Andrew W. Mulcahy

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?

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.

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.

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.

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.

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.

Journal Article

Impact of Drug Shortages on Consumer Costs

We identify and describe potential costs to patients from drug shortages, measure the impacts of shortages on available indicators of changes in costs to patients, and examine how shortage effects on patient costs vary by drug and patient characteristics.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Commentary

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

Commentary

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Commentary

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Commentary

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.

Commentary

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

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.

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.

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.

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.

Commentary

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.

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.

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.

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.

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.

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.

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.

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.