John F. Hoadley, Ph.D. serves as a research professor in Georgetown University’s Health Policy Institute. His research focuses primarily on health care financing issues, especially Medicare and Medicaid, with a particular interest in prescription drugs. Recently, Hoadley has been examining cost-containment approaches used to manage drug spending, the use of evidence-based formularies in Medicaid, the impact of changes to Medicare’s payment for chemotherapy drugs, and the role of formularies in the Medicare Part D benefit.
Prior to joining Georgetown University in 2002, Hoadley held a variety of positions as a policy analyst, allowing him to bring a true sense of the “real world” to his current research. Most recently, he was the director of health financing policy in the Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services. His key accomplishments as health financing policy director included preparing a report for the White House on prescription drug coverage, spending, and pricing, as well as coordinating a research conference on pharmaceutical pricing practices. He also assisted in the design of legislative proposals, including President Clinton’s 1999 proposal for a new Medicare prescription drug benefit. Prior to joining ASPE, Hoadley served as the Principal Policy Analyst for the Physician Payment Review Commission and its successor agency, the Medicare Payment Advisory Commission.
In January 2004, HCFO awarded Hoadley a grant to examine state pharmacy assistance programs and their implications for a Medicare prescription drug benefit. Through a series of case studies, Hoadley and colleagues gathered information on issues such as communicating with enrollees, administering eligibility and cost sharing, and managing drug costs. The objective of the project was to identify best practices and lessons learned that would be of use to those implementing the Medicare prescription drug benefit and those in states implementing or modifying pharmacy assistance programs.
Hoadley and his colleagues found that many state pharmacy assistance programs are reconfiguring their programs in light of the Medicare prescription drug benefit. Several of the smaller state programs will be terminated, but many others will pay at least a portion of their enrollees’ out-of-pocket costs under the Medicare benefit. Some have also considered other options for preserving current benefits at low cost and risk while maintaining administrative simplicity. In terms of cost containment, state pharmacy assistance programs and their enrollees are likely to see major changes as the Medicare prescription drug benefit is implemented. Compared to most state programs, the Medicare benefit is likely to bring tighter formularies, higher cost sharing for those who do not qualify for the low-income subsidy, and more use of techniques such as prior authorization. Although state policymakers are seeking to hold beneficiaries’ out-of-pocket costs constant, the impact of other changes remains unclear.
Publications from HCFO-Sponsored Work:
Goodell, S., Hoadley, J. et al. “State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans: How Do They Contain Costs?” Changes in Health Care Financing and Organization Issue Brief, AcademyHealth, October 2005. Also see www.hcfo.net/pdf/issue1005.pdf.
Williams, C., Hoadley J. et al. “State Pharmacy Assistance Programs at a Crossroads: How Will They Respond to the Medicare Drug Benefit?” Changes in Health Care Financing and Organization Issue Brief, AcademyHealth, July 2005. Also see www.hcfo.net/pdf/brief0705.pdf.
