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The Cost of Drugs in Addition to the Price of Drugs

Posted on June 27, 2025 by John C. Goodman

This article estimates that payers, manufacturers, physicians, and patients together incur approximately $93.3 billion in costs annually on implementing, contesting, and navigating utilization management. Payers spend approximately $6.0 billion annually administering drug utilization management, and manufacturers spend approximately $24.8 billion supporting patient access in response. Physicians devote approximately $26.7 billion in time spent navigating utilization management, whereas patients spend approximately $35.8 billion annually in drug cost sharing, even after taking advantage of manufacturer and philanthropic sources of financial support.

Source: Health Affairs

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KFF: Federal Proposals Threaten Key Source of State Medicaid Funding

Posted on June 27, 2025 by Devon Herrick

The Kaiser Family Foundation had this to say:

Republican efforts to restrict taxes on hospitals, health plans, and other providers that states use to help fund their Medicaid programs could strip them of tens of billions of dollars. The move could shrink access to health care for some of the nation’s poorest and most vulnerable people, warn analysts, patient advocates, and Democratic political leaders.

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Friday Links

Posted on June 27, 2025June 25, 2025 by John C. Goodman

More hospital systems are dropping Medicare Advantage.
An estimated 15.5 million U.S. adults now taking weight loss drugs like Wegovy.
Derek Thompson: “Face-to-face socializing has plunged more than 20 percent in the last 20 years. Daily time spent at home has increased by 99 minutes in the same period. Coupling rates—that is, the share of folks in long-term relationships—are collapsing in the U.S. and around the world.”
RFK, Jr.: Every American should be using a wearable health device within four years:

They can see … what food is doing to their glucose levels, their heart rates and a number of other metrics as they eat it, and they can begin to make good judgments about their diet, about their physical activity, about the way that they live their lives.

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No Surprises Act Dispute Resolution Arbitrators’ Awards Vary Widely

Posted on June 26, 2025 by Devon Herrick

Patients tend to choose doctors who are in their health plan network. Not every doctor is affiliated with a network, but most primary care providers (PCP) are. Refusing to affiliate with health plan networks makes it harder for PCPs to grow a practice, because patients dislike paying out of pocket.

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