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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

Biden's reengineer-America moment

Illustration: Sarah Grillo/Axios

The Senate's bipartisan $1.2 trillion infrastructure bill and President Biden's $3.5 trillion spending package could live or die this week — and take Democrats' fortunes with them. But all the minute-by-minute political drama obscures how much America could change if even a fraction of it passes.

The big picture: Anything short of total failure could have a transformative impact on day-to-day life — from how we move around to our access to the internet, paid family leave and child care, health care and college.

Biden says he'll make Supreme Court pick by end of February

President Biden speaks on the retirement of Supreme Court Justice Stephen Breyer in the Roosevelt Room of the White House. Photo: Yuri Gripas/Abaca/Bloomberg via Getty Images

President Biden on Thursday said he will announce the nominee for Supreme Court Justice Stephen Breyer's replacement by the end of February.

Driving the news: Biden also affirmed that he will nominate a Black woman to replace Breyer, saying "it's long overdue."

Stephen Breyer formally announces retirement from Supreme Court

Photo: Andrew Harnik/AP

Justice Stephen Breyer on Thursday sent a letter to President Biden formally announcing his retirement from the Supreme Court.

State of play: Breyer said his retirement will take effect when the court "rises for the summer recess (typically late June or early July) assuming that by then my successor has been nominated and confirmed."

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