National

Black pregnant people and pregnant individuals below the poverty line are less likely to access medication abortion, according to surveys of more than 4,700 patients by the Guttmacher Institute. 

Why it matters: It's evidence of how race and economic status can disadvantage some groups, especially in areas where medication abortion is the only option available. 

21 states have moved to ban or restrict abortion following the Supreme Court's decision to overturn Roe v. Wade, putting added emphasis on medication abortion as a means to maintain access.

What they found: The survey, drawing on data from 43 clinics concentrated in the South and Midwest, found 57% of respondents were obtaining, or expected to obtain, a medication abortion, as opposed to a surgical one.

Medication abortion was higher among individuals aged 18–19 (64%), those who identified as Asian (69%) or white (65%).

It was least common among Black respondents (48%), individuals with family incomes below the poverty threshold (53%), and those using insurance (49%).

What they're saying: "It's important to recognize that people need access to the method of abortion that's most suitable to their lifestyle and preferences," said Rachel Jones, principal research scientist at Guttmacher, an abortion-rights organization.

Surgical abortion can be preferable to medication abortion — a process that can involve several days, including time for recovery and rest. 

The survey found that people who reported having a prior abortion were more likely to have a procedure the second time around.

The bottom line: The demise of Roe v. Wade made access to abortion even more challenging for those living in the Midwest and the South, Jones said, noting that even in states where the procedure is legal, the cost of the procedure and travel remain significant barriers.

Black and poor people found less likely to access medication abortion

Black pregnant people and pregnant individuals below the poverty line are less likely to access medication abortion, according surveys by the Guttmacher Institute.

Illustration of a giant pencil drawing a line in front of a lone woman looking down at the line. 

Abortion

Black pregnant people and pregnant individuals below the poverty line are less likely to access medication abortion, <a class="gtmContentClick" data-vars-link-text="according to surveys" data-vars-click-url="https://www.contraceptionjournal.org/article/S0010-7824(23)00231-7/fulltext" data-vars-content-id="125252d9-99f3-4c6c-bc1a-67879387c483" data-vars-headline="Black and poor people found less likely to access medication abortion" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.contraceptionjournal.org/article/S0010-7824(23)00231-7/fulltext" target="_blank">according to surveys</a> of more than 4,700 patients by the Guttmacher Institute. Why it matters: It&#x27;s evidence of how race and economic status can disadvantage some groups, especially in areas where medication abortion is the only option available.

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

While the surge in prescriptions for ADHD drugs during the pandemic has often been attributed to expanded telehealth access, new research finds there has been little difference in prescribing rates for in-person or virtual care at large health centers since 2020.

Why it matters: There's been an ongoing debate about whether the explosion in telehealth enabled over-prescribing of ADHD medications like Adderall amid a prolonged drug shortage that's disrupted patient care. 

What they found: Epic Research analyzed more than 1 million initial patient visits for ADHD and anxiety from more than 200 large health systems to compare potential differences in prescribing rates.

Between the pandemic's first year and March 2023, about 60% of visits for both virtual and in-person care resulted in a prescription for an ADHD medication (both stimulants and non-stimulants) within 30 days of initial diagnosis.

While telehealth visits remained more popular than in-person visits during the pandemic, there was not an observable, significant difference in prescribing rates by visit type.

Of note: Epic's analysis was limited to their customers, who are large health systems that use the electronic health record system across many locations, so it doesn't account for telehealth-only providers, for instance. 

What they're saying: Shabana Khan, director of child and adolescent telepsychiatry at NYU Langone, said recent data shows that increased access to telehealth hasn't translated to over-diagnosing in younger patients. That's been the same experience for her psychiatry practice. 

"We've seen an increase in telehealth because of flexibility at the federal and state level, but there are mechanisms in place to make sure there's legitimate practice of medicine," said Khan, who wasn't involved in the Epic Research.

Yes, but: Prescriptions for adults increased by more than 10% during the first year of the pandemic, per the Centers for Disease Control and Prevention.

Earlier this month, federal drug regulators said the stimulant shortages were attributed to an increase in prescribing and the failure of the drug manufacturers to hit production quotas.

What's next: The ADHD drug shortage continues as kids are returning to school.  

Some providers are running out of options for their patients, as they struggle to keep up with which stimulants are cycling in and out of shortage. Some patients are simply going without their medication entirely.

Providers don't currently have a clear view into which pharmacies have stimulants in stock, Khan said, meaning patients often are left to hunt around for available medications.

Related: Biden admin seeks to limit telehealth prescriptions for some drugs

Biden admin seeks to limit telehealth prescriptions for some drugs

Telehealth didn't drive up ADHD prescriptions at large health centers: study

New research finds there has been little difference in prescribing rates for ADHD drugs at large health centers for in-person or virtual care since 2020.

Illustration of a magnifying glass inspecting a pill

Telehealth

While the <a class="gtmContentClick" data-vars-link-text="surge in prescriptions" data-vars-click-url="https://www.axios.com/2023/03/30/adhd-drug-prescriptions-among-adults-soared-in-covids-first-year" data-vars-content-id="3467f288-1471-4fdb-a32e-2b50e1fb6d47" data-vars-headline="Telehealth didn&#x27;t drive up ADHD prescriptions at large health centers: study" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/03/30/adhd-drug-prescriptions-among-adults-soared-in-covids-first-year" target="_self">surge in prescriptions</a> for ADHD drugs during the pandemic has often been attributed to expanded telehealth access, new <a class="gtmContentClick" data-vars-link-text="research" data-vars-click-url="https://epicresearchblob.blob.core.windows.net/cms-uploads/pdfs/adhd-medications-prescribed-at-similar-rates-during-telehealth-and-in-person-visits.pdf" data-vars-content-id="3467f288-1471-4fdb-a32e-2b50e1fb6d47" data-vars-headline="Telehealth didn&#x27;t drive up ADHD prescriptions at large health centers: study" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://epicresearchblob.blob.core.windows.net/cms-uploads/pdfs/adhd-medications-prescribed-at-similar-rates-during-telehealth-and-in-person-visits.pdf" target="_blank">research</a> finds there has been little difference in prescribing rates for in-person or virtual care at large health centers since 2020.Why it matters: There&#x27;s been an ongoing debate about whether the explosion in telehealth enabled over-prescribing of ADHD medications like Adderall amid a prolonged drug shortage that&#x27;s disrupted patient care.

The 25 drugs that accounted for the highest Medicare Part D spending in 2021 more than tripled in price since they first entered the market, according to a new report from AARP.

Why it matters: The report comes just weeks before the Biden administration is to announce the first 10 Medicare Part D drugs that will be considered for price negotiations under the Inflation Reduction Act, on Sept. 1.

What they found: All but one of the top 25 drugs' lifetime price increases exceeded the corresponding annual rate of general inflation, the AARP report finds. 

List prices rose sharply for drugs that have been on the market the longest: The average lifetime price increase for the five products on the market for 20 years or longer was 592%.

List prices for the top 25 drugs increased by an average of 226%.

Zoom in: On average, Medicare recipients take four to five prescription drugs a month, and higher costs can force seniors on fixed incomes to make difficult tradeoffs in order to afford their medications.

Pfizer and Bristol Myers Squibb's Eliquis, an anticoagulant, had a lifetime list price increase of 124%. Xarelto from Janssen, another common blood thinner, had a lifetime list price increase of 168%. Both are likely to be on CMS' September list, per Reuters.

"At AARP we hear from members who choose between drugs and other necessities," Leigh Purvis, senior director of health costs and access at the AARP Public Policy Institute, told reporters Thursday.

The other side: Drugmakers and their allies are challenging the Inflation Reduction Act in federal court, asserting that the law is unconstitutional and that drugs are priced to account for the cost of innovation and R&D.

PhRMA, the main drug lobby, said the AARP report was flawed "to spin a misleading narrative" and overlooks the significant discounts given to insurers and pharmacy benefit managers. 

Some specialty medical organizations are worried that setting price points or mandating negotiations might stifle or slow down drug development.

Costliest Medicare drugs more than tripled in price since entering market: report

A new analysis from AARP finds that most of the costliest drugs have increased in price beyond inflation.

Illustration of coins spilling out of a prescription pill container.

Drug price increases

The 25 <a class="gtmContentClick" data-vars-link-text="drugs" data-vars-click-url="https://www.axios.com/2023/07/13/drugs-drive-medicare-spending" data-vars-content-id="6167cfe5-ce63-4fc6-bba7-dc387394533c" data-vars-headline="Costliest Medicare drugs more than tripled in price since entering market: report" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/07/13/drugs-drive-medicare-spending" target="_self">drugs</a> that accounted for the highest <a class="gtmContentClick" data-vars-link-text="Medicare" data-vars-click-url="https://www.axios.com/2023/06/15/medicare-surge-health-spending-trillion" data-vars-content-id="6167cfe5-ce63-4fc6-bba7-dc387394533c" data-vars-headline="Costliest Medicare drugs more than tripled in price since entering market: report" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/06/15/medicare-surge-health-spending-trillion" target="_self">Medicare</a> Part D spending in 2021 more than tripled in price since they first entered the market, according to a new <a class="gtmContentClick" data-vars-link-text="report from AARP" data-vars-click-url="https://www.aarp.org/pri/topics/health/prescription-drugs/prices-top-medicare-part-d-drugs-tripled-since-entering-market.html" data-vars-content-id="6167cfe5-ce63-4fc6-bba7-dc387394533c" data-vars-headline="Costliest Medicare drugs more than tripled in price since entering market: report" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.aarp.org/pri/topics/health/prescription-drugs/prices-top-medicare-part-d-drugs-tripled-since-entering-market.html" target="_blank">report from AARP</a>.Why it matters: The report comes just weeks before the <a class="gtmContentClick" data-vars-link-text="Biden" data-vars-click-url="https://www.axios.com/politics-policy/joe-biden" data-vars-content-id="6167cfe5-ce63-4fc6-bba7-dc387394533c" data-vars-headline="Costliest Medicare drugs more than tripled in price since entering market: report" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/politics-policy/joe-biden" target="_self">Biden</a> administration is to announce the first 10 <a class="gtmContentClick" data-vars-link-text="Medicare" data-vars-click-url="https://www.axios.com/2023/06/15/medicare-surge-health-spending-trillion" data-vars-content-id="6167cfe5-ce63-4fc6-bba7-dc387394533c" data-vars-headline="Costliest Medicare drugs more than tripled in price since entering market: report" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2023/06/15/medicare-surge-health-spending-trillion" target="_self">Medicare</a> Part D drugs that will be considered for price negotiations under the <a class="gtmContentClick" data-vars-link-text="Inflation Reduction Act" data-vars-click-url="https://www.axios.com/2022/08/16/biden-reconciliation-inflation-reduction-act" data-vars-content-id="6167cfe5-ce63-4fc6-bba7-dc387394533c" data-vars-headline="Costliest Medicare drugs more than tripled in price since entering market: report" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/2022/08/16/biden-reconciliation-inflation-reduction-act" target="_self">Inflation Reduction Act</a>, on Sept. 1.

Already struggling rural hospitals see an increasing financial threat from the steady growth in Medicare Advantage enrollment.

Why it matters: Lacking the bargaining powers of their larger peers who depend on commercial payers to turn a profit, some rural hospitals are losing money on private coverage like Medicare Advantage. The Medicare alternative's popularity with seniors is cutting into a typically better funding source for rural hospitals — traditional Medicare — as hundreds of rural hospitals face down financial calamity. 

Context: Over half of Medicare enrollees are now enrolled in Medicare Advantage, up from a third less than a decade ago. That growth hasn't just been confined to big metropolitan areas — in a third of rural counties, Medicare Advantage accounts for at least 45% of Medicare enrollment, according to the USC Schaeffer Center. 

Driving the news: Almost 200 rural hospitals have closed since 2005, and more than 600 rural hospitals are at risk of closure because they lose money on patient services and have low cash reserves, according to a recent report from the Center for Healthcare Quality and Payment Reform. 300 of those facilities are at risk of immediate closure. 

Poor reimbursement from commercial plans and Medicare Advantage is largely to blame, rural hospital leaders say.

However, it can be hard to determine how much less Medicare Advantage plans pay than traditional Medicare, experts say. 

"CMS cost reports don't collect data on MA payments, and most hospitals' own reports lump Medicare Advantage together with regular Medicare," explained Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform.

How it works: For most other hospitals, Medicare payment is based on a predetermined fixed amount that's usually below what private insurance pays for the same service. But for certain rural hospitals, like critical access hospitals that are smaller and in typically underserved communities, Medicare pays more because their reimbursement is tied to actual cost of services.

But Medicare Advantage is different. Hospitals must contract with each MA plan separately, as they do with commercial plans.

That can be challenging for a rural hospital lacking the resources or staffing capacity to negotiate better contracts.

In a few states where it's possible to parse out the difference between Medicare and Medicare Advantage payments, the impact can be seen.

Small rural hospitals in California lost more money on services for MA patients than Medicare patients. MA accounted for the most profit loss for kind of insurance for small facilities, nearly double the losses experienced by those facilities for traditional Medicare patients.

In Tennessee, where rural hospitals actually make money on commercial payers, they still lose money on Medicare Advantage patients, at about an 18% profit loss on average.

What they're saying: Leaders at Arkansas-based Ozarks Community Hospital, which runs a 25-bed inpatient hospital and has clinics throughout the state and Missouri, earlier this year found the system was losing the most money on commercial payers. 

"The truth is the more we do for patients covered by commercial payers (including Medicare Advantage plans) the more money we lose," Paul Taylor, CEO of Ozarks Community Hospital, wrote in an open letter in March. 

After financial losses, including on Medicare Advantage patients, Alliance Healthcare Hospital in Mississippi earlier this year shuttered everything but its emergency services. Alliance is one of the first rural hospitals to opt for the new federal rural emergency hospital designation, which provides a payment bump to keep emergency rooms open at struggling rural facilities that would otherwise close down.

As of Q2, just six hospitals have converted to rural emergency hospitals, per CMS data.

About 40% of critical access hospitals, which have 25 beds or fewer, are losing money on commercial plans, according to an analysis of payer data conducted by Peiyin Hung, an assistant professor of public health at the University of South Carolina.

The other side: The leading Medicare Advantage advocacy group, whose membership includes many program insurers, says it's focused on keeping costs reasonable for seniors.

"We are concerned with the increase of health care costs broadly, and particularly in communities with limited providers and less competition, such as rural areas," Mary Beth Donahue, CEO of Better Medicare Alliance, told Axios in a statement. "We support efforts by the Medicare Advantage community to secure quality, affordable health care for seniors and people with disabilities."

The big picture: Rural hospitals have been struggling for years, and the pandemic only exacerbated their financial difficulties. 

Rural facilities serve older, sicker and fewer patients than urban facilities, making their financial situation more fragile. 

It's especially challenging for independent rural hospitals. About 40% of freestanding rural hospitals are losing money on commercial plans, compared to 25% of those affiliated with systems, Hung found. 

"They don't have a lot of private patients to have bargaining power," Hung said.

Editor's note: This story has been updated to clarify that the Better Medicare Alliance is an advocacy group that includes Medicare Advantage plans as its members

shuttered everything but its emergency services

Rural hospitals feel squeeze from Medicare Advantage

Illustration of a doctor in a white coat and scrubs standing at the end of a cliff formed by a large one hundred dollar bill which is laid flat then descends downward abruptly like a waterfall

Medicare Advantage

Already struggling rural hospitals see an increasing financial threat from the steady growth in Medicare Advantage enrollment.Why it matters: Lacking the bargaining powers of their larger peers who depend on commercial payers to turn a profit, some rural hospitals are losing money on private coverage like Medicare Advantage. The Medicare alternative&#x27;s popularity with seniors is cutting into a typically better funding source for rural hospitals — traditional Medicare — as hundreds of rural hospitals face down financial calamity.

Vitals

Axios Vitals

A federal drug discount program for safety-net providers that's been a perennial source of fierce disputes among health care industry powerhouses is back in the spotlight, with billions of dollars at stake. 

The big picture: Separate but coinciding issues are generating renewed focus on the decades-old 340B program, which requires that drugmakers give large discounts on outpatient drugs to health care providers serving low-income patients. 

A Biden administration proposal to issue hefty back payments due to 340B providers, drugmakers' efforts to limit discounts, and rebooted congressional interest in broader reforms are again igniting debate about the program's scope. 

Context: The Supreme Court last year unanimously sided with hospitals who challenged a nearly 30% reduction to their 340B payments by the Centers for Medicare and Medicaid Services that began under the Trump administration. 

In response to the court decision, CMS last month announced a $9 billion plan to repay 340B providers that's generated some controversy. While 340B hospitals are happy they're getting paid back, industry groups are upset that the payments are funded by clawing back money to other hospitals.

Meanwhile, the Biden administration is battling drugmakers in court over restrictions they've placed on where hospitals can use their 340B discounts. 

A bipartisan group of senators this summer also released a request for information on how to improve stability and oversight within the program.

Hospitals could face further cutbacks if Congress or the courts place new limits on 340B. 

Flashback: The 340B program began in 1992 to help providers serving patient populations who struggled to afford their prescription drugs. It allows hospitals and other safety-net providers like community health clinics to save an average of 25% to 50% on drug purchases, according to the federal government.

When hospitals partner with off-site pharmacies to dispense drugs, the pharmacies also benefit financially from 340B savings.

The program has grown significantly since its inception, increasing from 8,100 participating safety-net providers in 2000 to 50,000 in 2020.

Between the lines: The expansive program growth has drawn lawmakers' scrutiny and complaints from pharmaceutical companies, who accuse providers of using the program to pad their profits rather than help vulnerable patients. Providers dispute those accusations and say the program helps them stretch limited federal resources.  

More than 20 drug companies have placed restrictions on when providers can use 340B discounts at off-site pharmacies. Drug companies say the limits help prevent them from having to give duplicate discounts, which occurs when both the provider and state Medicaid agency receive a discount on the same drug. 

The Biden administration asked several drugmakers to lift their 340B restrictions and threatened fines if they don't comply. 

Several drugmakers have sued the administration, arguing federal officials didn't have the right to stop them from limiting discounts. One appellate judge ruled in favor of drugmakers earlier this year, and two other cases are pending in federal appellate courts. Experts say the cases could go all the way to the Supreme Court. 

As the legal fight plays out, 340B providers are urging Congress to approve new measures to prevent drugmakers from restricting access to discounts.  

The other side: Drugmakers, meanwhile, want lawmakers to tighten hospital eligibility standards and place stronger limits on how 340B pharmacies can profit from the program. 

Of note: Rural hospitals, some of which were spared from the 340B cuts made years ago, are especially concerned about the hit they would take from CMS' proposed funding clawbacks.

Rural facilities today rely heavily on 340B to offset other financial losses, Brock Slabach, chief operations officer at the National Rural Health Association, told Axios.

"You can't get out of this problem without harming those who were helped," Slabach said.

What we're watching: Expect to keep hearing about 340B in the coming months.

CMS still needs to finalize the 340B repayment plan after the public comment ends Sept. 5.

The D.C. Circuit Court of Appeals and the 7th Circuit Court of Appeals will issue rulings on whether the Biden administration can reverse drugmakers' 340B restrictions. 

Congress could take up a serious reform effort following the Senate's information request, though that would take time.

Federal drug discount program faces renewed scrutiny

A federal drug discount program for safety-net providers that's been a perennial source of fierce D.C. disputes is back in the spotlight, with billions of dollars at stake.

Illustration of a saline bag solution with money as the liquid in the bag. 

Hospitals

A federal drug discount program for safety-net providers that&#x27;s been a perennial source of fierce disputes among <a class="gtmContentClick" data-vars-link-text="health care" data-vars-click-url="https://www.axios.com/health/health-care-costs" data-vars-content-id="cb5d7199-90f7-4f1c-be5e-f3f8ecea62b2" data-vars-headline="Federal drug discount program faces renewed scrutiny" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/health/health-care-costs" target="_self">health care</a> industry powerhouses is back in the spotlight, with billions of dollars at stake. The big picture: Separate but coinciding issues are generating renewed focus on the decades-old 340B program, which requires that drugmakers give large discounts on outpatient drugs to <a class="gtmContentClick" data-vars-link-text="health care" data-vars-click-url="https://www.axios.com/health/health-care-costs" data-vars-content-id="cb5d7199-90f7-4f1c-be5e-f3f8ecea62b2" data-vars-headline="Federal drug discount program faces renewed scrutiny" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://www.axios.com/health/health-care-costs" target="_self">health care</a> providers serving low-income patients.

Arielle Dreher

Stories

Rural hospitals feel squeeze from Medicare Advantage

Telehealth didn't drive up ADHD prescriptions at large health centers: study

Costliest Medicare drugs more than tripled in price since entering market: report

Federal drug discount program faces renewed scrutiny

Black and poor people found less likely to access medication abortion