A series of structural constitutional arguments lodged in multiple cases against Centers for Medicare and Medicaid Services’ (CMS) authorities to negotiate prescription drug prices via the 2022 Inflation Reduction Act threaten the legitimacy of CMS program and federal agency powers.

This special JLME symposium addresses ways that federal policy can incentivize innovation in medical therapeutics and make pharmaceuticals more financially accessible.

The relationship between costs and health benefits of branded pharmaceuticals remains controversial. This paper examines the incremental costs incurred for incremental health benefits gained from the largest available sample of cost-effectiveness studies of branded drugs in the USA, the 1994–2015 Tufts Registry of Cost-Effectiveness Analyses. Earlier studies used small, specialized samples of drugs. We use linear regression analysis to estimate the association in those studies between additional quality-adjusted life years (QALYs) and incremental pharmaceutical costs. The preferred sample uses 476 studies involving branded pharmaceuticals with both higher costs and increased effectiveness compared to the previous standard of care. Regressions of costs on QALYs imply that an additional QALY is associated, on average, with a $28,561 increase in cost (95 % CI, $18,853–$38,270). This regression explains 20 % of the variation in sample costs. In this analytical sample, a share of the variation in the cost of pharmaceuticals is, therefore, not random but rather associated with variation in QALYs; prices are to some extent “value-based.” Our results are robust to varying sample inclusion criteria and to the funding source. In subgroup analyses, the highest cost per QALY was $44,367 (95 % CI, $35,373–$53,361). Costs of pharmaceuticals in this data set are, on average, lower than common estimates of the monetary value of a QALY to American consumers. As in other studies, we find that sellers of patent-protected beneficial new technology appear to capture only a fraction of the benefits provided.

A wide range of medications are being misused by people the world over and Sri Lanka is no exception. Reasons for this misuse are manyfold. Regulatory bodies, prescribers, dispensers, as well as the general public, have significant roles to play in mitigating the misuse of prescribed medications and their harmful consequences.

Low probability risks create challenges for individual decisions and potential pressures for government regulation. This article reports original survey evidence regarding the public’s perception and valuation of water-related risks from plastic bottles with bisphenol A, residues in drinking water of the herbicide atrazine, and trace amounts of prescription drugs in water. People who believe that they face high water-related risks generally believe that the risks apply and, given that belief, are willing to pay more to limit the risk. However, the expressed willingness to pay for risk reductions is inordinately high even among those who are unsure of whether they are even exposed to the risk, and therefore may not be reliable as values for the actual benefits.

Uncertain future risks pose cognitive and analytical challenges to household decision makers. Risks with uncertain probabilities, coupled with potentially severe outcomes pose problems for decision-making and are prone to overreactions. Imprecision in risk estimates generates behavioral distortions such as ambiguity aversion. This article presents new empirical results indicating household overvaluations of uncertain threats posed by several drinking water risks: traces of prescription drugs in drinking water, plastic water bottles with bisphenol-A, and the weed killer atrazine in drinking water. Negative reactions reflect responses to ambiguous risks, but policies driven by these concerns may misallocate regulatory resources due to risk conservatism and “no-regrets” responses.

Increasing expenditures for prescription drugs have placed seniors in the spotlight of health reforms because they are the main users of prescription drugs. Substantial improvements could be made in the utilization of prescription drugs that would enhance the benefits of therapy, and minimize adverse effects, particularly for seniors. A variety of problems have been documented, including the over- and under-use of drug therapy, prescribing errors, treatment compliance, and cost-ineffective prescribing. Health care system policies, selected physician and hospital-based pharmacist interventions, and decision-aids and compliance aids have been shown to be effective for components of the problem. Integration of key policies and interventions into a comprehensive solution for optimal drug use is needed. This will include: (1) revision of policies guiding the relationship between the drug industry and health sector, (2) regulations requiring adequate drug testing in seniors for drug approval, (3) a Consumer Health Institute to provide a central objective resource for patient information and decision support systems, (4) integrated clinical information systems to support prescribing, dispensing and drug and disease management systems for pharmacists and primary care physicians, and (5) reforms in medical training and licensure.

Persons aged 65 and older comprise about 9–12% of the population of industrialized countries but consume 25–30% of prescribed drugs. This high consumption may be due to an increase in disease and chronic illness and/or the result of over prescription.

The purpose of this study was to investigate the use of prescription drugs by the population of B.C. aged 65 and older. Using B.C. Pharmacare data for 1984, the cost and number of prescriptions were analysed, comparing consumption by the mobile elderly with that of the elderly in nursing homes. Both populations were found to receive a high number of prescriptions per person, particularly in the Central Nervous System therapeutic class.

The results indicate the need for further study into the prescription of drugs for both elderly groups, but particularly those in nursing homes.

Medication use is recognized as the least expensive, most cost-effective health care intervention. In older adults this is especially important, as they are the largest consumer of prescription medications. We describe the use of a linked data set including pharmaceutical, medical, and hospital claims to examine pharmaceutical use in the population of older adults and then give several examples of its application. Indicators to describe the population's overall use of medication and the appropriate use of specific medication have been developed. Indicators of appropriate use are characterized using the dispensation of benzodiazepines to older adults. We have found that a significant proportion of new users of benzodiazepines are still prescribed a long-acting version (over 10%), signifying potential inappropriate use. The data are also able to describe some significant outcomes from the use of pharmaceuticals such as death, fracture, and population-based clinical measures where available.

Provincial government drug plans are the primary source of insurance for drugs taken by seniors in outpatient settings. The adequacy of this coverage has been called into question, given the increased clinical importance of pharma-ceuticals, shifts in the provision of health care from inpatient to outpatient settings, increased use of restrictive formularies, and reductions in provincial drug subsidies. To assess the adequacy of provincial coverage, we estimated what a typical single senior beneficiary of a provincial drug plan paid out-of-pocket in 1998 on prescription drugs covered by the public program, depending on his/her province of residence, level of drug consumption, and income. We compared provincial coverage for seniors with large drug costs. We also assessed provincial coverage of drugs that were introduced into the Canadian market between 1991 and 1998. The cost of drugs consumed by a senior in a given province and year was estimated by multiplying the average number of prescription drugs consumed by senior drug users by the average per-prescription costs. High drug consumption was defined as twice the average. We used the provincial drug cost sharing rules to estimate the senior's share of the total cost of drugs consumed. Mean out-of-pocket costs range from $42 to $1,302 per year, are lower for lower-income seniors, and increase with drug use, although the charge per drug decreases with the number used. There was up to a 12-fold variation among the provinces in the charges faced by seniors with similar incomes and drug use. All but one province limits costs to seniors with catastrophic drug costs, but there was 21-fold variation in the expenditure limits. The substantial variation in seniors' out-of-pocket drug costs raises questions about the distributive equity of drug subsidies in Canada. Recent evidence on the deleterious health effects of drug charges faced by seniors in Quebec and the fact that seniors in some other provinces face direct charges similar to those faced in Quebec raise the possibility of adverse consequences of drug charges in other provinces.