Policy

Insurers grapple with expanding overage for weight loss medications; a new analysis reveals a potential correlation between COVID-19 vaccinations and various adverse effects (AEs); reshaping Medicaid programs remains an ongoing debate about ensuring health care access.

Carrie Kozlowski, OT, MBA highlights 3 key trends shaping the future of health care: a focus on health equity with actionable strategies for equitable access to care, a transition toward responsible AI utilization, and a push to maximize the potential of patient data while addressing privacy concerns.

Discontinuation of asthma drug leaves patients in search of alternative; FDA’s approach to artificial intelligence (AI) raises opportunities and challenges; landmark FDA approval signals hope for millions with severe food allergies.

This week in health equity and access includes challenges for independent physicians due to Medicare cuts, inequities in access to State Health Insurance Assistance Program counseling, a study on patient experiences in national health plans, strategies for building trust in cancer care, and increasing breast cancer rates in young Black women.

In the January issue of The New England Journal of Medicine, James Robinson, PhD, MPH, and his fellow investigators published their findings from an analysis of how insurer drug expenditures on infused drugs influenced price markups at hospitals.

Medicare beneficiaries are beginning to see the first savings from the Inflation Reduction Act; abortion pills prescribed to patients via telehealth and the mail are safe; nearly half of health care workers have witnessed racism or discrimination in their workplace.

Part of the recent Medicare reimbursement cuts could be addressed in a spending package next month; Medicaid/Medicare dual eligibles are expected to generate big profits for health insurers; FDA sent warning letters to online vendors selling unapproved and misbranded versions of semaglutide and tirzepatide.

Coverage from "Navigating the PBM Landscape: How a Heath Care Economist Sees It," at Patient-Centered Oncology Care 2023.

"I'll say what I don't think the issue is—it's not technology. We can solve this problem with technology," Carrie Kozlowski, OT, MBA, explains in the interview.

A ruling against Pharmaceutical Research and Manufacturers of America marks victory for efforts to lower health care costs; new guidelines align with flu and respiratory syncytial virus protocols; children and pregnant individuals are burdened with long-term health symptoms in the aftermath of COVID-19.

The federal State Health Insurance Assistance Program (SHIP) provides counseling and education on Medicare coverage options. This article highlights potential inequities in in-person SHIP service access.

Over the past 20 years, Medicare physician pay has plummeted by 26% when adjusted for inflation, while hospital reimbursement has surged by 70%, prompting over 100,000 doctors to abandon independent practice for hospital or corporate employment since 2019.

A wave of drug supply chain problems would occur if the FDA pulled cough and cold medications containing the active ingredient phenylephrine from shelves; lawmakers in 19 states are considering bills allowing medically assisted death; tuberculosis awareness is lagging as state and local health departments lack the resources to keep up with prevention and control efforts.

A provision in the Inflation Reduction Act will implement a $2000 out-of-pocket cap on Medicare beneficiaries’ prescription drug spending, which could save money for more than 1 million enrollees when it takes effect next year.

Miriam J. Atkins, MD, FACP, president of the Community Oncology Alliance, discusses the impact of pharmacy benefit managers (PBMs) on health care costs and offers potential ways to remedy certain CMS decisions that negatively affect oncologists and their patients.

Amazon and Health Warehouse’s direct-to-consumer pharmacies had the most expensive and commonly used generic drugs available in 2020, whereas Walmart only had a small fraction.

States channel billions into housing for the homeless using Medicaid funds; AstraZeneca invests $300 million to discover and develop cell therapies; the CDC highlights dangers of menthol cigarette addiction.

A total of 16,430,000 Medicaid enrollees have been disenrolled across all 50 states and the District of Columbia, as of February 1, 2024.

Although 30-day mortality rates did not worsen for Medicare beneficiaries at hospitals with high proportions of Black patients compared with other hospitals, gaps in outcomes widened for Black adults with pneumonia under the Medicare Value-Based Purchasing Program.

Novo Holdings to acquire Catalent for $11.5 billion; cancer incidence is expected to surge 77% by 2050; Silicon Valley’s county takes a bold step to address the rising loneliness crisis.

The Center on Health Equity and Access provides real-time updates, shares cutting-edge research, and supports continuous efforts dedicated to tackling health care disparities and enhancing widespread access to high-quality health services.

The article emphasizes the significance of accreditations in addressing health disparities and promoting health equity, highlighting programs for achieving accreditation and advocating for the integration of social determinants of health (SDOH) and health equity practices within pharmacy and health care.

Payers, health systems, and health professionals will experience expanded accountability for performance in closing health disparity gaps in 2024.

Medically integrated dispensaries could be in violation of the Medicare Physician Self-Referral Law, known as the Stark Law, due to an interpretation of the law released in 2021.

The newly appointed president and CEO of the National Alliance of Healthcare Purchaser Coalitions discussed timely issues where we may see progress in 2024.

The Inflation Reduction Act will likely change incentives surrounding single-indication launches and postapproval research for additional indications in small molecule drugs, affecting patient access.

Bevey Miner, executive vice president of health care strategy and policy, Consensus Cloud Solutions, discusses the complex landscape of proposed health care rules, and the potential impact of CMS' Advancing Interoperability and Prior Authorizations Rule.

Days spent obtaining health care outside the home may show access to needed care, but also add up to substantial time, effort, and cost burdens to patients and those who care for them, according to the study authors.

UnitedHealthcare is incorporating real-world evidence into pathways design and policy formulation, leveraging its members' data to evaluate the impact of different regimens on health resource utilization and costs, explains Lucy Langer, MD, MSHS, national medical director of oncology and genomics at UnitedHealthcare.

Drug prices in the US increased 4.4% annually and median out-of-pocket (OOP) costs increased 9.6% annually from 2009 to 2018, but there was no direct link between these amounts for individual drugs.