The Inflation Reduction Act (IRA) of 2022 mandates price negotiations for certain drugs under Medicare, shortening the exclusivity period historically used to recoup research and development investments and support follow-on innovation. This article characterizes the clinical significance of follow-on oncology drug approvals, using a novel data set of Food and Drug Administration oncology drug approvals from the period 2000-24. We found that, compared with initial approvals, follow-on drugs target earlier disease stages, where therapeutic success is often more likely. Among 184 cancer drugs analyzed, 41.8percent had at least one follow-on approval, with 59.7percent of those targeting earlier disease stages than the original approval. The average reduction in disease stage between original indication approval and follow-on approval was 0.54. The shortened exclusivity period under the IRA may have influenced these development trajectories. One potential effect is a shift from depth-oriented development toward horizontal expansion across tumor types or patient populations. This shift may disproportionately affect small-molecule drugs, which (compared with biologics) more commonly rely on sequential, indication-by-indication development.

Private equity (PE) firms have actively acquired substance use disorder treatment facilities in the past decade. Evidence on whether these acquisitions affect establishments' operations is limited. Using a novel catalog of treatment facilities acquired by PE firms and a difference-in-differences research design, we identified a relative increase in the probability that establishments accepted public health insurance after PE acquisition. We did not observe a differential change in the probability that the facility offered common forms of medication treatment. Our results suggest that PE acquisitions may increase participation in public insurance programs to expand the revenue sources at acquired facilities without necessarily changing the scope of service lines available.

The use of remote physiologic monitoring (RPM)-the remote transmission of patients' physiologic measures (such as blood pressure) to care teams-has grown rapidly. For practices, establishing an RPM program can improve patient care and increase revenue, but it may also require substantial investment, including hiring new staff. No prior work has quantified the impact of RPM on practices, such as its effects on practice revenue, care delivery, and resource allocation across patients. Using national Medicare claims, we identified 754 primary care practices that began billing for RPM during the period 2019-21 and examined practice-level outcomes through 2023. After these practices adopted RPM, Medicare revenue increased by 20.0percent relative to similar, matched, nonadopting practices. This was driven by direct billing for RPM as well as more outpatient visits and care management services. Although adopting practices experienced a 2.7percent increase in billing providers, revenue increases were predominantly driven by increased activity per provider. Increases in care volume for patients receiving RPM did not seem to come at the expense of other patients.

Adults with employer-sponsored insurance may remain in employment to retain health coverage for their children-a phenomenon we term dependent-related job lock. Using 2016-23 National Survey of Children's Health data, we estimated the prevalence of dependent-related job lock among families with children covered by employer-sponsored insurance and examined associations with caregivers' health. Nationally, 8.9percent of such families reported dependent-related job lock, with higher rates seen among families with children with special health care needs, particularly those with emotional, behavioral, and developmental problems (23.1percent). Dependent-related job lock was associated with a 4.5-7.1-percentage-point increase in poor or fair caregiver mental health and a 3.7-4.3-percentage-point increase in poor or fair caregiver physical health across groups of children with special health care needs. Sensitivity analyses adjusting for employment suggested some confounding. Findings underscore the need for policy reforms to address insurance-related barriers, reduce disparities in caregivers' health, and promote equitable employment mobility.

Interchangeability, a Food and Drug Administration (FDA) designation allowing pharmacists to substitute a biosimilar for its branded originator at the point of sale, is intended to increase biosimilar adoption. However, little is known about the relationship between interchangeability and biosimilar adoption. We conducted an interrupted time-series analysis to examine this relationship for Semglee, which gained interchangeability in July2021, in Medicaid and the employer-sponsored insurance market in 2021-22. Semglee is a biosimilar for Lantus (insulin glargine), the most-prescribed long-acting insulin in the US. We found that Semglee market share increased by 3.70percentage points in Medicaid and 19.25percentage points in employer-sponsored insurance beginning in the first quarter of 2022, coinciding with improved Semglee coverage, especially in employer-sponsored insurance. State-level variation in pharmacist substitution laws was not associated with Semglee adoption. These results suggest that increased adoption was mediated mainly through improved insurance coverage, with no detectable role for increased prescribing alone and only a secondary role, at most, for pharmacist substitution. Semglee's gains in market share after interchangeability suggest that easing of federal interchangeability requirements may moderately spur biosimilar adoption.

Prior authorization is a barrier to accessing medications for opioid use disorder (MOUD). Although private insurance covered about one-third of patients with OUD in 2023, the understanding of prior authorization prohibitions in private insurance remains limited. We synthesized state laws prohibiting prior authorization for MOUD in private insurance in the US. The number of states with such prohibitions grew from two in 2015 to twenty-two in 2023, with variations in the scope of these prohibitions. Seven states have fully prohibited prior authorization for all MOUD ("full prohibitions") since the effective date. Fifteen states adopted legislation that still allows prior authorization under some conditions ("partial prohibitions," including those covering at least one of any MOUD; those covering one of each MOUD; and those with limitations based on modality or formulation, generic or branded status, prior authorization frequency, prescription duration, or emergency conditions). Among these fifteen states, four states transitioned from partial prohibitions to full prohibitions, and eleven states maintained partial prohibitions, although many have broadened the scope of prohibitions over time. The proliferation of prior authorization prohibitions for MOUD highlights that this is an area of significant state legislative focus.