Health Care Cost

"It’s time for our industry to recognize the consequences of the lack of investment in maternal health and come together to bring forward innovations," Charlotte Owens, MD, stated.

The average direct cost for hospital treatment for patients with COVID-19 in the United States rose by 26% from 2020 to 2022; scientists have developed a new type of antibiotic to treat a deadly bacteria resistant to most current antibiotics; a survey conducted for Utah state officials gave some clues as to why millions of Americans lost Medicaid coverage last year.

Amy Laughlin, MD, MSHP, of Orlando Health commented on at-home cancer care costs and shared her predictions on how at-home cancer care will evolve.

Drugmakers are expected to increase prices on more than 500 drugs early this month; the FDA approved nearly 50% more novel drugs in 2023 than in 2022; the number of Americans who were not pregnant and wanted abortion pills increased by nearly 10 times after the Supreme Court’s 2022 Roe v Wade decision leaked.

Lawmakers contemplate the return of mental health institutions in response to the drug crisis; new measures to rein in insulin prices take effect; FDA intensifies efforts to curb the teen vaping epidemic.

While the first ustekinumab biosimilar, Wezlana, was approved in October 2023, a settlement with Johnson & Johnson (J&J) will keep it off the market until 2025, preventing competition, and causing purchasers to pay substantially more for the agent.

The most popular content from our Asembia coverage largely covered biosimilars.

The most popular reimbursement content of 2023 included coverage of the shift from the Oncology Care Model to the Enhancing Oncology Model, reactions to the 2024 Medicare Physician Fee Schedule, and concerns around denial of services in Medicare Advantage plans.

Patients with spinal muscular atrophy (SMA) treated with a more expensive medication were found to have higher pharmacy costs but lower SMA-related health care resource utilization and medical costs compared with patients receiving standard-of-care nusinersen monotherapy.

The top articles of 2023 addressed key issues such as representation gaps in aRCC research, concerns about the 340B program's impact on asthma disparities, slow adoption of equity innovations, potential biases in type 2 diabetes risk models, and addressing disparities in psoriasis treatment based on race and culture.

Employers, recognized as pivotal contributors to health equity, are urged to prioritize equitable benefits, address the complexity of health plans, and engage in education, data-driven interventions, and systematic measurements to comprehensively improve outcomes for diverse employee populations.

In September, The American Journal of Managed Care® joined 4 individuals whose involvement with UPMC Health Plan, a Strategic Alliance Partner of AJMC®, has proved to be instrumental in furthering health equity and providing high-quality care in Pennsylvania, Ohio, West Virginia, and Maryland.

“Unfortunately, limited access to these therapies worldwide appears to be a major challenge,” the researchers wrote.

Researchers assessed care and costs incurred by people with asthma, who account for a large share of hospital admissions.

This year’s top content in the Duchenne muscular dystrophy (DMD) space focused on a novel gene therapy approval, the high cost of care for this genetic disorder, and steps forward in other treatments.

From the 2023 Academy of Managed Care Pharmacy (AMCP) Nexus meeting, held in October, expert interviews and insightful updates on the Inflation Reduction Act, gene therapy affordability and access, and the 340B Drug Pricing Program comprise the conference highlights.

CDC warns of rapid spread of new COVID-19 JN.1 subvariant amidst holiday travel; drugmakers and physicians experience significant drops in reputation; HHS urges action amidst soaring drop in child enrollment for Medicaid plans.

In 2023, adalimumab biosimilars took center stage in the biosimilar space due to 8 long-anticipated products finally launching.

The Center on Health Equity and Access offers updates on recent news, breakthroughs in research, and ongoing initiatives aimed at tackling health care disparities and enhancing overall access to top-notch care.

The government of Australia’s pricing policy links the price of new medications with similar safety and efficacy, resulting in significant savings over the first 3 years after the etanercept biosimilar Brenzys was introduced.

This year’s most-read spinal muscular atrophy(SMA) articles explored mental health, new technologies, caregiver well-being, and more.

Also known as Sanfilippo syndrome, this rare genetic syndrome has no known cures and what current treatment options are available are expensive and limited in supply.

A vaccine is showing promising results in treating melanoma; the Biden administration will implement inflation penalties on dozens of drugmakers to reduce out-of-pocket costs for Medicare recipients; the CDC issued an alert urging health care providers to increase immunization coverage for influenza, COVID-19, and respiratory syncytial virus (RSV).

A new report from AHIP shows that Medicare Advantage outperformed traditional Medicare on several clinical quality measures, including preventive screenings. However, debate continues over these plans’ cost efficiency and impact on the financial sustainability of rural hospitals.

The commercial market got slightly less competitive while the Medicare Advantage market got a little more competitive, but both markets remain highly concentrated.

This year’s top content from the fall meeting of the Association of Community Cancer Centers (ACCC) highlights both treatment gains made through innovative referral, screening, and assistance initiatives and the ongoing need to improve health equity and research inclusivity.

Authors highlight key aspects of the California Cancer Care Equity Act, including its focus on Medi-Cal beneficiaries, the requirement for managed care plans to contract with specialized cancer centers, and the definition of complex cancers.

Treatment with blinatumomab or inotuzumab ozogamicin particularly confers higher total costs for patients with relapsed/refractory B-cell acute lymphoblastic leukemia.

The Biden administration recently met with manufacturers of respiratory syncytial virus (RSV) immunizations to encourage them to increase access to the vaccine; since the Dobbs v Jackson decision, many patients have been seeking more permanent reproductive health care solutions; a Mathematica analysis showed that Medicare prescription drug price negotiations could have cut seniors’ out-of-pocket costs by nearly a quarter had the program been in effect in 2021.

Data analysis showed that 40% of patients who filled a prescription for Wegovy in 2021 or 2022 were still taking it a year later; both Democrats and reproductive rights organizations are pressuring the Biden administration to ensure health insurers fully cover contraception; CMS implemented Medicare changes in March that limited access to blood tests that help transplant recipients ensure their organs remain healthy.