pub h 2

max deductible

615

copay vs coinsurance

set price vs set percentage

catastrophe limit

2100

Lis auto enroll

ssi, pt b assistance, full medicaid

Lis benefit

$0deduct/premium

Drug price negotiation

No generic, if generic made price hold until end of year

PAP reqs, manufacturer funded

uninsured/Medicare, legal resident, lower than specific %FPL

Grant-funded pt help

HealthWell, Rx Outreach, PAN

Copay (brand name) reqs

Commericial insurance, max month/annual limit, works with insurance

drug with free trial

eliquis

Goodrx

reduces cash prices, replace using insurance

Low cost generic options

Walmart, Mark Cuban, Gen Scripts, Amazon, Costco

Soonercare punches

2 brand, 6 total

Covered entity

Annual renew, purchase meds at a discount

340b eligibility

pt seen and filled at 340b, any insurance EXCEPT medicaid

340b pt pay

340b price + dispensing fee

what percentage of expenses is healthcare

20%

moral hazard

pt pay less so they use more health resources

average healthcare spending per person

$15k

how much healthcare spending is prescription drugs

10%

main cause of infant mortalities

premies, drug use

top 5% of population

responsible for 50% health care costs

stats among top 10% spenders

42 high, 30 reduce spend, 28 episodic

high needs (3+ conditions w/ limitations) costs

4x average

derived demand (health)

something we pursue through other demands

normal good (healthcare)

a price elastic good

adverse selection

sicker people want higher coverage

externality

your actions have effects on others

what percentage of drugs have unknown effect

50% (1/3 beneficial)

quality of care

increase desired outcomes and consistent with current knowledge

efficacy vs effective

efficacy = trial, effective = real world

medical errors

3rd leading cause of death in us

error of comission

doing something wrong (misfill)

error of omission

fail to prescribe/diagnose

2 main types of error

execution and planning

Med Error stats

1/5 drug related, half of those preventable

Med error cost

1.6 trillion, 1/3 of spending, 1 mil ppl

Pts who don’t receive appropriate care (omission)

>50%

Drug Related Problem includes

Med error, adr, ade, nonadherence, treatment failure

adr

bad rxn to a drug at a normal dose, assumes causal relationship

ade

includes all adrs, causation not necessary, includes error+improper use

Increase quality by

minimize drug problems, make pharma structures more efficient

If pharmacists only availble to dispense

<60% of pt have optimal outcomes

Pharmacotherapy Error stats

19% of pt, 58% of which are avoidable and 27% negligence

Preventable ade 25-50% inpatients

Associated with up to 7% hospital admit

Ambulatory error rates

up to 50%

Drugs prescribed =8

ADE >90%

nursing home ade

277 ade per 1000pt year.

number of serious med errors not detected by computers

1/3

structure

where/how care given

process

if good med practices followed

outcome

impact on pt health

iron triangle

cost, access, quality, pt, provider, payers

high needs (cost, intense care, fxn limit)

complex needs with multi services not served well by system

main ways to reduce cost

interdiscp prim care,transitional + coord help, chronic self management

groups at risk, 30% of ppl have 3 chronics

complex kids, multi(3)/complex chronic, non elderly disabled, frail elderly, advancing illness, rare disease

positive vs normative econ

positive = evidence, normative = ideal

rand takeaways

cost sharing no neg outcomes on health, overall qt health care low (60%) but some ppl benefited from free plan (6% of ppl, ht vision, dental, serious stuff

serious symptoms

bleed, cachexia,faint

non rand diseases (cost sharing doesnt lower health)

hf, diabetes, schizo, dyslip

4 comp market

no controlling interest, barriers to entry, equal data sharing, perfect substitutes available

pareto optimal

no overall gains without someone losing

increase 0.33 to 0.67 cost share

18% welfare gain

welfare loss %

10-30% hcare expenditures

profit

revenue - opp cost, function of risk, conferred to innovation

risk vs uncertaintly

risk is known probability, uncertainty unknown

Approved drug agents (3-4 bil each)

1/5k-10k, only 1/3 are profitable

Percentage ppl with health insurance

88%

Reasons for drug expenditure increases

Price(inflation) for 20%, 40% each for higher use and diff types of drugs

pharma structure

high barriers,patent protection, 15% money RD (5-10x other sectors), dependent on innovation

Time for drug process

14-15yrs

describe pharma market

differentiated structured oligopoly

peltzman effect-unintended consequences of regulation

new safety rules = net $3.2 bil loss to people

smaller firm advantage

development stage, not marketing

increase in tax rate effects

debt 27x, decrease in patent, rd expense, investment 90%