An estimated 80 percent of health outcomes stem from social, economic, environmental, and behavioral factors known as drivers of health (DOH) — everything from stable housing and food security to personal safety. On To the Point, experts from the Commonwealth Fund, the Blue Shield of California Foundation, and the Health Initiative find that the Centers for Medicare and Medicaid Services’ approval of the first DOH measures in Medicare’s history have, along with other actions, accelerated efforts to address drivers of health and advance equity. At the same time, however, consistent implementation has lagged, they say.
As Medicare begins negotiating prescription drug prices for the first time, federal officials will be requiring pharmaceutical manufacturers to factor in all of a medication’s formulations and apply a single price. As Anna Kaltenboeck explains on To the Point, drug makers frequently guard against competition by tweaking their products that are about to come off patent, then marketing these versions as new formulations — with new patent protection. In fact, four of the 10 drugs selected for the first round of negotiation fall into this category, she says.
Prices for Key Medicare Drugs in U.S. vs. Other Countries
Americans pay significantly more for brand-name drugs than people in most other countries. With Medicare set to begin historic price negotiations for 10 important prescription drugs, a new Commonwealth Fund study finds that, even after estimated discounts, U.S. prices eclipse those in nearly every peer country. Among the findings: list retail prices for the 10 selected drugs are, on average, three times higher in the U.S. compared to other high-income countries, and U.S. prices after estimated discounts and rebates are higher than nearly all prices in these countries even before discounts and rebates.
What Medicare Advantage Growth Means for Beneficiaries
If current trends continue, more than half of Medicare’s 66 million beneficiaries will be enrolled in private Medicare Advantage plans next year. “The anticipated predominance of Medicare Advantage raises obvious questions about why it has developed, what it means for the quality and cost of care available to Medicare beneficiaries, and what it means for our health care system as a whole,” wrote Gretchen Jacobson and David Blumenthal, M.D., in the New England Journal of Medicine (Dec. 14). In their article, Jacobson and Blumenthal explain how Medicare Advantage works, how plans are paid, and how plans perform compared to traditional Medicare.
Despite remaining eligible, many children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) cycle in and out of coverage for administrative reasons. This coverage churn is a bigger problem for children than adults, and it most affects children of color. Manatt Health’s Cindy Mann and Emma Daugherty review what states are doing to keep eligible children covered. As of January 1, 12-month continuous enrollment is in place for all children enrolled in Medicaid and CHIP. According to the authors, ending churn could be a game-changer for children’s health and well-being.
Listen to Young Adults for Better Mental Health Policy
Young people ages 18 to 25 are the least likely to get mental health treatment, despite being the age group with the highest rates of mental health conditions and substance use disorders. Diana Chao and Mary Giliberti of Mental Health America discuss the importance of bringing young adult voices to the forefront of policy conversations around mental care, including new Biden administration proposals to strengthen enforcement of the Mental Health Parity and Addiction Equity Act. Through panel discussions and a portal for submitting comments on policy changes, Mental Health America and partners are facilitating awareness and engagement among young people in an effort to inform the policy process.
Margaret A. (Peggy) Hamburg, M.D., former commissioner of the U.S. Food and Drug Administration, has been elected chair of the Commonwealth Fund’s board of directors. Hamburg’s tenure begins immediately. She succeeds Michael Drake, M.D., president of the University of California, who has served as the Commonwealth Fund chair since 2019. Hamburg, a member of the Fund’s board since 2015, currently coleads the InterAcademy Partnership, an international consortium of national academies of science, medicine, and engineering. Hamburg’s past positions include assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services and health commissioner for New York City.
The Pozen–Commonwealth Fund Fellowship in Health Equity Leadership at Yale University is still accepting applications for the 2026 class of fellows. The fellowship is a 22-month, degree-granting program that covers the cost of the MBA for Executives program and gives health care professionals the leadership skills and deep understanding of teams, markets, and organizations necessary to tackle major inequities in the U.S. health care system. The first step is to complete a pre-assessment, for which a member of the admissions team will provide personalized feedback regarding your candidacy for the MBA for Executives program. The deadline for applications is January 29. Please reach out to the Yale MBA for Executives team at [email protected] with any questions.
Forum: The Future of People-Centered Innovation
The Future of People-Centered Health Innovation, an OECD High-Level Policy Forum taking place on January 22, will explore policies and priorities for health system adoption of new innovations. Topics will include artificial intelligence and health; genomic and genetic medicine; and climate change and health. Conducted in partnership with the Commonwealth Fund and the Health Foundation and supported by FT Live, the forum will take place on the eve of the OECD Health Ministerial Meeting. Register to attend in person or online.
Webinar: Health Care Policy in the Election Year
Don’t miss the opportunity to stay informed about election-year dynamics, congressional priorities, and the administration’s agenda for health issues. On Wednesday, January 17, the Bipartisan Policy Center and the Commonwealth Fund will host a discussion with public opinion pollsters and policy experts who will explore what may impact health care policymaking in 2024. Register for the webinar here.
Protecting Patients During Climate Events
KFF Health News reported last week that California may soon join Minnesota and Oregon in adopting new rules to protect indoor workers from heat-related injuries and deaths during heat waves. A recent issue of Transforming Care looked at strategies health systems are using to support patients most at risk during major climate events, including heat waves, floods, hurricanes, and wildfires.
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