(As explained on the podcast home page, this is the fifth of eight interviews concerning federal healthcare policy reform. This discussion is with Arnold Ventures' Dr. Mark Miller and conducted in late November. As you will hear this podcast like all other eight is introduced by ProMedica's CEO, Randy Oostra. This series was produced in an effort to interest or persuade federal healthcare officials to pursue substantive healthcare policy reform.)
As has been widely reported and debated the US spends substantially more than comparative countries on prescription medicines. For example, Medicare Part B and D drugs cost approximately two to four times what comparable countries pay and spending is projected to continue to rise rapidly. High prices are explained largely by economic rent seeking and anti-competitive practices including so called patent evergreening and pay-for-delay tactics. As a result, medication nonadherence is epidemic, responsible for an estimated 10% of all hospitalizations. Among Medicare beneficiaries, upwards of of 60% are nonadherent due in part to cost. Among those that do adhere, a recent study published in the American Journal of Medicine an estimated 42% of cancer patients depleted their entire net worth within the first two years of treatment.
The interview begins with Dr. Miller providing a general overview of drug pricing, or what explains the failure of current drug pricing policy. The discussion moves on to his discussing practices commonly exploited by comparative countries, i.e., negotiating drug prices or how such a policy could be formulated, exploiting an inflation rebate, basing prices on value or comparative effectiveness research, using international drug prices, or some percent thereof, to set US drug prices and questions whether the US is willing to take a drug of formulary due to excessive price. He discusses the extent to which, like comparable countries, US drug pricing policy could or should apply to all patients. Dr. Miller concludes his comments by identifying Arnold Ventures policy recommendations regarding FDA and patent reforms and whether price regulation can drive greater competition in pharmaceuticals.
Dr. Mark E. Miller is currently the Executive Vice President of Health Care at Arnold Ventures, a philanthropy. Previously, he served as Executive Director of Medicare Payment Advisory Commission (MedPAC), as Assistant Director of Health and Human Resources at the Congressional Budget Office, as Deputy Director of health plans at the Centers for Medicare and Medicaid Services, as health financing Branch Chief at the Office of Management and Budget and as Senior Research Associate at the Urban Institute. Dr. Miller has extensive experience identifying emerging health care issues, developing policy solutions, working with policymakers, and engaging diverse stakeholders. Over the course of his career, he has been directly involved in the development of major health legislation such as the Balanced Budget Act; the Medicare Prescription Drug, Improvement, and Modernization Act; and the Affordable Care Act. Dr. Miller earned his Ph.D. in public policy analysis at the State University of New York at Binghamton and his MA and BA in political science from Old Dominion University.
To read a transcript of this interview or to post a comment or question, please go to: https://commissiononhealthcare.org/.