Pricing and Reimbursement in U.S. Pharmaceutical Markets

In this survey chapter on pricing and reimbursement in U.S. pharmaceutical markets, we first provide background information on important federal legislation, institutional details regarding distribution channel logistics, definitions of alternative price measures, related historical developments, and reasons why price discrimination is highly prevalent among branded pharmaceuticals. We then present a theoretical framework for the pricing of branded pharmaceuticals, without and then in the presence of prescription drug insurance, noting factors affecting the relative impacts of drug insurance on prices and on utilization. With this as background, we summarize major long-term trends in copayments and coinsurance rates for retail and mail order purchases, average percentage discounts off Average Whole Price paid by third party payers to pharmacy benefit managers as well as average dispensing fees, and generic penetration rates. We conclude with a summary of the evidence regarding the impact of the 2006 implementation of the Medicare Part D benefits on pharmaceutical prices and utilization, and comment on very recent developments concerning the entry of large retailers such as Wal-Mart into domains traditionally dominated by large retail chains and the "commoditization" of generic drugs

Research Notes : United States : Evaluation of Glycine soja from The People\u27s Republic of China and the USSR

A chromosome interchange was suspected by Williams (1948) in a cross involving Glycine soja Sieb. and Zucc. PI 101404B. This interchange was confirmed by Palmer and Heer (n.d.). The objective of the present study was to search for chromosome inter-changes among G. soja accessions from The People\u27s Republic of China and the USSR

From synchronization to multistability in two coupled quadratic maps

The phenomenology of a system of two coupled quadratic maps is studied both analytically and numerically. Conditions for synchronization are given and the bifurcations of periodic orbits from this regime are identified. In addition, we show that an arbitrarily large number of distinct stable periodic orbits may be obtained when the maps parameter is at the Feigenbaum period-doubling accumulation point. An estimate is given for the coupling strength needed to obtain any given number of stable orbits.Comment: 13 pages Latex, 9 figure

Price Indexes for Medical Care Goods and Services: An Overview of Measurement Issues

We review in considerable detail the conceptual and measurement issues that underlie construction of medical care price indexes in the U.S., particularly the medical care consumer price indexes (MCPIs) and medical-related producer price indexes (MPPIs). We outline salient features of the medical care marketplace, including the impacts of insurance, moral hazard, principal-agent relationships, technological progress and organizational changes. Since observed data are unlikely to correspond with efficient outcomes, we discuss implications of the failure of transactions data in this market to reveal reliable marginal valuations, and the consequent need to augment traditional transactions data with information based on cost-effectiveness and outcomes studies. We describe procedures currently used by the BLS in constructing MCPIs and MPPIs, including recent revisions, and then consider alternative notions of medical care output pricing that involve the price or cost of an episode of treatment, rather than prices of fixed bundles of inputs. We outline features of a proposed new experimental price index -- a medical care expenditure price index -- that is more suitable for evaluation and analyses of medical care cost changes, than are the current MCPIs and MPPIs. We conclude by suggesting future research and measurement issues that are most likely to be fruitful.

Some Consequences of the Shadowing Property in Low Dimensions

We consider low-dimensional systems with the shadowing property. In dimension two, we show that the shadowing property for a homeomorphism implies the existence of periodic orbits in every $\epsilon$-transitive class, and in contrast we provide an example of a $C^\infty$ Kupka-Smale diffeomorphism with the shadowing property exhibiting an aperiodic transitive class. Finally we consider the case of transitive endomorphisms of the circle, and we prove that the $\alpha$-H\"older shadowing property with $\alpha>1/2$ implies that the system is conjugate to an expanding map.Comment: 36 pages, 12 figures (revision based on referee's comments. To appear in Ergodic Theory Dynam. Systems

Spin-orbit torque switching of synthetic antiferromagnets

We report that synthetic antiferromagnets (SAFs) can be efficiently switched by spin-orbit torques (SOTs) and the switching scheme does not obey the usual SOT switching rule. We show that both the positive and negative spin Hall angle (SHA)-like switching can be observed in Pt/SAF structures with only positive SHA, depending on the strength of applied in-plane fields. A new switching mechanism directly arising from the asymmetric domain expansion is proposed to explain the anomalous switching behaviors. Contrary to the macrospin-based switching model that the SOT switching direction is determined by the sign of SHA, the new switching mechanism suggests that the SOT switching direction is dominated by the field-modulated domain wall motion and can be reversed even with the same sign of SHA. The new switching mechanism is further confirmed by the domain wall motion measurements. The anomalous switching behaviors provide important insights for understanding SOT switching mechanisms and also offer novel features for applications.Comment: 40 pages, 14 figure

Pricing and Reimbursement in U.S. Pharmaceutical Markets

In this survey chapter on pricing and reimbursement in U.S. pharmaceutical markets, we first provide background information on important federal legislation, institutional details regarding distribution channel logistics, definitions of alternative price measures, related historical developments, and reasons why price discrimination is highly prevalent among branded pharmaceuticals. We then present a theoretical framework for the pricing of branded pharmaceuticals, without and then in the presence of prescription drug insurance, noting factors affecting the relative impacts of drug insurance on prices and on utilization. With this as background, we summarize major long-term trends in copayments and coinsurance rates for retail and mail order purchases, average percentage discounts off Average Whole Price paid by third party payers to pharmacy benefit managers as well as average dispensing fees, and generic penetration rates. We conclude with a summary of the evidence regarding the impact of the 2006 implementation of the Medicare Part D benefits on pharmaceutical prices and utilization, and comment on very recent developments concerning the entry of large retailers such as Wal-Mart into domains traditionally dominated by large retail chains and the "commoditization" of generic drugs.

Infinitely Many Stochastically Stable Attractors

Let f be a diffeomorphism of a compact finite dimensional boundaryless manifold M exhibiting infinitely many coexisting attractors. Assume that each attractor supports a stochastically stable probability measure and that the union of the basins of attraction of each attractor covers Lebesgue almost all points of M. We prove that the time averages of almost all orbits under random perturbations are given by a finite number of probability measures. Moreover these probability measures are close to the probability measures supported by the attractors when the perturbations are close to the original map f.Comment: 14 pages, 2 figure