June 13, 2024

The NHE is published annually and is often referred to as the “official” estimates of U.S. health spending and health insurance enrollment. The historical and projected estimates of NHE measure total annual U.S. spending for the delivery of health care goods and services by type of good or service (hospital, physician, prescription drugs, etc.) and by payer (private health insurance (PHI), Medicare, Medicaid, etc.)

The Inflation Reduction Act President Biden signed in 2022 paved the way for the federal program to negotiate prices directly with drugmakers for the first time. But for now, the high price of Ozempic, Trulicity and other drugs in the class known as GLP-1 agonists have put them out of reach for many low-income patients.

This legislation, if passed, could significantly impact payers by mandating more efficient and transparent prior authorization processes, potentially reducing administrative burdens but also requiring investment in electronic systems and compliance with stricter deadlines.

Overcoming these challenges is crucial as biosimilars can substantially reduce costs; however, this will require investments in educating healthcare providers, simplifying regulatory frameworks, and fostering patient confidence in these alternatives.

The win by Elevance follows a lawsuit won by SCAN earlier this month, both over the way calculations for 2024 Medicare Advantage Star Ratings were done by the government.