A study by Anna Morenz and colleagues examines disparities in telemedicine use between Native Hawaiian and Pacific Islanders (NHPI) and non-Hispanic White individuals insured through Medicaid living in Washington state.
Although the authors found telemedicine use to be 7.5 percent lower among the NHPI group, they noted much of the difference stemmed from the differential effects of key predictors of telemedicine use, including age, gender, and English language proficiency.
Johanna Maclean and coauthors report a 6 percent per year increase in prescription medications dispensed for mental health disorders among Medicaid enrollees following the adoption of a state paid sick leave mandate.
A study by Ilina Odouard, Jeromie Ballreich, and Mariana Socal underscores the need for new payment models to address Medicaid budget constraints given the substantial increase in spending and utilization of rare disease gene and RNA therapies.
Their findings indicate that pooled purchasing, preferred drug lists, and carve out initiatives may broaden access to therapies among Medicaid beneficiaries, but their impact on spending is unclear.
Continuing our exploration of Medicaid coverage for groundbreaking gene therapies, we revisit a notable Editor’s Choice article from our previous issue.
In December 2023, the FDA approved two potentially curative gene therapies for individuals with the most severe forms of sickle cell disease (SCD), currently priced at $2.2 million and $3.1 million.
In their brief report, Junelle Speller and colleagues explore the prevalence of this condition and analyze current health care service utilization and costs among SCD patients enrolled in Medicaid.
Their analysis shows the average annual total cost of care for a SCD enrollee was more than double that of a typical full-benefit enrollee, with costs disproportionately concentrated among those with severe SCD and clinical trial-eligible genotypes.
Those in the top 5 percent of health care spending incurred nearly $200,000 in annual costs, in addition to multiple inpatient stays and ED visits.
Findings from both studies emphasize the need to further explore innovative payment models that strike a balance between expanding access to transformative therapies and fiscal responsibility.
Be sure to sign up for new issue email alerts on the Health Affairs Scholar website to stay up-to-date on the latest research.
