Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

The Centers for Medicare and Medicaid Services (CMS) is working to help state Medicaid programs get the best deal possible when purchasing prescription drugs. The second phase of CMS’s Medicaid retail drug price survey will poll pharmacies on a monthly basis to create a National Average Drug Acquisition Cost...
Pharmaceutical manufacturers face an economic transformation as payors look more toward value-based – as opposed to transactional, unit-based – models for drug reimbursement.  This value-based revenue model presents enormous implications for the future of pharma and biotech, impacting everything from innovation, clinical trials, pricing, and marketing. The Health Research Institute at PwC surveyed...
A new study highlights interesting health care cost and utilization trends for Americans under age 65 with employer-sponsored health coverage. The Health Care Cost Institute (HCCI) analyzed data from Aetna, Humana, and United HealthCare, assessing price and utilization levels and changes, in their publication, Health Care Cost and Utilization Report: 2010....
Prescription drug spending rose by $135 billion between 2001 and 2010 to comprise approximately 12 percent of the nation’s overall healthcare outlay. While drug expenditure was one of the fastest growing components of U.S. healthcare spending prior to the early 2000s, generic drugs helped reduce the rate of annual...
Direct-to-Consumer (DTC) advertising of prescription drugs, especially new brand-named drugs, remains controversial.  Some in Congress remain eager to prohibit advertising of brand-name prescription drugs to consumers in the first two years following a drug’s approval by the Food and Drug Administration (FDA).  Is this a good idea or is it...
The latest issue of the journal American Health & Drug Benefits includes a valuable mix of studies and articles of interest to decision makers. Topics include health reform, bundled payment, drug pricing, benefit design, Medicaid, medication therapy, and specific clinical conditions. The Health Reform Law: Key Changes to Be Implemented...
Federally mandated rebates for prescription drugs in Medicaid were expanded significantly - by $38 billion - under the new health reform law, with extraordinary financial, administrative, and compliance implications for pharmaceutical manufacturers, Medicaid health plans, and state Medicaid programs. In a new journal article, I explain changes to the Medicaid...
The Medicare Payment Advisory Commission (MedPAC) has released its Medicare payment recommendations to Congress for 2011. In addition to specific recommendations for payment updates for fee-for-service providers and Medicare Advantage plans, MedPAC's report includes interesting information and analysis on spending trends, consequences of rapid spending on Medicare and the...
Here are articles from the latest issue of American Health & Drug Benefits. AHDB is a peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: Orphan Drug Pricing and Payer Management in the United States: Are We Approaching the Tipping Point?...
The Centers for Medicare and Medicaid Services' Office of the Actuary (CMS/OACT) has released its projections of U.S. health care spending for the ten years 2010 through 2019, with premliminary estimates of 2009 health spending. The projections, released each year around this time, offer a fascinating, detailed look at...

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