Constraints on Formulary Design Under the Affordable Care Act.

Abstract:

:I study the effect of prescription drug essential health benefits (EHB) requirements from the Affordable Care Act on prescription drug formularies of health insurance marketplace plans. The EHB regulates the number of drugs covered but leaves other dimensions (cost sharing and utilization management) of the formulary unregulated. Using data on almost all formularies in the country, I demonstrate that requiring insurers to cover one additional drug adds 0.22 drugs (3.3%) to the average formulary, mostly owing to firms increasing the number of drugs covered to comply with the EHB requirement. The EHB requirement also increases the probability that a drug is subject to utilization management and is assigned to a higher (more costly) formulary tier. My results suggest that newly covered drugs are 22.3 percentage points more likely to be subject to utilization management, compared to 36.7% for the average covered drug. Using formularies for Medicare Advantage plans, which are subject to uniform, nationwide benefit design standards, and the formulary status of newly approved drugs that do not satisfy the EHB requirement, I reject the hypotheses that consumer demand or effects on plan entry can explain my results. Copyright © 2017 John Wiley & Sons, Ltd.

journal_name

Health Econ

journal_title

Health economics

authors

Andersen M

doi

10.1002/hec.3491

subject

Has Abstract

pub_date

2017-12-01 00:00:00

pages

e160-e178

issue

12

eissn

1057-9230

issn

1099-1050

journal_volume

26

pub_type

杂志文章
  • Suboptimal provision of preventive healthcare due to expected enrollee turnover among private insurers.

    abstract::Many preventive healthcare procedures are widely recognized as cost-effective but have relatively low utilization rates in the US. Because preventive care is a present-period investment with a future-period expected financial return, enrollee turnover among private insurers lowers the expected return of this investmen...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1484

    authors: Herring B

    更新日期:2010-04-01 00:00:00

  • Can Physicians Affect Patient Adherence With Medication?

    abstract::Non-compliance with medication therapy remains an unsolved and expensive problem for healthcare systems around the world, yet we know little about the factors that affect a patient's decision to follow treatment recommendations. In particular, there is little evidence on the extent to which doctors can influence patie...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3357

    authors: Koulayev S,Simeonova E,Skipper N

    更新日期:2017-06-01 00:00:00

  • A discrete random effects probit model with application to the demand for preventive care.

    abstract::I have developed a random effects probit model in which the distribution of the random intercept is approximated by a discrete density. Monte Carlo results show that only three to four points of support are required for the discrete density to closely mimic normal and chi-squared densities and provide unbiased estimat...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.627

    authors: Deb P

    更新日期:2001-07-01 00:00:00

  • Priority setting in health care: disentangling risk aversion from inequality aversion.

    abstract::In this paper, we introduce a tractable social welfare function that is rich enough to disentangle attitudes towards risk in health outcomes from attitudes towards health inequalities across individuals. Given this preference specification, we evaluate how the introduction of uncertainty over the severity of illness a...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.2858

    authors: Echazu L,Nocetti D

    更新日期:2013-06-01 00:00:00

  • Child protection and adult depression: evaluating the long-term consequences of evacuating children to foster care during World War II.

    abstract::This paper combined data collected from war time government records with survey data including background characteristics, such as factors that affected eligibility, to examine the adult depression outcomes of individuals who were evacuated from Finland to temporary foster care in Sweden during World War II. Using war...

    journal_title:Health economics

    pub_type: 历史文章,杂志文章

    doi:10.1002/hec.2913

    authors: Santavirta N,Santavirta T

    更新日期:2014-03-01 00:00:00

  • Teacher training and HIV/AIDS prevention in West Africa: regression discontinuity design evidence from the Cameroon.

    abstract::We assess the impact on teenage childbearing as well as student knowledge, attitudes, and behavior of a typical HIV/AIDS teacher training program in the Cameroon. Applying a regression discontinuity design identification strategy based on the key administrative criterion that determined program deployment, we find tha...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1643

    authors: Arcand JL,Wouabe ED

    更新日期:2010-09-01 00:00:00

  • This is US: Geography of evidence in top health economics journals.

    abstract::The Journal of Health Economics and Health Economics are arguably the top two journals in the field of health economics. Together, they published 1,679 empirical research articles in the past decade (2010-2019). In line with analyses based on earlier periods, the empirical evidence in top health economics journals con...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.4128

    authors: Hirvonen K

    更新日期:2020-10-01 00:00:00

  • Does involvement of local NGOs enhance public service delivery? Cautionary evidence from a malaria-prevention program in India.

    abstract::Partnerships between government and non-state actors that aim to enhance the quality or efficiency of service delivery are increasingly common in today's development policy landscape. We investigate the impacts of such an approach using data from an experimental supportive intervention to India's malaria control progr...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3529

    authors: Das A,Friedman J,Kandpal E

    更新日期:2018-01-01 00:00:00

  • Inferring capitation rates from aggregate health plans' costs.

    abstract::Setting risk-adjusted capitation rates in health systems with centralized financing and decentralized delivery is one of the most intriguing policy issues. The common practice to set capitation group rates is based on individual data collected from either population surveys or medical records, using a single-and in mo...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/(sici)1099-1050(199909)8:6<547::aid-hec463

    authors: Shmueli A

    更新日期:1999-09-01 00:00:00

  • The black box of health care expenditure growth determinants.

    abstract::In this paper, the determinants of growth of aggregate health expenditures are investigated. The study departs from previous literature in that it looks at differences across countries in growth (and not levels) of health care expenditures. Estimation is made for 24 OECD countries. Health system characteristics usuall...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/(sici)1099-1050(199809)7:6<533::aid-hec374

    authors: Barros PP

    更新日期:1998-09-01 00:00:00

  • The price of placements in residential and nursing home care: the effects of contracts and competition.

    abstract::A variety of contract types are used in the placement of elderly people in residential and nursing care homes in the UK. Contracts vary according to how and when providers are paid. Among other things, prices can be made contingent on the total quantity of service to be purchased and on production cost characteristics...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/1099-1050(200010)9:7<643::aid-hec528>3.0.c

    authors: Forder J,Netten A

    更新日期:2000-10-01 00:00:00

  • Trends in Managed Care Cost Containment: An Analysis of the Managed Care Backlash.

    abstract::Consumer dissatisfaction with the quality and limitations of managed health care led to rapid disenrollment from managed care plans and demands for regulation between 1998 and 2003. Managed care organizations, particularly health maintenance organizations (HMOs), now face quality and coverage mandates that restrict th...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3115

    authors: Dugan J

    更新日期:2015-12-01 00:00:00

  • Does the earned income tax credit increase children's weight? The impact of policy-driven income on childhood obesity.

    abstract::I exploit substantial increases in the earned income tax credit to study how a policy-driven change in family income affects childhood obesity. Using the National Longitudinal Survey of Youth 1979, my difference-in-differences estimates indicate that the probability of being obese increased by 3 percentage points amon...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3658

    authors: Jo Y

    更新日期:2018-07-01 00:00:00

  • Presenting results of probabilistic sensitivity analysis: the incremental benefit curve.

    abstract::Cost-effectiveness acceptability curves have become a common way of presenting the results of probabilistic sensitivity analysis. However, these curves do not provide information on what the loss of welfare or net benefit (NB) is for cases where a given intervention is not the optimal one. We describe an alternate app...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1274

    authors: Bala MV,Zarkin GA,Mauskopf J

    更新日期:2008-03-01 00:00:00

  • Risk perception, prevention and diagnostic tests.

    abstract::The objective of this paper is to study the impact of risk perception and diagnostic information on medical prevention decisions. The intertemporal preferences of individuals are represented by a model of recursive rank dependent utility, which has the advantage of allowing risk perceptions to vary over time and with ...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1822

    authors: Etner J,Jeleva M

    更新日期:2013-02-01 00:00:00

  • Limiting health-care access to undocumented immigrants: A wise option?

    abstract::The number of undocumented migrants in high-income countries has increased in recent decades, imposing considerable political, fiscal, and social pressures on governments. This has fostered discussions on whether and to what extent undocumented migrants should get access to public programs and public benefits. Looking...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.4115

    authors: Jiménez-Rubio D,Vall Castelló J

    更新日期:2020-08-01 00:00:00

  • A Bayesian approach to stochastic cost-effectiveness analysis.

    abstract::The aim of this paper is to briefly outline a Bayesian approach to cost-effectiveness analysis (CEA). Historically, frequentists have been cautious of Bayesian methodology, which is often held as synonymous with a subjective approach to statistical analysis. In this paper, the potential overlap between Bayesian and fr...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/(sici)1099-1050(199905)8:3<257::aid-hec427

    authors: Briggs AH

    更新日期:1999-05-01 00:00:00

  • The effects of pay and job satisfaction on the labour supply of hospital consultants.

    abstract::There is little evidence about the responsiveness of doctors' labour supply to changes in pay. Given substantial increases in NHS expenditure, new national contracts for hospital doctors and general practitioners that involve increases in pay, and the gradual imposition of a ceiling on hours worked through the Europea...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1220

    authors: Ikenwilo D,Scott A

    更新日期:2007-12-01 00:00:00

  • Estimating Lifetime Costs of Social Care: A Bayesian Approach Using Linked Administrative Datasets from Three Geographical Areas.

    abstract::We estimated lifetime costs of publicly funded social care, covering services such as residential and nursing care homes, domiciliary care and meals. Like previous studies, we constructed microsimulation models. However, our transition probabilities were estimated from longitudinal, linked administrative health and so...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3110

    authors: Steventon A,Roberts A

    更新日期:2015-12-01 00:00:00

  • When do fat taxes increase consumer welfare?

    abstract::Previous analyses of fat taxes have generally worked within an empirical framework in which it is difficult to determine whether consumers benefit from the policy. This note outlines on simple means to determine whether consumers benefit from a fat tax by comparing the ratio of expenditures on the taxed good to the we...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1789

    authors: Lusk JL,Schroeter C

    更新日期:2012-11-01 00:00:00

  • High School Physical Education Requirements and Youth Body Weight: New Evidence from the YRBS.

    abstract::Previous research has found that high school physical education (PE) requirements are largely ineffective at reducing youth body weight. However, these studies were forced to rely on cross-state variation in PE requirements to identify their impacts, raising concerns that estimated policy effects may be confounded by ...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3399

    authors: Sabia JJ,Nguyen TT,Rosenberg O

    更新日期:2017-10-01 00:00:00

  • Do Capitation-based Reimbursement Systems Underfund Tertiary Healthcare Providers? Evidence from New Zealand.

    abstract::One of the main concerns about capitation-based reimbursement systems is that tertiary institutions may be underfunded due to insufficient reimbursements of more complicated cases. We test this hypothesis with a data set from New Zealand that, in 2003, introduced a capitation system where public healthcare provider fu...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3478

    authors: Shin S,Schumacher C,Feess E

    更新日期:2017-12-01 00:00:00

  • The association of alcohol dependency with employment probability: evidence from the population survey 'Health 2000 in Finland'.

    abstract::In this paper, we investigate to what extent alcohol-dependent individuals fare worse in the Finnish labour market, using data from a large Finnish health survey. We used the DSM-IV criteria for alcohol dependence assessed by a composite international diagnostic interview (CIDI). We find that there are substantial dis...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1201

    authors: Johansson E,Alho H,Kiiskinen U,Poikolainen K

    更新日期:2007-07-01 00:00:00

  • Inequality of opportunities in health in France: a first pass.

    abstract::This article analyses the role played by childhood circumstances, especially social and family background in explaining health status among older adults. We explore the hypothesis of an intergenerational transmission of health inequalities using the French part of SHARE. As the impact of both social background and par...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1528

    authors: Trannoy A,Tubeuf S,Jusot F,Devaux M

    更新日期:2010-08-01 00:00:00

  • The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes.

    abstract::In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3315

    authors: Carr JB,Packham A

    更新日期:2017-04-01 00:00:00

  • Informal and formal care among single-living elderly in Europe.

    abstract::The aims of this study were to analyse (1) whether informal care, provided by children or grandchildren to their elderly parents, and formal care are substitutes or complements, and (2) whether this relationship differs across Europe. The analyses were based on cross-sectional data from the newly developed SHARE (Surv...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1275

    authors: Bolin K,Lindgren B,Lundborg P

    更新日期:2008-03-01 00:00:00

  • The impact of the Affordable Care Act on self-employment.

    abstract::This paper estimates the impact of the implementation of the Affordable Care Act (ACA) in 2014 on the decision to be self-employed. Using data from the Current Population Survey, we employ two identification strategies. Utilizing prereform variation in state nongroup health insurance market regulations, we find that t...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3500

    authors: Heim BT,Yang LK

    更新日期:2017-12-01 00:00:00

  • Does social capital determine health? Evidence from eight transition countries.

    abstract::There is growing interest in the role of social relationships in explaining patterns of health. We contribute to this debate by investigating the impact of social capital on self-reported health for eight countries from the Commonwealth of Independent States. We rely on three indicators of social capital at the indivi...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.1445

    authors: d'Hombres B,Rocco L,Suhrcke M,McKee M

    更新日期:2010-01-01 00:00:00

  • Empirical Testing of the External Validity of a Discrete Choice Experiment to Determine Preferred Treatment Option: The Case of Sleep Apnea.

    abstract::There is an increasing use of the discrete choice experiment (DCE) method in health care to estimate preferences of individuals and the public for different services. Despite this increasing use, there are few studies that investigate the validity of the DCE in health. This study investigates the external validity of ...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.3076

    authors: Krucien N,Gafni A,Pelletier-Fleury N

    更新日期:2015-08-01 00:00:00

  • The effect of prenatal care on birthweight: a full-information maximum likelihood approach.

    abstract::This paper uses a full-information maximum likelihood estimation procedure, the Discrete Factor Method, to estimate the relationship between birthweight and prenatal care. This technique controls for the potential biases surrounding both the sample selection of the pregnancy-resolution decision and the endogeneity of ...

    journal_title:Health economics

    pub_type: 杂志文章

    doi:10.1002/hec.801

    authors: Rous JJ,Jewell RT,Brown RW

    更新日期:2004-03-01 00:00:00