Honored Social Butterfly

Pricey drugs paid by Medicare lack cost-effectiveness data

So WHY should these even be included in any Medicare formulary if their efficacy, including price,  has not been proven?  They should not be on the Medicare formulary at all until proven to be not just effective but be the best drug for the cost and the effectiveness.


Why are people still taking the Brand when there is a generic already available ?


I assume that Medicare beneficiaries know how Medicare Part D works - cost are shared between the beneficiary, the insurance company AND the government (we are the government).


Axios 06/21/2021 - Pricey drugs paid by Medicare lack cost-effectiveness data 


from the link~

Nearly $50 billion or a third of Medicare Part D costs in 2016 were for drugs with absent cost-effectiveness analyses, according to a report from JAMA Network Open. 

Why it matters: The lack of a quality analysis that weighs the relative cost with outcomes of these drugs may create hurdles toward efforts aimed at addressing drug spending in terms of value.

Background: Reports have consistently showed higher drug prices are driving up Medicare spending.

By the numbers: Nearly half of 250 drugs with the greatest Medicare Part D spending in 2016 showed no available cost-effectiveness analyses. For the other half that did have studies, many did not "meet minimum quality standards."

  • Of these 250 drugs, 91 had a generic equivalent and the remaining 159 had some exclusivity.

The big picture:  Some in Congress have supported the idea of policy reforms like improving the value of spending on prescription drugs by negotiating or setting Medicare drug prices.

The bottom line: Cost-effectiveness analysis has been an efficient way to compare clinical value across alternative treatments. However, "efforts for value-based reforms may be hampered by a lack of cost-effectiveness data," the authors write.

It's Always Something . . . . Roseanna Roseannadanna
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Bronze Conversationalist

I can assure you most Medicare beneficiaries do not understand their PDP. Sadly, the same is true for a number of agents. I have no idea what carriers and Medicare.guv reps tell folks but it is probably equally frightening.


Most D plans have a deductible. Ask any beneficiary how it works and most will say they have to spend ~$400 before they have a copay.


Most chronic situations (BP, cholesterol, type II, etc) can be prevented or corrected with lifestyle changes . . . diet and exercise. THOSE are cost-effective and no side effects.


Most of my clients are primarily on generics and very seldom do they use their PDP. Cash discount cards like GoodRx are easier on the wallet.


Not all generics are equally effective. Delayed release generics are among the worst.


Hypothyroid med's that are man-made are fine for most folks but some can only use desiccated medication like Armour Thyroid.


And don't get me started on cancer med's.


Researchers say many new cancer drugs don’t improve life or increase lifespan. Some doctors suggest we need to speed up the cancer drug approval process.

Bark less. Wag more.
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Honored Social Butterfly

Drugs are added because Medical Experts think they can help people. It is up to the Dr. and patient wheather to use a drug not the general public taking a vote. If you want to lower the cost of drugs let Medicare negotiate prices or have a law that sets the formula for pricing. Most people have little understanding of the total medical system and that means when the general public would vote on what to do we would get the wrong answer most of the time, so let the experts handle this and they should read  the Axios article since they will know how to use it.

Honored Social Butterfly


Price should be part of the approval process - just like other countries do now.  Cost-effectiveness has to be part of the equation because if not, we (the beneficiary, the Med D insurance company & the government) are spending money needlessly on meds that compared to their price don't give an acceptable outcome.


Isn't that what is wrong with the American health care system - We pay MORE for LESSER Outcomes.


If a drug does not go onto a formulary because of price to benefit - doctors will not prescribe it or if they do, the beneficiary may not want to pay the uncovered price for it.

Let's say, that an oral cancer drug cost $ 25,000 a month but yet only has a potential to extend life for 3 - 4 months - is that a good value ?


This [Axios] information is coming from JAMA Network Open -  the experts, as you refer to them -

Who They Are:  JAMA Network Open is an international, peer-reviewed, open access, general medical journal that publishes research on clinical care, innovation in health care, health policy, and global health across all health disciplines and countries for clinicians, investigators, and policy makers. JAMA Network Open is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.







It's Always Something . . . . Roseanna Roseannadanna
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Honored Social Butterfly

I am sure price part of the process but we have no central pricing formula. We need one. I laid out 2 starting points.  

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