Prescription Drugs

Sean Dickson and coauthors analyze the effect on prices, net of rebates, for all instances when a new brand-name pharmaceutical is introduced that competes with an existing therapy. Between 2011 and 2019, this type of competition "was associated with a 4.2 percent decrease in annual net price growth and resulted in net prices that were 6.8 percent lower, on average, than net prices before competition."

Annabelle Fowler and coauthors track the prevalence and characteristics of authorized generics: approved drugs that are identical to their brand-name drug counterpart but are sold without brand-name labeling.

A total of 854 authorized generics launched between 2010 and 2019, with entry spiking in 2014. The authors find that authorized generics are introduced "when the threat of generic entry is heightened after the first traditional generic is approved for the authorized generic’s brand-name drug."

Julia Dennett and Gregg Gonsalves examine the long-term effects of the initial marketing of OxyContin in 1996.

They find that states with higher levels of exposure to initial OxyContin marketing had significantly increased rates of fatal synthetic opioid–related overdose; increased incidence of acute hepatitis A, B, and C; and increased rates of infective endocarditis–related mortality compared to states with lower levels of exposure to early OxyContin marketing.

James Robinson’s Policy Insight offers an analysis of industrial policy opportunities within the three principal sectors of the life sciences. Among other policies, Robinson advocates for the support of start-ups and the strengthening of public procurement for pharmaceutical and medical technologies.

In Perspectives, J. Stephen Morrison and Michaela Simoneau caution that an industrial policy–based approach to the life sciences requires heightened geopolitical awareness, significant public funding, and bipartisan support, and Thomas Bollyky critiques Robinson’s global competition lens, arguing that "the US needs an industrial policy for global health."

Hospitals

Congress allocated $178 billion to the Provider Relief Fund (PRF) in 2020, to offer financial support to hospitals and providers during the COVID-19 pandemic.

Anuj Gangopadhyaya and coauthors assess how these funds were distributed and find both that PRF funding was "appropriately targeted" and that the most financially vulnerable hospitals received payments.

Mark Meiselbach and colleagues compare hospital prices negotiated in commercial health insurance and Medicare Advantage (MA) plans by the same insurer.

When considering prices paid in the same hospital for the same services, they estimate that "commercial prices are, on average, two to three times higher than MA prices" and that commercial plans at times pay more than five times what MA plans pay for the same service.

Vivian Ho and coauthors analyze claims data in five states from 2012 and 2019 and find that price increases were the primary drivers of increased emergency department spending in four of the five states examined (Colorado, North Carolina, Ohio, and Texas), with upcoding playing a significant but smaller role.

Equity

Rebecca Gourevitch and coauthors report the results of a randomized controlled trial of a nurse home visiting program for Medicaid-eligible pregnant people in South Carolina.

The authors "found little evidence of statistically significant changes in health care use, use of guideline based prenatal care, or prenatal health" and little effect for socially vulnerable or non-Hispanic Black program participants.

Jun Li and coauthors explore adoption of the standard medical deduction (SMD), designed to reduce administrative barriers to accessing the Supplemental Nutrition Assistance Program (SNAP), and find that "reducing administrative barriers through the SMD is likely an effective tool to increase SNAP participation."

Corwin Rhyan and coauthors conduct a cost-benefit analysis of Michigan’s recently revised Lead and Copper Rule, which "requires water utilities to inventory existing water service lines by 2025 and replace all lead-containing lines by 2041."

The authors estimate that these policies, in addition to protecting hundreds of thousands of children, and particularly those who are low income or children of color, would generate $1.91 billion in net savings.

Joshua Mak and coauthors calculate the return on investment (ROI) for the introduction of a four-dose malaria vaccine for the period 2021–30 in twenty sub-Saharan African countries.

Using two different models, they estimate ROIs of 0.42 and 2.30, respectively, indicating that although there is room for improvement, there is a "modest positive ROI for the integration of malaria vaccines in pediatric immunization schedules."

Accountable Health Communities

The Center for Medicare and Medicaid Innovation’s Accountable Health Communities (AHC) Model, launched in 2017, connects eligible Medicare and Medicaid beneficiaries with community services to address health-related social needs.

Presenting interim findings of an external evaluation, William Parish and coauthors conclude that beneficiaries who received navigation assistance had lower rates of emergency department visits than those in the control group, but the effects of receiving navigation assistance on other outcomes were not statistically significant.

Jeanette Renaud and coauthors assess whether the AHC Model adequately addresses beneficiaries’ health-related social needs through navigator facilitated connections to community service providers.

After analyzing survey results, the authors find that although the AHC Model effectively engaged participants, with more than 75 percent of beneficiaries opting in to receive navigation, "the assistance-track intervention did not significantly increase the rate of community service provider connection or the rate of health-related social needs resolution."

A Health Podysssey: Chip Kahn on Value-based Payment Problems

Earlier this week, Health Affairs Editor-in-Chief Alan Weil interviewed Chip Kahn from the Federation of American Hospitals on his recent paper in which he and co-authors argue that CMS hospital value-based programs should be refined to reduce health disparities and improve outcomes.

Health Affairs This Week: FDA Comes Under Scrutiny

Health Affairs' Michael Gerber and Rob Lott discuss the latest developments at the FDA, including the first oral treatment for postpartum depression, the Accelerated Approval Program, and the agency being namechecked on the GOP presidential campaign trail.

About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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