International Journal For Multidisciplinary Research

E-ISSN: 2582-2160   •   Impact Factor: 9.24

A Widely Indexed Open Access Peer Reviewed Multidisciplinary Bi-monthly Scholarly International Journal

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Volume 8 Issue 2
March-April 2026

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Methodological Frameworks for Evaluating Patient Access Barriers to High-Cost Therapies in Medicaid and Medicare Populations

Author(s) Karen Mends
Country United States
Abstract The rapid expansion of high-cost therapies within public insurance programs has intensified concerns regarding affordability, sustainability, and equitable patient access. This study develops a structured comparative methodological framework to evaluate patient access barriers to high-cost therapies across Medicaid and Medicare populations. Five dominant evaluative approaches are examined: cost-effectiveness and health technology assessment models, budget impact analyses, real-world evidence integration frameworks, payment innovation models, and behavioral disparity-oriented methodologies. The comparative analysis reveals that no single framework sufficiently captures all dimensions of access barriers. Cost-effectiveness models provide strong long-term value estimation but require recalibration for one-time curative therapies with high upfront costs. Budget impact models support short-term fiscal planning yet frequently overlook equity dynamics. Real-world evidence frameworks enhance policy adaptability, while spread payment and insurance redesign models mitigate financial volatility but introduce administrative complexity. Behavioral and disparity-focused frameworks uniquely detect structural inequities invisible to purely economic approaches. The study concludes that integrated hybrid methodological approaches, combining economic valuation, fiscal forecasting, real-world data integration, payment reform assessment, and equity-sensitive metrics, provide the most comprehensive structure for evaluating access barriers and informing policy reform within evolving Medicaid and Medicare systems.
Field Medical / Pharmacy
Published In Volume 8, Issue 2, March-April 2026
Published On 2026-04-09
DOI https://doi.org/10.36948/ijfmr.2026.v08i02.73174
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E-ISSN 2582-2160
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