The United States relies on the interactions of private entities – drug manufacturers, health plans and pharmaceutical benefit managers (PBMs) - to achieve value by negotiating prices, operating formularies and implementing other benefit management strategies.
The September 13, 2020 Executive Order on Lowering Drug Prices by Putting America First declared, “It is the policy of the United States that the Medicare program should not pay more for costly Part B or Part D prescription drugs or biological products than the most-favored-nation price.”
Medicare covers prescription drugs provided during inpatient hospital and skilled nursing facility stays through Part A, retail prescription drugs through Part D, and drugs provided in physicians’ offices and hospital outpatient departments through Part B.
Beginning in mid-March 2020, the COVID-19 pandemic has had an unprecedented impact on health care utilization. The impact on patients, their families and the health care system was significant.
Research generally has demonstrated the employment benefits of providing child care. However, much of the existing research on child care policies on parental labor force participation was conducted prior to the early 2000s or in non-U.S. contexts. This brief provides policymakers and researchers with new evidence from a study of the effects o
This study used a rigorous difference-in-differences approach to examine the effect of child care policy on women's labor force participation. The study examined the effects of state-level spending, copayment rates, and income eligibility thresholds on the probability of employment and labor force participation by potentially eligible women (defin
In this Issue Brief, we examine spending growth through 2014, the first year the Affordable Care Act’s coverage provisions were in effect, and 2015, where possible. We provide detailed cost growth trends for Medicare and the private insurance market. We also estimate the effect of recently introduced specialty drugs on current and future spendin
Key findings • Expenditures on prescription drugs are rising and are projected to continue to rise faster than overall health spending thereby increasing this sector’s share of health care spending. • ASPE estimates that prescription drug spending in the United States was about $457 billion in 2015, or 16.7 percent of overall personal
Characteristic Alabama Florida Michigan New Jersey APPENDIX TABLE 1 LOGISTIC REGRESSION OF THE PROBABILITY OF MAINTAINING MEDICAID COVERAGE WHEN ADULTS LEAVE AFDC (Adults in HMOs Excluded) Estimated Odds Ratio a
Czajka, John L. “Analysis of Children’s Health Insurance Patterns: Findings from the SIPP.” Washington, DC: Mathematica Policy Research, Inc., 1999. Dubay, Lisa, and Genevieve Kenney. “Effects of Medicaid Expansions on Insurance Coverage of Children.” Future of Children , vol. 6, no. 1, 1996, pp. 152-61. Ellwood, David T., and E. Ka
Study findings add to the body of evidence--that declines in the welfare caseload which began in 1995 are likely to have a noticeable effect on state Medicaid programs in the future, in terms of overall enrollment, caseload mix, and per capita expenditure levels. The findings also point to problems of continuity in Medicaid enrollment, which may b
Welfare Leavers and Medicaid Dynamics: Five States in 1995. How Much Turnover and Churning Occurs in Medicaid Caseloads?
A final study objective was to look at the extent to which turnover and churning in each state’s Medicaid caseload might be contributing to enrollment declines. As background for understanding these additional measures, it is useful to review the different ways Medicaid enrollment is counted. Most analyses of trends in Medicaid enrollment rely o
Welfare Leavers and Medicaid Dynamics: Five States in 1995. Were the Welfare Leavers Staying on Medicaid Different From Those Who Left?
Policymakers and Medicaid officials are understandably interested in whether welfare leavers who also leave Medicaid are different from those who remain enrolled in Medicaid. In particular, they want to know whether welfare leavers who continue on Medicaid are likely to be more costly than those who leave Medicaid would have been. Differences in e
A key part of our analysis was to see what happened to the Medicaid status of individuals leaving AFDC. We focused on those who left from February through July 1995, so that we could follow the Medicaid status for six months after AFDC exit. Six months seemed to us a sufficient time to assess whether Medicaid coverage continued. We counted persons
Consistent with the national pattern, all five study states experienced a decline in Medicaid enrollment for children and adults during 1995, although the extent of the decline varied (Table 3). New Jersey’s Medicaid enrollment in December was only 0.8 percent below its January level, compared to a 4.2 difference in Florida by year end. The othe
Welfare Leavers and Medicaid Dynamics: Five States in 1995. Eligibility Policies of Study States in 1995
By 1995, interstate differences in Medicaid eligibility policy had been considerably reduced as a result of the federally mandated poverty-related expansions for children. That same year, all states were required to extend Medicaid coverage to children under age six and pregnant women with family income below 133 percent of the federal poverty lev
Concerns about Medicaid enrollment patterns are not new. Although Medicaid enrollment of children and their parents increased by just over 60 percent during the period from 1987 to 1995,
State welfare caseloads have been declining at an unprecedented rate since 1994, partly as a result of state and federal welfare reform efforts and partly because of a strong economy. From a peak of 14.2 million recipients in 1994, by 1998 monthly welfare enrollment had dropped more than 40 percent to an average of 8.3 million recipients. Medicaid