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Health care dollars, disparities make headlines

SmartBrief readers in April were interested in big money spent in drug expenditures and health system acquisitions.

4 min read


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The Change Healthcare cyberattack continued to generate headlines in April as health systems and providers assessed their costs from the breach, but SmartBrief readers were also interested in big dollars spent in other areas — namely, drug expenditures and health system acquisitions. They also wanted to know more about health and service disparities that affect underserved populations. 

Here’s a closer look at some of the most-read stories last month.

Drugs that top the charts in US spending

What happened: Research published in the American Journal of Health-System Pharmacy showed that semaglutide — sold under the brand names Ozempic and Wegovy — was the drug with the greatest total US outlay in 2023, coming in at $38.6 billion for the year. The medication, approved by the FDA for type 2 diabetes, weight loss and cardiovascular indications, saw a 100% spending hike from the previous year. Tirzepatide, approved for diabetes treatment, came in 8th at $13.2 billion, a 373% increase from 2022.

Ranking second on the list was the monoclonal antibody adalimumab, which reached $35.3 billion in 2023 spending and has several indications including arthritis, and coming in third was the anticoagulant apixaban, which totaled $22.1 billion. The list included several other monoclonal antibody drugs, with ustekinumab totaling $15.9 billion in spending, pembrolizumab hitting $15.4 billion and dupilumab reaching $11.5 billion. Insulin aspart and insulin lispro also appeared in the ranking, which took into account list pricing, newly approved medications and utilization levels. 

What’s next: News reports continue to highlight shortages of weight loss and diabetes medications due to high demand. The FDA updated its drug shortage list to show that most doses of Eli Lilly’s Zepbound, or tirzepatide, have been in low supply, along with Novo Nordisk’s Wegovy, it is likely to remain so for the next several months. Manufacturers said they are working to meet demand for the medications.

The changing landscape of health system ownership

What happened: Recent research suggests that consolidation in health care may lead to higher costs, reduced competition and lower skilled-worker pay, but it is unknown whether it affects care quality. It’s also unclear how consolidation affects care in rural and underserved areas.

The proportion of US physicians working for corporate organizations rose from 15% in January 2019 to 22% three years later. Private-equity health system acquisitions also increased significantly from 2010 onward, though they have slowed in the past three years. Some policymakers are concerned about the impact of private-equity consolidation on care quality, pricing and the financial health of practices and systems being assimilated.

What’s next: The Federal Trade Commission and Department of Justice have been focusing more attention on acquisitions by private equity firms and private payers. New policies have been proposed to bolster antitrust enforcement, reduce incentives for health care organizations to consolidate, improve price transparency and let more providers participate in the market.

Strategies for curbing care disparities

What happened: A recent Commonwealth Fund report highlighted continuing racial and ethnic disparities in access to health care in the US. Researchers looked at health and service differences in and between states based on residents’ racial and ethnic backgrounds and assigned performance “scores” for each.

The findings showed especially marked disparities affecting Black and American Indian/Alaska Native populations. They tend to have shorter average life spans, higher rates of pregnancy-related complications, more deaths due to treatable conditions and greater risk of chronic health conditions than their white and Hispanic counterparts. Disparities in insurance coverage were noted, as well, with Hispanic residents experiencing the highest uninsured rates.

What’s next: Researchers wrote that policymakers must evaluate existing regulations affecting the health of people of color, with an eye toward reforms that can close gaps. They reported that policy changes are needed in the following areas: ensuring universal, affordable and equitable health coverage, bolstering primary care availability and delivery of services, simplifying administrative burdens for clinicians and patients, and increasing investment in social services such as housing and transportation.


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