The Role Of Financial Incentives In Biosimilar Uptake In Medicare: Evidence From The 340B Program.

Biosimilar drugs-lower-cost alternatives to expensive biologic drugs-have the potential to slow the growth of US drug spending. However, rates of biosimilar uptake have varied across hospital outpatient providers. We investigated whether the 340B Drug Pricing Program, which offers eligible hospitals substantial discounts on drug purchases, inhibits biosimilar uptake. Almost one-third of US hospitals participate in the 340B program. Using a regression discontinuity design and two high-volume biologics with biosimilar competitors, filgrastim and infliximab, we estimated that 340B program eligibility was associated with a 22.9-percentage-point reduction in biosimilar adoption. In addition, 340B program eligibility was associated with 13.3 more biologic administrations annually per hospital and $17,919 more biologic revenue per hospital. Our findings suggest that the program inhibited biosimilar uptake, possibly as a result of financial incentives making reference drugs more profitable than biosimilar medications.

Using Administrative Data to Examine Telemedicine Usage Among Medicaid Beneficiaries During the Coronavirus Disease 2019 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic necessitated the replacement of in-person physician consultations with telemedicine. During the pandemic, Medicaid covered the cost of telemedicine visits. OBJECTIVES: The aim was to measure the adoption of telemedicine during the pandemic. We focus on key patient subgroups including those with chronic conditions, those living in urban versus rural areas, and different age groups. METHODS: This study examined the universe of claims made by Florida Medicaid beneficiaries (n=2.4 million) between January 2019 and July 2020. Outpatient visits were identified as in-person or telemedicine. Telemedicine visits were classified into audio-visual or audio-only visits. RESULTS: We find that telemedicine offsets much of the decline in in-person outpatient visits among Florida's Medicaid enrollees, however, uptake differs by enrollee type. High utilizers of care and beneficiaries with chronic conditions were significantly more likely to use telemedicine, while enrollees living in rural areas and health professional shortage areas were moderately less likely to use telemedicine. Elderly Medicaid recipients (dual-eligibles) used audio-only telemedicine visits at higher rates than other age groups, and the demand for these consultations is more persistent. CONCLUSIONS: Telemedicine offset the decline in health care utilization among Florida's Medicaid-enrolled population during the novel coronavirus pandemic, with particularly high uptake among those with prior histories of high utilization. Audio-only visits are a potentially important method of delivery for the oldest Medicaid beneficiaries.