Dear John,

The January issue of Health Affairs includes the annual national health spending report, prepared by Micah Hartman and colleagues at the Centers for Medicare and Medicaid Services, which shows that in 2022, spending growth returned to its prepandemic rate.

Other articles in this issue discuss drug development, treatment for opioid use disorder, and more. 

The Orphan Drug Act of 1983 introduced financial incentives to encourage the development of drugs for rare diseases.

Kathleen Miller and Michael Lanthier examine the approval of orphan drugs and find that of the 491 novel approvals between 1990 and 2022, 65 percent of orphan drugs have been approved for a single rare disease, 15 percent for multiple rare diseases, and 20 percent for both rare and common diseases.

The latter group “represented an outsize share of the top-selling orphan drugs in 2021.” 

Sanket Dhruva and coauthors survey physicians about the Food and Drug Administration (FDA) drug and medical devices approval processes and find that “many physicians lacked understanding of the level of evidence required for FDA approval and that they expect (or believe) it to be more rigorous than it is.”

Physicians believe that the FDA should require higher-quality evidence standards and conduct more follow-up after expedited approval processes. 

With no-cost coverage of preventive services under legal challenge, Lorraine Dean and coauthors estimate how the use of oral HIV pre-exposure prophylaxis (PrEP) would change in the face of patient cost sharing.

They conclude that about one-third of commercially insured patients receiving PrEP could abandon their prescriptions if they faced cost sharing between $100 and $500. 

Olivia Sugarman and coauthors examine Louisiana Medicaid claims data for enrollees with opioid use disorder (OUD) between 2018 and 2021 and find that uptake of medications for OUD (MOUD) more than tripled.

The authors conclude, “The combination of policy tools enacted during [this period] was likely a potent contributor to this change.”

Despite the improvement, disparities in MOUD persisted, with use highest among enrollees who were White, were older, had comorbidities, and lived in a metropolitan area.

Medicaid managed care plans vary widely in their requirements for prior authorization of buprenorphine, which providers often cite as a barrier to appropriate OUD care.

Analyzing plan coverage documents, Christina Andrews and coauthors find higher rates of prior authorization requirements among plans operating in states with a Republican-leaning electorate and among for-profit plans relative to nonprofit plans.

Using federal treatment locator data, Caroline King and coauthors identify 160 residential addiction treatment facilities nationwide that serve adolescents with OUD.

Of these, a little more than half had a bed immediately available at the time of inquiry. Four-fifths of nonprofit facilities and one-fifth of for-profit facilities accepted Medicaid.

Overall, “only seven states had a facility that accepted Medicaid, had a bed open the same day, and offered buprenorphine.” 

Lauren Taylor and Len Nichols describe their experience in three cities seeking to implement the Collaborative Approach to Public Good Investments (CAPGI) model, which aims to align financing among multiple stakeholders to support investment in programs that address social determinants of health.

Among the essential ingredients: “clearly bounded coalitions whose membership was well understood and roles that were clearly specified.” 

Amy Finkelstein and coauthors present follow-up analysis of their 2020 experiment, which concluded that the Camden Coalition’s care coordination model, targeting people in Camden, New Jersey, with complex medical and social needs, did not reduce hospital readmission rates or other related outcomes.

Seeking to understand the earlier disappointing results, they find that the program increased ambulatory care visits after hospitalization, suggesting that more than care coordination is needed to generate measurable effects for this high-need population.

Corianne Scally Gives an Overview on Housing and Health

In a special series on housing and health, Health Affairs' Rob Lott interviews Corianne Scally from the Urban Institute.

This is a special series leading up to the release of a theme issue on housing and health in February.

Generative AI In Health Care: Opportunities, Challenges, And Policy

Niam Yaraghi

Building A Resilient, Sustainable, And Representative Clinical Trials Enterprise

Carolyn Shore et al.

Increasing Transparency In The 340B And Medicaid Drug Rebate Programs

Anthony M. DiGiorgio et al.

EMTALA Pregnancy Protections Versus State Abortion Bans: The Supreme Court Will Decide

Sara Rosenbaum

Why The Star Ratings Medication Adherence Measures Must Go

C. Annette DuBard et al.

An Innovation-Driven Future For The Food And Drug Administration

Brian J. Miller et al.

To Prepare For The Next Pandemic, We Must Spend Now On TB And Other Major Diseases

Shan Soe-Lin et al.

Navigating Misalignment: Real-World Advice For D-SNP Enrollee Advisory Committees

Evelyne Kane et al.

Lessons For Global Health From COVID-19: Views From Sub-Saharan Africa

Haley MacGregor et al.

Join us for the following event:

• January 16: Journal Club: “Nursing Home Staffing: Share Of Immigrant Certified Nursing Assistants Grew As US-Born Staff Numbers Fell, 2010–21”

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