Reports from University of Colorado Anschutz Medical Campus Describe Recent Advances in Managed Care (Opportunities for CMS to Further Specify and Broaden Its Approach to Assessing Unmet Medical Need in the Context of the Medicare Drug Price …): Managed Care

2025 OCT 20 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators publish new report on Managed Care. According to news reporting out of Aurora, Colorado, by NewsRx editors, research stated, “The United States Inflation Reduction Act of 2022 established the Medicare Drug Price Negotiation Program, directing the Centers for Medicare and Medicaid Services (CMS) to establish ‘maximum fair prices’ for select drugs. In arriving at maximum fair prices, CMS is required to consider several criteria, including the extent to which a selected drug addresses unmet medical need (UMN).”

Our news journalists obtained a quote from the research from the University of Colorado Anschutz Medical Campus, “Through a targeted literature review of 48 original research studies, we identified and categorized 40 potential elements of UMN as they relate to pharmaceuticals, as well as treatment-related barriers to addressing this UMN, from the patient, caregiver, and societal perspectives. We synthesized these elements of UMN into seven domains: (1) traditional clinical effectiveness, (2) impacts on patient, caregiver, or family quality of life, (3) economic burden on the patient, caregiver, or family, (4) economic burden on society, (5) societal perspective elements, (6) elements of treatment administration, and (7) availability of other treatments.”

According to the news editors, the research concluded: “Comparing these elements with the United States Food and Drug Administration guidance regarding UMN reveals potential key gaps in the current CMS approach to assessing UMN in the Medicare Drug Price Negotiation Program, particularly regarding domains 2 through 6, including quality of life, economic burdens, societal elements, and treatment administration.”

This research has been peer-reviewed.

For more information on this research see: Opportunities for CMS to Further Specify and Broaden Its Approach to Assessing Unmet Medical Need in the Context of the Medicare Drug Price Negotiation Program. Applied Health Economics and Health Policy, 2025. Applied Health Economics and Health Policy can be contacted at: Springer Int Publ Ag, Gewerbestrasse 11, Cham, Ch-6330, Switzerland.

Our news journalists report that additional information may be obtained by contacting Michael J. DiStefano, Dept. of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States. Additional authors for this research include R. Brett McQueen, Hanke Zheng, Harry Gyimah Gyamfi, David Ameyaw, Jonathan D. Campbell and Antal Zemplenyi.

Publisher contact information for the journal Applied Health Economics and Health Policy is: Springer Int Publ Ag, Gewerbestrasse 11, Cham, Ch-6330, Switzerland.

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