Dear John,

The October issue of Health Affairs includes articles on topics ranging from emergency department (ED) readiness to serve children to global inequities in access to essential medicines.

We are also pleased to publish an Entry Point by Heidi de Marco, which describes the disproportionate burden that Alzheimer’s places on Latino communities, in both English and Spanish as part of the Age-Friendly Health series supported by the John A. Hartford Foundation.

C H I L D R E N

Since 2005, the Food and Drug Administration has required black-box warnings on antidepressants regarding suicide risk for children and young adults.

A systematic review by Stephen Soumerai and coauthors concludes that the warnings yielded significant negative unintended consequences, including reduced depression diagnoses and antidepressant use, along with increases in suicide attempts and suicide deaths, without the intended benefit of increased physician monitoring for suicidal thoughts and behaviors.

Each year, one in five children visit an ED, with only a small share of visits occurring at children’s hospitals.

Christopher Weyant and coauthors estimate the cost of bringing all EDs to a high level of pediatric readiness to be $8.0 million per 100,000 children served, while yielding a more than 40 percent reduction in initial mortality rates.

This leads the authors to call it “a compelling intervention with small costs relative to the health improvements it confers.”

Samantha Goldfarb and colleagues document variable progress across states in closing the gap between Black and White infant mortality rates during 2007–19.

No state eliminated the Black-White disparity in infant mortality, and in eight states, the disparity grew.

M E D I C A R E

Enrollment in Institutional Special Needs Plans (I-SNPs), which are designed to serve the critical population of people with sustained need for an institutional level of care, makes up a small sliver of overall SNP enrollment.

Amanda Chen and colleagues document a quadrupling in the share of long-stay nursing home residents enrolled in I-SNPs between 2006 and 2021, but they find that in more than 60 percent of US counties, no I-SNPs are available.

Avni Gupta and coauthors find significant cost-associated unmet need for dental, vision, and hearing services among enrollees in Medicare Advantage plans that offer these supplemental benefits.

Enrollees with incomes below twice the federal poverty level experience unmet need at more than twice the rate of those with higher incomes.

P H A R M A C E U T I C A L S

In an effort to understand the potential change in investment incentives under the drug price negotiation provisions of the Inflation Reduction Act of 2022, Henry Grabowski and coauthors examine clinical trials and approvals for new indications after the initial approval of cancer drugs.

They find that more than half of all indications are postapproval, with about half of these indications reflecting new disease areas for the drug and most drugs having at least one orphan drug indication.

Olivier Wouters and Jouni Kuha examine the timing of drug launches around the world for the World Health Organization’s designated essential medicines.

The median time from first launch to availability was less than three years for high-income countries but almost seven years for lower-middle-income countries and eight years for low-income countries, demonstrating significant inequities.

Medicare Part D plans are required to cover “all or substantially all” drugs in six protected classes.

Pragya Kakani and coauthors find that this translates into low rates of formulary exclusions and a rate of growth in average rebates during 2011–19 about one-sixth for protected-class drugs relative to those not in a protected class.

Although Paxlovid is an effective drug for high-risk patients with COVID-19, Gillian SteelFisher and coauthors analyze survey data and find that about 85 percent of Americans report no or low awareness of it.

Low awareness is most common among those who could benefit most from the drug, and misperceptions regarding its effectiveness and how to use it are widespread.

Health Affairs Branded Post:

Improving Adherence with Continuous Glucose Monitoring: A Risk Profile-based Digital Intervention Program

Richard Mackey et al.

Sponsored by CCS Medical

The Curious Case Of Hospital Indemnity Insurance For Medicare Beneficiaries

Dmitry Khodyakov et al.

Advancing Equity through Accountable Care with Purva Rawal from the CMS Innovation Center

Join Health Affairs Thursday, October 17, 2024, for a virtual event featuring a conversation between Health Affairs Senior Editor Margaret Winchester and Purva Rawal, the Chief Strategy Officer for the CMS Innovation Center, on advancing equity through accountable care.