Gerard F. Anderson’s research while affiliated with Johns Hopkins Bloomberg School of Public Health and other places

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Publications (339)


Figure 1. Horizontal Mergers 2010-2015.
Changes in Average AWP after a Horizontal Merger by number of labelers.
Differences in Differences Estimators.
Differences in Differences Estimators by Number of Competing Labelers in Market.
Effects of Horizontal Mergers on Prices of Generic Drugs
  • Article
  • Full-text available

January 2025

Journal of Economic Analysis

Antonio J. Trujillo

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Mariana Socal

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Gerard Anderson

This paper quantifies the impact of horizontal mergers on the prices of drugs. We study all mergers between two publicly traded pharmaceutical companies working in the US between 2010 and 2015 and their effect on their drugs prices. Using a differences-in-differences approach, we estimate that drugs marketed by the merging firms experience an AWP increase of about between 8% and 15% during the five years following the merger. These price increases are present even in markets with more than five competitors.

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Lower Commercial Rates for Breast Surgical Procedures are Associated with Socioeconomic Disadvantage: A Transparency in Coverage Analysis

December 2024

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10 Reads

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1 Citation

Annals of Surgical Oncology

Danielle H. Rochlin

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Yang Wang

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[...]

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Evan Matros

The Centers for Medicare & Medicaid Services (CMS) implemented the Transparency in Coverage Rule in 2022, which requires payers to disclose commercial rates for the first time in the history of the US healthcare system. The purpose of this study was to characterize payer-disclosed commercial facility rates and examine the relationship with county-level social disadvantage for common breast surgical procedures. We performed a cross-sectional study of 2023 pricing data for 14 ablative and reconstructive breast procedures from Turquoise Health. Socioeconomic disadvantage was quantified using the Social Vulnerability Index (SVI). Within- and across-payer ratios quantified rate variation. Linear regression assessed the relationship between relative value unit (RVU)-adjusted median commercial rates and facility-level variables including SVI quartile. There were 4,748,074 unique commercial rates disclosed by four payers from negotiations with 10,023 hospitals. Rates varied by a factor of 9.8–15.6 within and 10.0–18.1 across payers. RVU-adjusted commercial rate decreased in a stepwise fashion as SVI quartile increased and varied by payer (p < 0.001). Higher RVU-adjusted rates were associated with hospitals compared with ambulatory facilities (β = 138, 95% CI 138–139, p < 0.001). Lower rates were associated with areas of less healthcare infrastructure (β = − 37, 95% CI − 38 to − 37, p < 0.001). Facility rates for breast surgical procedures varied significantly within and between payers and were higher for hospitals compared with ambulatory surgery centers. Facilities in areas of higher social vulnerability were associated with lower negotiated rates. The health equity implications of lower payment in areas of higher disadvantage, particularly in terms of access to care, deserve further investigation.


Within-Hospital Price Gaps Across National Insurers

December 2024

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3 Reads

JAMA Network Open

Importance Commercial prices for hospital care are high and vary widely in the US. Employers and state policymakers are exploring reference-based pricing (RBP) to set their payment rates as multiples of Medicare prices; understanding the range of commercial price variation within a hospital is important for calculating the appropriate price targets that are effectively low to generate savings but also feasible and viable to local hospital markets. Objective To examine within-hospital maximum-to-minimum commercial hospital price gaps negotiated by 5 national insurers and estimate plan savings if the minimum prices within each hospital are used as new payment level. Design, Setting, and Participants This cross-sectional study used the insurer-disclosed Transparency in Coverage data as of March 2024. There were 40 382 commercial hospital facility prices extracted for 10 common services negotiated by CVS Health, Elevance Health, Blue Cross Blue Shield, Cigna, and United Healthcare, measured at the hospital-service-insurer level relative to the 2024 Medicare prices. For each hospital-service pair, the minimum, enrollment-weighted mean, and maximum prices were calculated, as well as the maximum-to-minimum price gaps. Plan savings were then estimated using the minimum within-hospital prices as the new payment levels. Exposure Insurer price disclosure under federal Transparency in Coverage rule. Main Outcomes and Measures Maximum-to-minimum commercial price gaps and estimated savings if using the minimum prices at hospital-service level. Results Among 40 382 commercial hospital prices negotiated by 5 national insurers, the national means of minimum prices were 168% (95% CI, 167%-169%) of Medicare rates for inpatient services and 220% (95% CI, 215%-226%) of Medicare rates for outpatient services. National mean minimum-to-maximum price gaps were 86% (95% CI, 85%-87%) and 222% (95% CI, 215%-229%) of Medicare rates for inpatient and outpatient services, respectively. If using the minimum within-hospital prices, compared with current prices, payers could save 21% (95% CI, 20%-21%) for inpatient services and 29% (95% CI, 28%-30%) for outpatient services. Conclusions and Relevance In this cross-sectional study, commercial prices across different national insurers varied substantially for the same hospital and service. These results suggest that employers and policymakers interested in RBP benchmarking may use the lowest prices among major insurers in their local hospital market as references to negotiate lower prices.


Beyond the Bottom Line: Assessing Charity Care, Community Benefits, and Tax Exemptions in Nonprofit Hospitals

November 2024

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7 Reads

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1 Citation

Journal of Healthcare Management

Goal This study aimed to compare the value of tax exemptions and community benefits across various nonprofit hospitals and show how hospital and geographical characteristics can explain the values. Methods Data from 2017 to 2021 Internal Revenue Service Form 990s were used to evaluate 17 types of community benefits in nonprofit hospitals and assess six categories of tax benefits. Descriptive analyses compared charity care, community benefits, and estimated tax exemptions among nonprofit hospitals while considering variations in teaching status, location (rurality), and US region. Additionally, random effect regression analyses, both unadjusted and adjusted, explored the connection between the community benefit-to-expense ratio and a range of hospital and geographical features. Principal Findings Between 2017 and 2021, nonprofit hospitals allocated, on average, 8.8% of their total expenses to 17 types of community benefits, with 1.8% of their expenses dedicated to charity care; 5.2% benefited from tax exemptions. There were significant disparities among nonprofit hospitals, as 24.0% received more tax benefits than they spent on community benefits, and 81.0% received more than their charity care expenditures. The characteristics and location of nonprofit hospitals influenced the provision and composition of community benefits. Teaching hospitals allocated a higher percentage of total community benefits compared to nonteaching hospitals (9.2% vs. 8.6%). The top three categories in teaching hospitals were Medicaid shortfall, charity care, and unreimbursed education, whereas nonteaching hospitals focused more on charity care and subsidized health services, in addition to Medicaid shortfall. Furthermore, the location of a nonprofit hospital impacted the distribution of community benefits. Rural hospitals prioritized Medicaid shortfall, subsidized health services, and charity care, while urban hospitals concentrated more on Medicaid shortfall, charity care, and subsidized health service (in that order). The regression results showed that system affiliation and location in the Southern region of the United States were positive predictors of charity care spending at nonprofits. Practical Applications Lack of transparency and explicit requirements from federal agencies and states for what is necessary to receive tax benefits results in wide variations in community benefits spending by nonprofit hospitals. Some receive more in tax benefits than they provide in community benefits, and three-quarters of all nonprofit hospitals receive more in tax benefits than they provide in charity care. Developing a more explicit definition of community benefits can make all nonprofit hospitals more accountable.


Figure A.1. Correlation of income and preventive behaviors.
Figure A.2. Correlation of age and preventive behaviors.
Pearson correlation matrix.
The effect of trust on preventive behaviors: Fixed Effects Models.
Trust in Government and COVID-19 Preventive Behaviors

November 2024

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19 Reads

Journal of Economic Analysis

High levels of trust are positively correlated with increased collaboration, prosocial actions, and heightened adherence to preventive behaviors during the COVID-19 pandemic. Previous studies on trust during the pandemic have primarily focused on either cross-sectional data or its impact in conjunction with other related variables, such as political party affiliations or vaccine availability. In this study, we employed a national survey panel comprising data from 760 individuals interviewed at three intervals between July 2020 and January 2021. We used pooled datasets, panel datasets, and dependent variable lags to control for time-invariant unobservable variables and endogeneity. Our findings reveal that trust in government influences individuals’ behavior when they are requested to follow public interventions. Notably, trust in local government is associated with increased adherence to COVID-19 preventive behaviors, similar to the effect observed with an annual income exceeding $100,000.


Medigap Guaranteed Issue Associated with Medicare Advantage Disenrollment for Beneficiaries Administered a Part B Drug

October 2024

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1 Read

Health Affairs Scholar

While many Medicare beneficiaries are enrolling in Medicare Advantage (MA), some beneficiaries may want to return to traditional Medicare and purchase Medigap, especially beneficiaries that have greater medical needs. Beyond minimal federal regulations, states impose additional regulations that impact Medigap affordability. Beneficiaries in some states have greater difficulty obtaining Medigap coverage because the states where they live allow Medigap insurers to experience rate the beneficiary, which can make Medigap insurance prohibitively expensive. We examined beneficiaries who received physician-administered drugs, which can be expensive and subject to high cost-sharing, to see if disenrollment from MA for these beneficiaries was greater in states with Medigap consumer protection policies levels. In 2020, we find a 1.0% average baseline average probability of MA disenrollment. For beneficiaries that received a physician-administered drug in our sample, the probability of MA disenrollment is 3.7 (95% C I: 2.6-4.8; p<0.001) percentage points higher in Medigap guaranteed issue states compared to states with no protections. We find a greater association between MA disenrollment and Medigap protection policies with higher-cost drugs. These findings suggest that beneficiaries who receive a high-volume and high-spending physician-administered drug are more likely to disenroll from MA back to traditional Medicare when Medigap is more affordable.


Figure 1. Trends in the distribution of venture capital investment deals by drug types-total capital invested, January 2014-March 2024.
Figure 2. Trends in the distribution of VC investment deals by clinical trial phase-percentage of deals, January 2014-March 2024. Abbreviation: VC, venture capital.
Changes in the distribution of total venture capital invested by deals and therapeutic areas, 2014 vs 2023.
Biopharmaceutical Pipeline Funded by Venture Capital Firms, 2014 to 2024

October 2024

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29 Reads

Health Affairs Scholar

Venture capital (VC) firms fund biopharmaceutical research and development (R&D) while incurring substantial financial risk. VC firms seek to invest in clinical areas with the greatest potential for financial return. Using a combination of data for clinical trials and VC investment deals between January 2014 and March 2024, we found that approximately seventy five percent of VC investments were allocated to clinical trials studying small molecule drugs compared to biologics or gene therapies, without substantial changes over the study period. Most of VC firms’ investment in the biopharmaceutical R&D was concentrated in phase 1 and phase 2 clinical trials. This trend has increased in recent years, with phase 1 trials accounting for nearly half of total deals and capital investments in 2023. VC investments were concentrated in several therapeutic areas, including cancer.



Macular Degeneration Drug Prescribing Patterns After Step Therapy Introduction in Medicare Advantage

August 2024

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18 Reads

JAMA Health Forum

Importance In Medicare Advantage (MA), step therapy for physician-administered drugs is an approach to lowering drug spending. The impact of step therapy in MA on prescribing behavior and the magnitude of any changes has not been analyzed. Objective To evaluate the impact of step therapy on macular degeneration drug prescribing patterns for 3 large MA insurers. Design, Setting, and Participants This was a retrospective encounter-based analysis using 20% nationally representative MA outpatient and carrier encounter records for 2017 to 2019. Participants were MA beneficiaries who were 65 years or older and had received a macular degeneration drug administration. Macular degeneration drug administrations for beneficiaries of MA Aetna, Humana, and UnitedHealthcare (UHC) insurers were assessed. Humana implemented macular degeneration step therapy in 2019, setting bevacizumab as the plan-preferred drug, and aflibercept and ranibizumab as the plan-nonpreferred drugs. Aetna and UHC, which did not implement macular degeneration step therapy, served as the control group. Data analyses were performed from May 2024 to December 2024. Exposures A macular degeneration drug administration subject to a step therapy policy. Main Outcome and Measures A binary indicator of whether the drug administered was bevacizumab. Linear probability models and a difference-in-differences framework were used to quantify changes in prescribing patterns before and after the introduction of step therapy for MA insurers that did and did not implement step therapy. To empirically measure the impact of step therapy, the first administration of a treatment episode was assessed, followed by switching patterns. Results A total of 18 331 MA beneficiaries, 21 683 treatment episodes, and 171 985 drug administrations were included across the control and treatment groups. The difference-in-differences regressions found a 7.8% (95% CI, 4.9%-10.7%; P < .001) greater probability of being prescribed bevacizumab for the first administration due to step therapy. The predicted probabilities of preferred-drug administration in the treatment group increased from 0.61 to 0.70 between the periods before and after step therapy implementation for the first administration. Step therapy was not significantly associated with an increased rate of medication switching (hazard ratio, 0.86; 95% CI, 0.71-1.06; P = .15). Conclusions and Relevance The findings of this retrospective encounter-based analysis indicate that step therapy is associated with a greater probability of prescribing the plan-preferred drug for the first administration. The analysis failed to find a statistically significant greater rate of medication switching within a treatment episode. Step therapy changed macular degeneration prescribing patterns, but step therapy alone did not transition all administrations to the plan-preferred drug.



Citations (58)


... In this paper, 5 we make a preliminary connection between prices and health equity by demonstrating that negotiated rates decrease in a stepwise fashion as socioeconomic disadvantage increases. We use the Centers for Disease Control/ Agency for Toxic Substances and Disease Registry (CDC/ ATSDR) Social Vulnerability Index (SVI) as our metric for socioeconomic disadvantage, and the county of the respective hospital as the geographic unit of analysis. ...

Reference:

ASO Author Reflections: The Intersection of Price Transparency and Health Equity
Lower Commercial Rates for Breast Surgical Procedures are Associated with Socioeconomic Disadvantage: A Transparency in Coverage Analysis
  • Citing Article
  • December 2024

Annals of Surgical Oncology

... 2 Variation in uptake of biosimilars by insurance coverage has been widely documented. [4][5][6] However, many of these assessments were conducted when only the first biosimilar infliximab was on the market. Research shows coverage restrictions on biosimilars when there were fewer competitors on the market, 5 and from the small molecule literature, we know that uptake increases with each entrant. ...

Filgrastim and infliximab biosimilar uptake in Medicare Advantage compared with Traditional Medicare, 2016-2019
  • Citing Article
  • January 2024

Journal of Managed Care & Specialty Pharmacy

... The Medicare Advantage (MA) plans, that are offered by private insurance companies, were the first to this SDOH system along with their system and provided other facilities for free like the transportation, scheduling medical appointments, delivery for the meal, and home nursing for the patients who are dealing with the acute health issues. The other programs like the Accountable Care Organization (ACOs), that have the number of doctors, hospitals, and healthcare workers are registered helps to lower the cost of visiting the hospital and using the emergency beds [7]. ...

Comparison of social determinants of health in Medicaid vs commercial health plans

Health Affairs Scholar

... A national study by Wang et al of commercial prices for colonoscopies at 3582 hospitals and 3899 ASCs found that fees for colonoscopies paid to hospitals were approximately 55% higher than those paid to ASCs in the same county and with the same insurer. 60 The fact that the price difference applies to sites of care within the same geographic data has been observed elsewhere. For example, Chernew et al observed that patients, on average, bypassed 6 lower-priced providers on their way to their eventual MRI treatment location. ...

Facility Fees for Colonoscopy Procedures at Hospitals and Ambulatory Surgery Centers

JAMA Health Forum

... Physician prescribing practices play a crucial role in driving competition between brand-name and generic medications. While some physicians may prefer to prescribe brand-name drugs based on familiarity or perceived quality, others may opt for generics to achieve cost savings for patients and healthcare systems [5,6]. ...

Settled: Patent characteristics and litigation outcomes in the pharmaceutical industry
  • Citing Article
  • December 2023

International Review of Law and Economics

... The commercial determinants of health require pharmacies to balance profitability, social responsibility, and value-based care [188][189][190]. An example of profit-driven practices is the contribution of pharmacy benefit managers to the high prices of prescription drugs [191,192]. Rising healthcare costs and the economic burden of chronic diseases prompted some innovative pharmacy initiatives, e.g., "Flip the Pharmacy" practice transformation [193][194][195], embracing digital health [196,197], and a pharmacist-provided "Food Is Medicine" care program [186]. To further address the contributions of pharmacists to improve health outcomes, herein we reason that (1) selling and marketing digital health technologies in retail pharmacies may improve both therapies and prevention of chronic diseases, and (2) eliminating sales of sugar-sweetened beverages may improve prevention of chronic diseases and mortality. ...

Pharmacy Benefit Manager Pricing and Spread Pricing for High-Utilization Generic Drugs

JAMA Health Forum

... 26 Coverage for lecanemab required enrollment in a registry that documents adverse events, including ARIA. 27 So why give special consideration to the role of pMRI when fixed MRI is already in wide use in ADRD research and will for the foreseeable future produce a wider range of sequences and higher quality of images? There are several reasons for this. ...

Role of Registries in Medicare Coverage of New Alzheimer Disease Drugs
  • Citing Article
  • September 2023

JAMA The Journal of the American Medical Association

... Previous analyses have simulated potential IRA savings, predicted what drugs will be selected for negotiation, and suggested IRA modifications (Assistant Secretary for Planning and Evaluation -Office of Health Policy, 2023; Dickson & Hernandez, 2023;DiStefano et al., 2023;Reitsma et al., 2023;Rome et al., 2023). However, these studies all examined 2020 prescription drug use and spending, an anomalous year because of the COVID-19 pandemic (IQVIA, 2020; IQVIA Institute for Human Data Science, 2022), and it remains unclear what proportion of high-expenditure drugs, and attributable Medicare spending, would typically be eligible for CMS negotiations in a given year. ...

Estimated Savings From Using Added Therapeutic Benefit and Therapeutic Reference Pricing in United States Medicare Drug Price Negotiations
  • Citing Article
  • September 2023

Value in Health

... The findings of this literature have the potential to provide implications for healthcare policy and practices aiming at containing healthcare spending, improving affordability for patients, and reducing the financial burden for employers. [1][2][3][4][5][6] In this Viewpoint article, we summarize some findings and their implications. This article is not intended to provide a comprehensive literature review of the large number of studies using price transparency data. ...

Do Insurers With Greater Market Power Negotiate Consistently Lower Prices for Hospital Care? Evidence From Hospital Price Transparency Data
  • Citing Article
  • August 2023

Medical Care Research and Review

... The findings of this literature have the potential to provide implications for healthcare policy and practices aiming at containing healthcare spending, improving affordability for patients, and reducing the financial burden for employers. [1][2][3][4][5][6] In this Viewpoint article, we summarize some findings and their implications. This article is not intended to provide a comprehensive literature review of the large number of studies using price transparency data. ...

Hospital Prices For Commercial Plans Are Twice Those For Medicare Advantage Plans When Negotiated By The Same Insurer
  • Citing Article
  • August 2023

Health Affairs