Gerard Anderson, PhD

Angela Liu Kelly E. Anderson, Joseph Levy, Daniel Polsky, and Gerard Anderson in JAMA Health Forum

Gerard Anderson with Richard Frank recently commented on draft guidance by the Centers for Medicare and Medicaid Services (CMS) on the Medicare Drug Price Negotiation Program

Getting hospitals to participate in value-based payment reform voluntarily is a challenge.

Biosimilar uptake in the United States is limited. It has not been comprehensively studied in Medicare Advantage (MA).

This article is the latest in the Health Affairs Forefront series, Provider Prices in the Commercial Sector, featuring analysis and discussion of physician, hospital, and other health care provider prices in the private-sector markets and their contribution to overall spending therein.

As of 2020, 70% of Medicaid beneficiaries (57 million) were insured through Medicaid managed care (MMC), in which a private insurer covers a beneficiary’s medical care in exchange for fixed payments from state Medicaid agencies.1 A key role of MMC insurers is to negotiate prices with hospitals. MMC prices have important implications for government health expenditures and access to care for Medicaid beneficiaries. However, little is known about MMC prices.2 We used hospitals’ self-disclosed pricing information to characterize MMC hospital prices.

In this cross-sectional analysis of the top 1000 generics in Colorado’s all-payer claims database in 2019, 45 high-cost generics that had lower-cost therapeutic alternatives of same clinical value were identified. Overall, high-cost generics were 15.6 times more expensive than their therapeutic alternatives (median values); if the lower-cost alternatives had been used, total spending would have been reduced by 88.3%.

Despite varying levels of non-profit hospital community benefit investment across counties, higher community benefit expenditures are not associated with an improvement in the selected health outcomes at the county level.