911勛圖Principal Investigator: Huseyin Naci
Start Date: 1 January 2025
End Date: 31 December 2025
Funder: NIHCM Foundation
Region: North America
Country: USA
Partner institutions: Brown University School of Public Health. York University and Tufts University School of Medicine
Keywords: Medicare
Prescription drug spending in the United States has increased substantially over the past four decades. The U.S. healthcare system has traditionally differed from other countries in its approach to drug coverage decisions, with less formal use of economic evaluation methods, though recent legislation has introduced new mechanisms for Medicare to engage in drug price negotiations. This research investigates the health outcomes and value delivered by Medicare's coverage of new prescription drugs recommended between 2015-2020.
Using data from the Institute for Clinical and Economic Review assessment reports and Medicare claims records, this project analyses the health benefits and costs of new drugs that were recommended for coverage during this period. The study calculates how much additional health benefit Medicare beneficiaries received from these new treatments, and compares this to what the same money could have achieved if spent on other healthcare services. The research also examines how many Medicare patients actually used these drugs and whether the coverage decisions varied in their effectiveness across different medical conditions.
The findings will contribute to ongoing policy discussions about prescription drug pricing and coverage decisions, particularly as Medicare implements new price negotiation authorities under recent legislation. By providing empirical evidence about the health outcomes associated with new drug coverage, this research aims to inform evidence-based decision-making that supports optimal health outcomes for Medicare's 65 million beneficiaries while maintaining sustainable healthcare spending.