finally making very small strides towards pulling healthcare prices out of the shadows. Here is a recent media story on the topic.

U.S. hospitals are now required to list the prices of medical services online and update them annually, under a rule change that went into effect Jan. 1.

Previously, hospitals only needed to provide standard pricing to people and to make it available upon request.

To read the rest of this piece, please visit the The Epoch Times.

Posted in Behavioral Economics and Public Policy

When Farmer Joe Gets Sick, Here’s Who He Sees

In this March 22, 2010 photo, Amanda Cockrell, 32, left, a nurse practitioner at Rush Lifetime Medical Associates examines Shanequa Reeves, 18, in Chicago. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.” (AP/John Smierciak) photocredit: ASSOCIATED PRESS

The U.S. isn’t exactly overflowing with primary care physicians. The job pays poorly compared to most medical specialties, while often requiring mastery of a fraud range of material. In fact, with expansion of insurance coverage through the Affordable Care Act, many experts worried that it would become increasingly difficult for people to gain access to primary care physicians, especially in rural parts of the country, which have long-standing shortages of such professionals.

So when Farmer Joe gets sick, who does he see? With increasing likelihood, he’s being cared for by a nurse practitioner (NP).

(To read the rest of the article, please visit Forbes.)

Posted in Health Policy | Tagged

How Hospitals Turn Charity Care Into Profits — At Taxpayers’ Expense

photocredit: Getty

Sometimes it is hard for hospitals to provide expensive care to poor patients. When a low-income patient needs $20,000 of chemotherapy, a hospital loses money if that patient cannot pay for the medicine, or pays through Medicaid, with its relatively stingy reimbursement. Fortunately, the federal government created a program for hospitals that care for a disproportionate share of low-income patients, whereby they can purchase those medicines at a discount. The program is called the 340B Drug Pricing Program and, unfortunately, hospitals are taking advantage of the program, leaving taxpayers on the hook.

Here’s how the program works. Under 340B, if more than 11.75% of a hospital’s patients are low-income, the hospital can purchase the medicines at a steep discount. When, subsequently, the hospital doesn’t get paid for the medications – say, in the case of an uninsured patient with acute leukemia – the discounts reduce the hospitals losses. In other cases, when the hospital cares for Medicaid recipients (a program that often doesn’t cover hospital costs adequately), the discounts once again reduce their losses.

Here’s how the program fails. When the hospital treats a Medicare enrollee, it will typically receive a payment that is significantly greater than its costs. In those circumstances, the hospital will have bought the medicine at a discount while selling it at full price.

(To read the rest of this article, please visit Forbes.)

Posted in Uncategorized

Christmas Shopping Tip — Your Brain Knows What You Like Better Than You Do

photocredit: Getty

A song comes through your earbuds: good rhythm, clever lyrics, pleasing melody. You know whether you like the song, right?

Maybe not. A series of studies using brain imaging raise the possibility that sometimes we think we like or dislike things, but our brains know better.

I will explain what I mean, by describing one of the studies. In it, teenagers listened to songs while researchers measured their brain activity using fMRI machines. Basically, an fMRI shows how much blood is flowing to various regions of the brain over time; when a pleasurable song pipes into kids’ ears, for example, the pleasure centers of their brains light up. After playing music and scanning people’s brains, the researchers and participants went their own separate ways. Two years later, the researchers looked at how the songs they played for the teenagers that day faired in the ensuing time. Surprisingly, the teenagers’ readings of the songs – of how much they liked or disliked – did not predict subsequent downloads their expressed opinions about the songs were like faulty political polls, failing to predict how they actually felt about the music.

(To read the rest of the article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy

The Insurance Companies That Are Most Likely To Refuse To Pay Doctors

Grunge red denied wording round rubber seal stamp on white background photocredit: Getty

Healthcare reimbursement in the U.S. is frighteningly complex. We have federal payers, like Medicare; state/federal payers, like Medicaid; private, for-profit insurance companies, like Aetna; private, not for profit insurers, like many local Blue Cross Blue Shield networks. Oh yes, and we have private insurance companies managing reimbursement for many Medicare and Medicaid recipients.

This complexity comes with costs. Doctors and hospitals need to hire armies of people to process bills for all those different payers. By one estimate, in fact, physician offices spend 30 billion dollars a year on billing-related costs.

A recent study shows which payers are most likely to reject the bills submitted to them by physicians’ offices. The winner, in case you haven’t guessed it already, is Medicaid, regardless of whether the program is run by the government or private insurers.

(To read the rest of this article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy, Health Policy