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Illustration: Rae Cook/Axios

Nearly $50 billion or a third of Medicare Part D costs in 2016 were for drugs with absent cost-effectiveness analyses, according to a report from JAMA Network Open.

Why it matters: The lack of a quality analysis that weighs the relative cost with outcomes of these drugs may create hurdles toward efforts aimed at addressing drug spending in terms of value.

Background: Reports have consistently showed higher drug prices are driving up Medicare spending.

  • Prior to the COVID-19 pandemic, forecasts showed spending on prescription drugs by the U.S. would reach $350 billion by 2020 or about 10% of the country's health care spending.
  • Separately, another report out last week in Health Affairs found a very high concentration of Medicare Part D spending on an increasing number of these expensive drugs.

By the numbers: Nearly half of 250 drugs with the greatest Medicare Part D spending in 2016 showed no available cost-effectiveness analyses. For the other half that did have studies, many did not "meet minimum quality standards."

  • Of these 250 drugs, 91 had a generic equivalent and the remaining 159 had some exclusivity.

The big picture: President Biden and Democrats have supported the idea of policy reforms like improving the value of spending on prescription drugs by negotiating or setting Medicare drug prices.

The bottom line: Cost-effectiveness analysis has been an efficient way to compare clinical value across alternative treatments. However, "efforts for value-based reforms may be hampered by a lack of cost-effectiveness data," the authors write.

Go deeper

Sep 23, 2021 - Politics & Policy

Scoop: Dems seek new green deal

Rep. Stephanie Murphy. Photo: Chip Somodevilla/Getty Images/Bloomberg via Getty Images

House Democrats discussed with President Biden on Wednesday a plan to exempt billions of dollars of new climate spending from his requirement that his $3.5 trillion "soft" infrastructure plan be offset with additional revenue.

Why it matters: The accounting proposal — a version of "dynamic scoring" — would dramatically lower the amount of taxes Democrats would need to raise while creating wiggle room to increase the ultimate size of the package.

At least 3 dead after Amtrak train derails in Montana

Photo: Jacob Cordeiro/Twitter

An Amtrak train derailed near Joplin, Montana, resulting in at least three deaths and multiple injuries to passengers and crew on Saturday, per authorities and a company statement.

The big picture: 141 passengers and 16 crew members were estimated to be on the Empire Builder train, traveling from Chicago to Seattle and Portland, when eight of the 10 cars derailed about 4p.m., Amtrak said early Sunday.

Updated 7 hours ago - Politics & Policy

Federal judge blocks vaccine mandate for NYC teachers

Students are dismissed from the first day of school at PS 133 in Brooklyn on Sept. 13. Photo: Michael Nagle/Xinhua via Getty Images

A federal appeals court is set to hear a challenge Wednesday to a vaccine mandate planned for New York City school employees.

Why it matters The vaccine mandate was set to begin on Monday, prompting concerns over staffing shortages in schools across the nation's largest school system. But a judge on Friday temporarily blocked the measure, per AP.

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