What enrollment patterns are required for premiums to meet or exceed claims paid on the health insurance exchanges (HIEs), and can we reasonably expect these patterns to emerge? We showed…
Summary To better understand how the Affordable Care Act (ACA) may have affected price / value relationships in the market for individually purchased coverage, we’ve compared premiums (by age), deductibles,…
Summary and Conclusions Despite the ACA’s razor-thin margin of passage and ideologically narrow base of support, more Americans want to see the Act implemented than to see it dismantled, or…
Price : Quantity relationships in the employer sponsored (ESI) market To estimate price elasticity of demand for health insurance in the employer sponsored (ESI) market, we define the price of…
Background State Medicaid programs use a variety of drug pricing benchmarks to determine how much a retail pharmacy is paid when a multi-source (generic, essentially) prescription is dispensed to a…
We’ve long argued that PBM gross margins should decline[1] as a byproduct of several pressures, the most prominent being a shift away from the Average Wholesale Price (AWP) drug pricing…
Summary and Investment Conclusion Five separate lawsuits challenging the constitutionality of the individual coverage mandate in the Affordable Cart Act (ACA) have been heard in four federal appeals courts, so…
Our bearish thesis on the drug trades generally and PBMs specifically has several moving parts; of these, the effect of the AWP[1]benchmark on generic dispensing margins is key The heart…