The cost to U.S.consumers of specialty drugs is too high,and cost-sharing obligations are reducing patient access to affordable and life-changing medications.While accounting only for approximately two percent of prescriptions filled,specialty drugs accounted for nearly 45 percent of the U.S.drug spend in 2018,and this rate continues to rise.This review analyzes the current state of the U.S.specialty drug market and recommends six policy options for decreasing out-of-pocket costs to consumers.A systematic review was conducted,gathering articles from peer-reviewed and government resources published from January 2014 to May 2019 using databases such as PubMed,OVID,and the Congressional Research Service (CRS).Articles were reviewed for unique and relevant information relating to cost specialty drugs,industry trends,underlying legislation and policy challenges,and viable policy options.The findings show that,while the cost of specialty drug prices is growing,the rate of growth is projected to slow to a compound annual growth rate (CAGR) of 4 to 7 percent between 2019 to 2023,as compared to a CAGR of 7.2 percent from 2014 to 2018,largely due to the Food and Drug Administration's approval of 10 new biosimilars in 2018 and early 2019.However,specialty drug spending as a percentage of total spending continues to rise and can cost payers and patients more than USD 3,500 on average per month.We recommend six policy options for reducing consumers' out-of-pocket cost obligations:(1) discourage "pay-for-delay" agreements and patent evergreening;(2) align incentives across the specialty drug supply chain with value-based pricing;(3) tighten orphan drug eligibility or impose a sales tax on drugs if the sales tax exceeds a specified threshold until federal subsidies are recouped;(4) increase transparency in transactions between specialty drug supply chain stakeholders;(5) tax the direct-to-consumer advertising of specialty drugs and use the proceeds to fund public research;and (6) support copay cards and patient assistance programs.While the consensus across the industry is that the out-of-pocket costs of specialty drugs to patients are too high,industry stakeholders must agree about which set of policy options to implement.Lawmakers must explore options for reducing the out-of-pocket costs of specialty medications and gather public input on how to best align stakeholder incentives across the specialty drug supply chain.

Diabetes is a chronic disease that affects over 30 million people in the United States.Of these,approximately 7.4 million use one or more formulations of insulin to manage their condition.There is a significant financial burden on diabetic individuals,as the price of insulin keeps increasing each year.Such consistent and drastic increases in the price of insulin are due to the complexities in the insulin supply chain,pricing mechanisms particularly due to pharmacy benefit managers (PBMs),and the dominance of a few insulin manufacturers in the market.This policy analysis has been undertaken independently and is based on information from peer-reviewed journals,government organizations and agencies,and credible news sources.Politicians and various stakeholders in the supply chain have made several policy recommendations on the pricing of insulin.From the data and information collected,we suggest basing a patient's co-payment on the net price instead of the list price of insulin,and that there should be real-time transparency in the negotiations between PBMs and pharmaceutical companies on rebates.

Objectives:Economic growth and rapid development of health technology in China have created opportunities to strengthen health technology assessment (HTA) capacity.Over the time,HTA institutions have been established to conduct HTA related work.This study reviewed the current status of HTA in China and analysed the challenges of HTA development in the context of health reform under"new normal"economy.Methods:Literature review and webpage searches were used to document the development of HTA in China.An institutional survey has also been conducted to collect information on the HTA research institutions in China.Results:The number of articles and research projects on HTA were rising and are continuing to rise.HTA development has made substantial progress in China in terms of growing number of research institutions and qualified HTA workforce.However,HTA has notable weaknesses such as low capacity for conducting HTA research,limited experience in HTA researchers,and lack of knowledge translation.Conclusion:Currently,the translation of HTA findings to policy-making is limited and the integration of HTA in the policy-making processes is still in its infancy.The HTA development in China has had opportunities due to demands of health care,health insurance,and health technology as a result of health reform.Capacity building and institutionalization of HTA are urgently needed for further development of HTA in China.

Objectives:The widespread usage of traditional Chinese medicine (TCM) and the government's emphasis on TCM in China have created a positive macro-environment and great opportunities to develop and strengthen health technology assessment (HTA) in TCM.Over the past ten years,a series of policies have been issued by the government to promote the application of HTA and the development of TCM in China.This study reviews the concepts and characteristics of TCM,summarizes the current status of HTA in TCM,and analyzes the opportunities and challenges faced by HTA development in TCM with respect to deepening of healthcare reforms.Methods:Literature review and website searches were used to acquire information regarding the basic theories of TCM and the current status,opportunities,and challenges for HTA in TCM.Results:The number of articles on HTA in TCM rose substantially,especially those published in China National Knowledge Infrastructure (CNKI).With the optimistic policy environment and huge market demand for TCM,the development of HTA in TCM is expected to flourish in China.However,HTA in TCM also faces numerous challenges such as the absence of a clinical efficacy evaluation system for TCM and insufficient basic research evidence and qualified personnel.Conclusions:TCM has unique characteristic that distinguishes it from Western medicine.Currently,it is important to take all measures to address the existing main challenges and thereby take advantage of the present opportunities to develop and improve HTA in TCM.

Objective An attempt to develop a patient survey questionnaire on the public benefit nature of medical institutions as seen by patients,along with an evaluation of its reliability and validity.Methods A field survey was conducted among the patients visiting these institutions.The Cronbach's α coefficient was calculated to test the reliability.Factor analysis and spearman correlation analysis were applied to test the validity.The validity was also tested by analyzing the demographic factors and comparing the results between different kinds of medical institutions.Results The Cronbach's α coefficient of the questionnaire was 0.853,meanwhile the Cronbach's α coefficient of the three items was 0.845(quality of care),0.845 (suitability of services) and 0.752 (professional ethics).Three common factors were extracted,which coincided with the three items-quality of care,suitability of services and professional ethics.And the results are hardly affected by common demographic characteristics.Condusion The reliability of the questionnaire was acceptable,and the items were reasonably divided in the questionnaire with good structural validity.The questionnaire can be widely applied to evaluate the public benefit nature of medical institutions.

Background: and Purpose The association between hemoglobin A1c (HbA1c) and stroke risk along with its subtypes is rarely reported. We aimed to investigate the association between HbA1c and the risk of incident stroke in patients with type 2 diabetes based on real world data from three healthcare systems. Methods: We performed a retrospective cohort study of 27,113 African Americans and 40,431 whites with type 2 diabetes. Demographic, anthropometric, laboratory, and medication information were abstracted from the National Patient-Centered Clinical Research Network common data model. Incident stroke events including both ischemic and hemorrhagic stroke were defined. Results: During a mean follow-up period of 3.79±1.68 years, 7,735 patients developed stroke (6,862 ischemic and 873 hemorrhagic). Multivariable-adjusted hazard ratios across levels of HbA1c at baseline (<6.0%, 6.0% to 6.9% [reference group], 7.0% to 7.9%, 8.0% to 8.9%, 9.0% to 9.9%, and ≥10%) were 1.07, 1.00, 1.13, 1.23, 1.27, and 1.37 (Ptrend <0.001) for total stroke, 1.02, 1.00, 1.13, 1.20, 1.24, and 1.35 (Ptrend <0.001) for ischemic stroke, and 1.40, 1.00, 1.14, 1.47, 1.47, and 1.51 (Ptrend=0.002) for hemorrhagic stroke. When we used an updated mean value of HbA1c, the U-shaped association of HbA1c with stroke risk did not change. This U-shaped association was consistent among patients of different subgroups. The U-shaped association was more pronounced among patients taking antidiabetic, lipid-lowering, and antihypertensive medications compared with those without these medications. Conclusions These data suggest that diabetes management may have to be individualized according to the guideline recommendations rather than intensively attempting to lower HbA1c.

Although a key tenant of the Sustainable Development Goals is to achieve universal health coverage,the global drug gap persists—over a third of the global population lack access to essential medicines.Without access to affordable drugs,people have worse health outcomes,higher medical expenses,and productivity loss,pushing them into poverty.Health technology assessments (HTAs) offer an opportunity to decrease the global drug gap and increase access to essential medicines by overcoming barriers to medicine access.These barriers include drug procurement,drug affordability for payers and patients,a patient's ability to obtain essential medicines,and health system capacity.Using HTAs can therefore close the global drug gap by increasing access to affordable essential medicines.In turn,people have better health outcomes,spend less money on medical care,and can have better productivity.Ultimately,use of HTAs can lift the population out of poverty and force fewer people into poverty by creating better health outcomes at affordable prices.

Background:In the context of China's aging population,meeting consumer demand is an essential way for nursing homes to fulfill social responsibilities and improve competitive advantages.However,since little is known about the elderly's service level and price choices for nursing home care,this study aims to explore the non-disabled elderly's nursing home admission intention,service level,and price choices.Methods:A cross-sectional survey of 402 non-disabled respondents was conducted in three different income level cities of Zhejiang Province,in July and August 2018.Multinomial logistic regression and multiple linear regression were used to identify the determinants of admission intention,service level choice,and price choice.Results:Education,residence,and number of children were significantly associated with nursing home admission intention.Compared to those with no intention,the elderly with higher income and household wealth were less likely to have conditional intentions,and those living with the family were less likely to have unconditional intentions.Compared to medium-level services,the elderly with higher monthly income(relative risk ratio[RRR]3.07,95％confidence interval[CI]:1.801 to 5.233),household wealth(RRR 5.451,95％CI:2.249 to 13.216),and age(RRR 1.528,95％CI:1.004 to 2.326)were more likely to prefer high-level services,while older adults with higher monthly income(RRR 0.516,95％CI:0.344 to 0.774),and those with pensions(RRR 0.267,95％CI:0.076 to 0.931)were less likely to prefer low-level services.The elderly's price preference increased by 398 CNY as monthly income increased by 1 000 CNY,and by 270 CNY as the housing number increased by one.Having pensions increased price preference(468 CNY),whereas having health insurance decreased price preference(-690 CNY).Conclusion:The elderly's intention of nursing home admission was primarily affected by sociodemographic fac-tors,while price and service level choices were primarily affected by financial factors.Nursing homes should use the market segmentation method to provide precision nursing home care for different groups of non-disabled elderly.

Unreasonable growth of total health expenditure at various extent has been found to be prevalent among many countries for a long time. Thus how to deal with this global public health challenge has become a hot topic among the consumers, providers, and payers alike. Echoing the global trend of value-based healthcare, value-based management of total health expenditure could be a direction of cost containment in the future. Through promoting the rational development of healthcare industry, assisting the decision-making of health insurance authority, improving health authority′s supervision of health technology allocation and utilization, maximizing resource utilization efficiency at hospitals, standardizing physician practices, guiding patients′ medication preferences and behaviors, health technology assessment could mobilize stakeholders′ participation in the value-based management of total health expenditure and serve as an important decision-making tool to optimize the allocation and utilization of scarce health resources, reducing and avoiding waste in healthcare sector, and promoting high-value and sustainable development of total health expenditure.