Health affairs
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Medicare's End-Stage Renal Disease Quality Incentive Program is a mandatory pay-for-performance program for US dialysis facilities, in which facilities are penalized up to 2 percent of their total Medicare payments based on their performance on quality metrics. While analyses of similar programs in other settings have shown performance to be related to social risk factors, it is unknown whether this program displays similar patterns. ⋯ Further study is needed to determine the degree to which these patterns reflect low-quality care delivery versus patient factors beyond providers' control. In the meantime, the impact of these penalties on providers serving vulnerable populations should be tracked closely.
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The 2011 German Pharmaceutical Market Restructuring Act subjected brand-name drugs for nonrare diseases to price regulation based on an assessment of their clinical benefit. Indication-specific assessment outcomes range from major added benefit to less benefit than the appropriate comparator(s) and affect price negotiations beyond the first year on the market. Using data on drugs that entered the market in the period 2012-16, we evaluated benefit assessment findings, subsequent drug exits, and their correlates. ⋯ Of these, 66 drug-indication pairs (55 different drugs) were found to have added benefit. Almost all drugs with a positive benefit assessment (98 percent) remained on the market, while drugs without a positive benefit assessment were over ten times more likely to exit (25 percent versus 2 percent). US policy makers considering how to address rapidly increasing drug costs may draw valuable lessons from the German experience.
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The current Medicare Part D benefit may require greater out-of-pocket spending for beneficiaries filling prescriptions for higher-price generic drugs, compared to those filling brand-name counterparts. This can occur among patients who reach the catastrophic coverage phase under the Part D benefit, when differences between the prices for generic and brand-name drugs are not large. ⋯ Overpayments for specialty generic drugs relative to brand-name drugs ranged from $869 to $1,072 in 2019, despite lower point-of-sale prices for these drugs. Policy makers should consider modifying the Part D benefit to increase incentives for generic drug use.