Andrew W. Mulcahy

@AndrewWMulcahy on Twitter

Senior Policy Researcher

Washington Office

Education

Ph.D. in health care management and economics, The Wharton School; M.P.P. in health policy, The Johns Hopkins University; A.B. in molecular biology and public policy, Princeton University

One Page Bio

Overview

Andrew Mulcahy is a senior policy researcher at the RAND Corporation. His key research areas are prescription drugs, payment for health care services and drugs, and policy evaluation in general. He routinely uses large-scale health care claims and transactional data in his research.

Mulcahy leads projects using Medicare and other health care claims and encounter data to answer research questions related to health insurance coverage, insurance benefit design, payment for health care services, and other health policy topics. His recent research on prescription drugs includes studies on international drug price comparisons, estimating U.S. savings from biosimilars, and drug shortages. In the area of payment, Mulcahy's recent research focuses on the accurate valuation of services under the Resource-Based Relative Value Scale system used by Medicare and many other payers to set payment rates.

Mulcahy's portfolio also includes analyses of the U.S. blood system and ground ambulance industry. More broadly, Mulcahy's research at RAND has touched on policy issues around value in health care and incentives for innovation in health.

Mulcahy earned his Ph.D. from the University of Pennsylvania's Wharton School Health Care Management and Economics program, his M.P.P. at the Johns Hopkins University with a concentration in health policy, and his A.B. in molecular biology and public policy at Princeton University.

Research Focus

Selected Publications

Andrew W. Mulcahy, Daniel Schwam, Preethi Rao, Stephanie Rennane, and Kanaka Shetty, "Estimated Savings From International Reference Pricing for Prescription Drugs," JAMA, 326(17), 2021

Mulcahy, Andrew W., Christopher M. Whaley, Mahlet Gizaw, Daniel Schwam, Nathaniel Edenfield, and Alejandro Uriel Becerra-Ornelas, "International Prescription Drug Price Comparisons: Current Empirical Estimates and Comparisons with Previous Studies," AJMC, 28(7), 2021

Mulcahy, Andrew W., Christopher M. Whaley, Mahlet Gizaw, Daniel Schwam, Nathaniel Edenfield, and Alejandro Uriel Becerra-Ornelas, International Prescription Drug Price Comparisons: Current Empirical Estimates and Comparisons with Previous Studies, RAND Corporation (RR-2956-ASPEC), 2021

Andrew Mulcahy, Katie Merrell, and Ateev Mehrotra , "Payment for Services Rendered – Updating Medicare’s Valuation of Procedures," NEJM, 382, 2020

Mulcahy, Andrew W., Melony E. Sorbero, Ammarah Mahmud, Asa Wilks, Jennifer Gildner, Anne Hornsby, and Arthur Pignotti, Measuring Health Care Utilization in Medicare Advantage Encounter Data: Methods, Estimates, and Considerations for Research, RAND Corporation (RR-2681-CMS), 2019

Commentary

Prescription Drug Benefits

Medicare Drug Price Negotiation: Key Decisions to Reach a 'Fair Price'
Government negotiation of Medicare drug prices—even for a small set of older, single-source drugs—is a remarkable policy development. But how exactly will the government do it?
Nov 7, 2022
Health Affairs Forefront
Health Care Payment Approaches

Why States' 'Netflix Model' Prescription Drug Arrangements Are No Silver Bullet
Despite the buzz and catchy notion that subscription models are “Netflix for drugs,” it's hard to come up with a theoretical case that supports subscription models over traditional price negotiation between payers and manufacturers over a per-dose or per-unit price.
Jul 1, 2020
Health Affairs Blog
Coronavirus Disease 2019 (COVID-19)

Coronavirus Outbreak Intensifies: Q&A with RAND Experts
Cases of the coronavirus have now spread to several dozens of countries, infecting thousands and thousands of people across the globe. With concerns about the disease rising, we asked a group of RAND researchers to answer a wide range of questions about the crisis.
Mar 5, 2020
Pharmaceutical Drugs

The Promise and Peril of Offshoring Prescription Drug Pricing
Most Americans, including Congress and the president, agree that prescription drug prices are too high. Policy proposals from both major parties could promise some relief. Several of them look to drug prices in other countries to help set prices in the United States.
Sep 16, 2019
The Hill
Price-Fixing Case Reveals Vulnerability of Generic Drug Policies
A massive lawsuit filed by 44 states accuses 20 major drug makers of colluding to inflate prices on more than 100 generic drugs, including HIV, cancer, and depression treatments. If these allegations are true, then this isn't just a violation of antitrust law. It's a betrayal of the policies that created and defended the entire generic drug industry.
Jul 15, 2019
The Health Care Blog
Affordable Care Act

Covering Emergency Care for Young Adults: Is the ACA Doing Its Job?
The dependent coverage provision of the Affordable Care Act is working as intended, say Andrew Mulcahy and Katherine Harris. In 2011, it spared individuals and hospitals from $147 million in emergency room costs.
Jun 5, 2013

Publications

Report
Impacts of increasing requirements for research and development (R&D) cost transparency: Literature review
A literature review shows that increasing the transparency of the research and development costs of new medicines is much discussed. But there is no evidence of the impact this would have on medicines' prices or the rate of innovation.
Mar 31, 2023
Journal Article
Projected US Savings From Biosimilars, 2021–2025
Biosimilar drugs could drive down prices for expensive medicines, with savings estimated at $38.4 billion from 2021 to 2022.
Jul 1, 2022
Journal Article
Estimated Savings from International Reference Pricing for Prescription Drugs
International reference pricing would have lowered 2020 US spending on select prescription drugs by 52% ($83.5 billion).
Dec 9, 2021
Report
Assessing Relationships Between Drug Shortages in the United States and Other Countries
Drug shortages, which occur when the supply does not meet the demand, are a public health concern. The authors assess whether U.S. shortages result in measurable changes in U.S. volume and price of drugs and the same outcomes in other countries.
Oct 27, 2021
Report
Prescription Drug Supply Chains: An Overview of Stakeholders and Relationships
The authors describe the stakeholders involved in prescription drug supply chains and the flows of products, payments, and information between stakeholders.
Oct 27, 2021
Report
Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2018 Data
The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in 2018 and paid for by Medicare. This report follows an earlier report that summarized these patterns from July 1, 2017, through June 30, 2018.
Sep 14, 2021
Report
Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data
The authors of this report summarize patterns of post-operative visits for surgical procedures furnished in calendar year 2019 and paid for by Medicare. This report follows two earlier reports that summarized these patterns for earlier periods.
Sep 14, 2021
Report
Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data
This report describes how the Centers for Medicare & Medicaid Services could use claims-based data on post-operative visits to adjust the valuations of surgical procedures with 10- and 90-day global periods.
Sep 14, 2021
Research Brief
U.S. Prescription Drug Prices Are 2.5 Times Those in Other OECD Countries
RAND researchers used 2018 prescription drug volume and price data to compare U.S. drug prices with those in 32 other nations, both overall and for specific categories of drugs, such as brand-name and generic medications.
Apr 14, 2021
Report
Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Final Report
The authors of this report summarize patterns of post-operative visits where Medicare bundles payment for post-operative care into payment for surgical procedures. The results suggest fewer visits occur than Medicare assumes in its payment rates.
Feb 5, 2021
Report
Responses to Comments on RAND Global Services Reports
RAND researchers respond to comments on three earlier reports related to post-operative visits bundled into Medicare payments for many procedures.
Feb 5, 2021
Report
Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods
This report describes how CMS could use new claims-based data on post-operative visits to adjust the valuations of surgical procedures with 10- and 90-day global periods.
Feb 5, 2021
Report
International Prescription Drug Price Comparisons: Current Empirical Estimates and Comparisons with Previous Studies
This report provides findings related to international prescription drug price comparisons, noting that 2018 drug prices in the United States were substantially higher than those in other countries.
Jan 28, 2021
Report
Balancing Access and Cost Control in the TRICARE Prescription Drug Benefit
The Military Health System provides health and drug coverage to beneficiaries through TRICARE. This report describes the TRICARE pharmacy benefit and the trade-offs in TRICARE pharmacy policies between increasing access and controlling costs.
Jan 14, 2021
Journal Article
Estimating the Cost of Industry Investment in Drug Research and Development: A Review of Methods and Results
We review and synthesize papers estimating drug R&D costs incurred by industry. We find a substantial range of per-drug costs, from $113 million–$6 billion. We discuss the data sources, methods, and assumptions used in each study and suggest areas for future research and data collection.
2021
Report
Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis
The authors compared international prices for insulins using a price index approach. They describe the shares of volume and sales for all insulins and different categories of insulin in the United States and 32 comparison countries in 2018.
Oct 6, 2020
Report
Evaluation of California Senate Bill 863 Medical Care Reforms
This report uses data from the California Worker's Compensation Information System and interactions with subject-matter experts to evaluate the impact of Senate Bill 863 on medical care utilization and spending for injured workers in California.
Sep 28, 2020
Report
Subscription Models for Prescription Drugs: The Motivation, Potential, and Limitations of a New Payment Model
The authors argue that, conceptually, the main advantage of subscription models over traditional prescription drug payment arrangements is that they could reduce some sources of uncertainty in spending for payers and in revenue for manufacturers.
May 21, 2020
Journal Article
Payment for Services Rendered: Updating Medicare's Valuation of Procedures
Medicare appears to be overpaying surgeons for post-operative care associated many medical procedures. Federal officials should incorporate ways to more objectively measure the amount of postoperative care surgeons provide to patients
Jan 24, 2020
Journal Article
Patterns of Postoperative Visits Among Medicare Fee-for-service Beneficiaries
To describe patterns of postoperative visits reported for Medicare fee-for-service (FFS) patients.
2020
Report
Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report
For many surgeries and procedures, Medicare and most other insurers cover a bundle of services, including post-operative visits, during the global period. This survey was designed to capture the level of post-operative visits during this period.
Jul 31, 2019
Report
Measuring Health Care Utilization in Medicare Advantage Encounter Data: Methods, Estimates, and Considerations for Research
This report describes methodologies, estimates, and technical considerations related to measuring health care utilization in Medicare Part C encounter data.
Jul 25, 2019
Report
Access to Medical Treatment for Injured Workers in California: Year 2 Annual Report
This Year 2 report updates the trends in care for injured workers in California that were examined in a Year 1 report -- all part of a three-year state effort. This study uses data from claims, a physician survey, and Medical Provider Network listings.
Dec 27, 2018
Report
Access to Medical Treatment for Injured Workers in California: Year 1 Annual Report
This report describes access to medical care among injured workers in the state of California, as mandated by Labor Code Section 5307.2.
Sep 27, 2018
Report
Medical Care Provided to California's Injured Workers: Monitoring System Performance Using Administrative Data
This report provides a framework for understanding changes in medical spending levels and provides the results from RAND's analysis of Workers' Compensation Information System data for 2007--2012.
May 16, 2018
Journal Article
Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares
Following Medicaid expansion, non safety-net hospitals experienced a greater percentage increase in Medicaid stays than did safety-net hospitals, which may reflect patient choice or a crowd-out of private insurance.
Feb 14, 2018
Journal Article
Medical Costs for Osteoporosis-Related Fractures in High-Risk Medicare Beneficiaries
The objective of this study was to estimate the incremental direct medical care costs associated with first fracture observable in high-risk older adults.
2018
Report
Biosimilar Cost Savings in the United States: Initial Experience and Future Potential
This Perspective estimates potential future savings from biosimilars, summarizes the experience to date with the first marketed biosimilar, and discusses key policy issues surrounding biosimilars in the United States.
Oct 23, 2017
Journal Article
Simulated Effects of Policies to Reduce Diabetes Risk Among Adults With Schizophrenia Receiving Antipsychotics
Policies to promote early diabetes detection among Medicaid patients receiving antipsychotic medication could reduce the rate of diabetes over ten years, but would likely require higher spending.
Sep 28, 2017
Report
The Impact of Health Reform on Purchased Care Access: National Health Reform and Modernization of the Military Health System Study
Newly insured patients through the Affordable Care Act coverage expansion may change how civilian providers interact with the TRICARE program. Some physicians may face financial incentives to drop TRICARE patients for newly insured patients.
Sep 27, 2017
Journal Article
Estimating the Long-Term Functional Burden of Osteoporosis-Related Fractures
Osteoporosis-related fractures are associated with significant longer-term (up to two years and beyond) declines in functional health status.
Aug 3, 2017
Report
Modeling the Economic Impact of a California Workers' Compensation Formulary
This report estimates the potential impacts of a California Workers' Compensation formulary in terms of changes in prescription drug use and spending and discusses the potential broader impacts of these changes on the California economy.
Jul 17, 2017
Journal Article
Variation in Dermatologist Visits by Sociodemographic Characteristics
Medicaid enrollees are less likely than those with private insurance to see a dermatologist or receive care for a skin condition, suggesting that efforts need to be made to increase access to skin specialists.
May 1, 2017
Research Brief
Building a More Sustainable U.S. Blood System
Describes trends affecting the U.S. blood system, presents insights into its sustainability, and offers recommendations for how policymakers can ensure the safety and sustainability of the blood supply.
Nov 28, 2016
Report
Toward a Sustainable Blood Supply in the United States: An Analysis of the Current System and Alternatives for the Future
This report aims to describe the U.S. blood system, identify and discuss potential threats to the functioning and sustainability of the blood system, and describe recommendations with the potential to improve the sustainability of the blood system.
Nov 21, 2016
Report
Implementing a Drug Formulary for California's Workers' Compensation Program
This report supports the California Division of Workers' Compensation's efforts to establish a drug formulary by comparing existing workers' compensation formularies and analyzing options for designing and implementing the formulary.
Aug 25, 2016
Journal Article
Gaining Coverage Through Medicaid or Private Insurance Increased Prescription Use and Lowered Out-of-Pocket Spending
A growing body of literature describes how the Affordable Care Act (ACA) has expanded health insurance coverage. What is less well known is how these coverage gains have affected populations that are at risk for high health spending.
Aug 19, 2016
Journal Article
Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees
Offering teledermatology appeared to improve access to dermatology care among Medicaid enrollees and played an especially important role for the newly enrolled.
May 19, 2016
Report
Avoiding the Tragedy of the Commons in Health Care: Policy Options for Covering High-Cost Cures
In this Perspective, the authors discuss the risk that strategic behavior by health insurers could unravel the market for curative therapies for chronic diseases. They present a framework to analyze policy options to remedy this problem.
May 3, 2016
Journal Article
Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records
Anesthesia and operating room (OR) times can be used to estimate surgical time, thereby improving the payment for surgical procedures in the Medicare fee schedule.
Mar 18, 2016
Report
Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs
Veterans who rely on Department of Veterans Affairs (VA) health care are older and less healthy than other veterans. Analysis of a range of data sources showed how the veteran population and demand for VA health care could change in the next decade.
Dec 31, 2015
Journal Article
Access and Quality of Care in Direct-To-Consumer Telemedicine
Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided.
Nov 20, 2015
Journal Article
Medicare's Step Back from Global Payments: Unbundling Postoperative Care
Many experts believe that the U.S. health care system's continued dependence on fee-for-service payments is a key driver of excessive health care spending.
Jul 16, 2015
Journal Article
Early Marketplace Enrollees Were Older and Used More Medication Than Later Enrollees: Marketplaces Pooled Risk
Little is known about the health status of the 7.3 million Americans who enrolled in insurance plans through the Marketplaces established by the Affordable Care Act in 2014.
May 29, 2015
Report
Specialty Payment Model Opportunities and Assessment: Oncology Model Design Report
This report shares research and analyses of claims data related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services.
Mar 17, 2015
Report
Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report
This report shares results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services.
Mar 17, 2015
Report
Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report
Describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Centers for Medicare and Medicaid Services' Center for Medicare and Medicaid Innovation.
Mar 17, 2015
Report
Development of a Model for the Validation of Work Relative Value Units for the Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) uses the resource-based relative value scale to pay physicians and other practitioners for services. CMS asked RAND to develop a model to validate physician work values using external data sources.
Jan 16, 2015
Research Brief
RAND Modeling Offers Support for Transparent and Consistent CMS Physician Fee Schedules
The current process used by the Centers for Medicare & Medicaid Services for valuing physician work is based on physician survey responses. RAND researchers examined the feasibility of developing a model based instead on external data sources.
Jan 16, 2015
Journal Article
Antibiotic Prescribing for Acute Respiratory Infections in Direct-to-Consumer Telemedicine Visits
Patterns of antibiotic prescribing behavior show that both telemedicine and office-based clinicians over-prescribed antibiotics to treat acute respiratory infections, but telemedicine clinicians tended to prescribe broad-spectrum antibiotics.
2015
Journal Article
The Relationship Between Influenza Vaccination Habits and Location of Vaccination
Medical settings are still best at capturing individuals who are not in the habit of getting regular influenza vaccinations.
Dec 23, 2014
Report
Health Sector Reform in the Kurdistan Region — Iraq: Financing Reform, Primary Care, and Patient Safety (Arabic-language version)
This report summarizes work on health financing, primary care, and quality and patient safety in Kurdistan: policy options, plans to achieve policy objectives, and implementation of a new management information system.
Dec 1, 2014
Report
Health Sector Reform in the Kurdistan Region — Iraq: Financing Reform, Primary Care, and Patient Safety (Kurdish-language version)
This report summarizes work on health financing, primary care, and quality and patient safety in Kurdistan: policy options, plans to achieve policy objectives, and implementation of a new management information system.
Dec 1, 2014
Report
Health Sector Reform in the Kurdistan Region — Iraq: Financing Reform, Primary Care, and Patient Safety
This report summarizes work on health financing, primary care, and quality and patient safety in Kurdistan: policy options, plans to achieve policy objectives, and implementation of a new management information system.
Dec 1, 2014
Report
The Cost Savings Potential of Biosimilar Drugs in the United States
The U.S. Food and Drug Administration is expected to release regulations outlining lower-cost approval requirements for so-called biosimilar drugs. This Perspective combines prior research and recent data to estimate cost savings in the U.S. market.
Nov 3, 2014
Report
The 340B Prescription Drug Discount Program: Origins, Implementation, and Post-Reform Future
The federal 340B Drug Pricing Program lowers drug prices for specific categories of
Jul 21, 2014
Report
Implementing a Resource-Based Relative Value Scale Fee Schedule for Physician Services: An Assessment of Policy Options for the California Workers' Compensation Program
RAND researchers used 2011 medical data to examine the impact of implementing a resource-based relative value scale to pay for physician services under the California workers' compensation system. This report details their findings.
Apr 28, 2014
Research Brief
Healing Medical Product Innovation
Identifies promising policy options to spur the creation of new medical technologies that will reduce total U.S. health care spending or will provide health benefits that justify any increase in spending.
Apr 22, 2014
Report
Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value
This report identifies promising policy options to spur the creation of new medical technologies that will reduce total U.S. health care spending or will provide health benefits that justify any increase in spending.
Mar 31, 2014
Draft
Fee Schedule Options for Services Furnished by Hospitals to Outpatients under the California Workers' Compensation Program
This report presents an analyses of the policy options regarding allowable amounts for certain facility services provided by hospitals on an outpatient basis under California's workers' compensation system.
Feb 7, 2014
Report
The New Neglected Diseases? Policy Interventions Are Needed to Encourage CNS Drug Development
This paper evaluates the causes of the unmet need for investment in drugs targeting central nervous system diseases and discusses policy solutions to better align drug development with untreated disease burden.
Dec 11, 2013
Report
Development of a framework to estimate the cost of opioid dependence
This report sets out the findings of a targeted review of the harms of opioid dependence, and an assessment of existing estimates of the its costs. A proposed framework for developing estimates of the costs of opioid dependence is outlined.
Nov 5, 2013
Journal Article
Insurance Coverage of Emergency Care for Young Adults Under Health Reform
The Affordable Care Act (ACA) established nationwide eligibility for young adults 19 to 25 years of age to retain coverage under their parents' private health plans. We conducted a study to determine how the implementation of this provision changed rates of insurance coverage for young adults seeking medical care for major emergencies.
2013
Research Brief
Flattening the Trajectory of Health Care Spending: Facilitate High-Value Innovation
Health information technology has not achieved its full potential, but its benefits should grow over time. Because health care is largely regulated at the state level, the states can play a valuable role as laboratories for innovative policies.
Nov 15, 2012
Research Brief
Flattening the Trajectory of Health Care Spending: Foster Efficient and Accountable Providers
Providers can dramatically improve American health care by focusing on value instead of volume, eliminating wasteful and inappropriate care, applying the best available evidence to their practices, and enhancing patient safety.
Nov 15, 2012
Research Brief
Flattening the Trajectory of Health Care Spending: Engage and Empower Consumers
Cost-sharing leads consumers to reduce both highly beneficial and less beneficial care, so they must be empowered with useful information to make informed decisions. Public cost and quality reports must be accurate, accessible, and understandable.
Nov 15, 2012
Research Brief
Flattening the Trajectory of Health Care Spending: Insights from RAND Health Research
RAND Health research supports four strategies to restrain health care spending growth and maintain quality: foster efficient and accountable providers, engage and empower consumers, promote population health, and facilitate high-value innovation.
Nov 15, 2012
Research Brief
Flattening the Trajectory of Health Care Spending: Promote Population Health
Reversing the rising tide of obesity and further reducing rates of tobacco use could produce substantial long-term dividends in terms of lives saved and disabling illnesses prevented. Communities, employers, and parents all have important roles.
Nov 15, 2012

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The Global Spread of COVID-19
Mar 4, 2020