Featured Partner Research

Authorized generics (AGs) are exact copies of a brand-name drug sold under the generic name by the brand-name manufacturer or its licensee. In the case of entacapone, introduction of 4 AGs delayed independent...

List prices for brand-name drugs have risen steeply, often despite the introduction of competition from other brand-name drugs in the same therapeutic class. List prices, however, do not reflect any rebates that manufacturers provide payers. To understand how net prices (after rebates and other discounts) respond to competition, we compared changes in inflation-adjusted, revenue-weighted mean list and net prices of a one-month supply of three classes of diabetes drugs.

Brand-name drugs have periods of market exclusivity before generic competition begins. Due to high brand-name drug prices charged during this period, market exclusivity is an important determinant of US prescription drug spending. We used claims data to estimate the market exclusivity period for 264 small molecule and 4 biologic drugs that faced new generic or biosimilar competition from 2012–2018. 

Some experts have proposed combating rising drug prices by promoting brand–brand competition, a situation that is supposed to arise when multiple US Food and Drug Administration (FDA)-approved brand-name products in the same class are indicated for the same condition. However, numerous reports exist of price increases following the introduction of brand-name competition, suggesting that it may not be effective. We performed a systematic literature review of the peer-reviewed health policy and economics literature to better understand the interplay between new drug entry and intraclass drug prices.

Substitution of brand-name drugs with less expensive, equally effective interchangeable generics is an important strategy for promoting adherence and controlling prescription drug spending. US state laws govern generic substitution, but there is variability among states in how these laws are designed. We aimed to determine how different features of state laws regulating generic substitution are associated with use of generic drugs.

In the United States, brand-name prescription drugs remain expensive until market exclusivity ends and lowercost generics become available. Delayed generic drug uptake may increase spending and worsen medication adherence and patient outcomes. We assessed recent trends and factors associated with generic uptake.

The findings suggest that policy makers should consider policies that prevent manufacturers from delaying generic competition by introducing a new version of an existing drug and provide incentives to develop incremental innovations to existing drugs that are commensurate to the level of investment and risk involved.

Existing frameworks for segmenting high-cost patients are derived from expert opinion and are based predominately on patterns of comorbidity and functional status. There may be an opportunity to supplement these approaches using machine learning methods.

Drug manufacturers sometimes offer co-payment coupons to offset patient out-of-pocket costs. Although coupons can help patients afford necessary medications, they increase overall drug spending by encouraging use of expensive brand-name drugs over less expensive generics. Coupons are prohibited by Medicare and Medicaid, but they are available for commercially insured patients. 

Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact.

The Medicare program is transforming its approach to delivering quality healthcare and reducing the rate of cost growth primarily through the use of reimbursement models that incentivize better healthcare outcomes. Greater emphasis on care coordination, efficient resource use, and payment models that encourage improved outcomes are key elements of this transformation.

Better understanding the clinical composition of high-cost patient populations has the potential to improve care management program design. Researchers and policymakers have suggested that suboptimal patient targeting—singular interventions are frequently applied to diverse patient populations—may be driving the limited effectiveness of current care management approaches.