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Biologic drugs represent advances in medical research and treatment but are a major driver of drug spending in the United States. Spending on biologics increased by 50% between 2014 and 2018 in the U.S. even though just 2% of Americans used them. Biosimilars, clinically equivalent, lower-cost versions of original biologic drugs, analogous to generic versions of brand name "small molecule" drugs, c...

Every year, 1 million people in the U.S. receive chemotherapy for cancer treatment. Most chemotherapy treatment requires patients to be present in a physician's office or hospital outpatient department to receive the treatment (typically an infusion or injection). Chemotherapy plays a critical role in treatment for many patients with cancer, but it also often leads to high financial costs for pati...

Colorectal cancer screenings are essential for early disease detection, prevention, and treatment. Since 2014, Cologuard, a DNA-based screening test that can detect colorectal cancer and precancerous cells, has been available to individuals 45 and older at average risk for colorectal cancer. In contrast to colonoscopies, which must be done at a health care facility, Cologuard is non-invasive ...

Colorectal cancer is the third most common cancer diagnosed in the U.S., and the second most common cause of cancer deaths among men and women combined. Screening via colonoscopy is highly effective in terms of improving prognosis of colorectal cancer via early detection; over 90% of patients who are diagnosed early (i.e., when the cancer is small and has not spread) live five years or l...

November and December of 2022 saw growth in rates of flu, RSV, and COVID, that renewed attention to a seasonal trend of increased respiratory illnesses in the winter months. Data from Medicare, Medicaid, and private insurance illustrate the seasonal ups and downs of respiratory infections. Earlier HCCI research showed that hospitalizations from respiratory illness increased in the winter months (N...

Reproductive and sexual health services play an important role in daily life and wellbeing for many people. These services include preventive services (such as screenings for sexually transmitted infections and reproductive cancers), contraceptive services, and services relating to pregnancy and childbirth. The objective of this report is to provide national and state data on the use of repro...

Each year, HCCI creates the Healthy Marketplace Index (HMI) to examine how health care spending varies across the United States. The HMI shows health care spending, prices, and use compared to the national median for close to 200 local metro areas. By describing how health care spending varies geographically and how use and price contribute to spending in each area, HMI is a starting point in unde...

HCCI's commercial claims dataset includes claims for over one-third of the population with health insurance through their job (employer-sponsored insurance, or ESI). There are a number of unique features of these data that make them valuable for answering important health care and health policy questions. One such feature is the 5-digit zip codes of ESI enrollees (i.e., where people live) and thei...

Sexually transmitted infections (STIs) are infections caused by pathogens spread through sexual contact. STIs can progress from an infection into a sexually transmitted disease (STD). Chlamydia, gonorrhea, syphilis and HIV are the most commonly screened for STIs in the US. The CDC STD Surveillance Data estimates that there were more than 2.5 million cases of chlamydia, gonorrhea, and syphilis...

High out-of-pocket costs for health care services can put necessary care and medications out of reach for many people. In one survey, nearly half of adults reported difficulty paying for health care services. In this brief, we used HCCI's commercial claims dataset, which includes health care spending information for over one-third of the population who receives health insurance through their job, ...

A recent KHN article reported on the growing presence of "obstetric emergency departments" (OBEDs) in U.S. hospitals. Hospitals suggest that OBEDs, which are generally located within labor and delivery departments and often indistinguishable from standard triage rooms, allow pregnant patients with potential emergent conditions (or when they are in labor) to be seen quickly by hospitalists. Pa...

Obesity is a serious and costly chronic disease that has been increasingly common among the U.S. population. Electronic health record (EHR) data have the potential to support research and patient care interventions. The timeliness and availability of aggregated clinical data can be used in near-real time to monitor obesity prevalence based on body mass index (BMI) at the population-level to guide ...

Telehealth facilitates medical care, allows for the sharing of health information, and offers patient health education through remote communication. In 2020, the onset of the public health emergency prompted many localities to restrict in-person gatherings to prevent transmission of the virus. Health care providers responded by expanding telehealth services in an effort to continue serving their p...

The onset of the COVID-19 pandemic fundamentally shifted health and health care in the US in 2020. Hospitals have been central to responding to the pandemic and treating COVID, which means that hospitalizations can provide an important lens to understanding the pandemic's impact. Earlier HCCI research looked at hospital use and spending among people with employer-sponsored insurance (ESI) before t...

Diabetes is a chronic health condition that affects over 10% of the U.S. population. It is possible for people  who are diagnosed with diabetes to live a healthy, long life if the condition is managed properly. However, management often involves significant health care use, which can be costly for patients. Over the past few months, we used HCCI's commercial claims dataset to e...

Inequities in health care access and outcomes among vulnerable populations are well-documented, as is the fact that where you live affects health outcomes to a similar or even greater extent than your health behaviors. Previous HCCI work shows that employer-sponsored health insurance (ESI) plays an important role in many vulnerable communities. Among the population in the United States with health...

Previously, HCCI analyzed prescription drug spending to understand how many insulin users with employer sponsored insurance (ESI) would be affected by a $35 monthly cap on patient out-of-pocket spending on insulin. Our estimates were based on average monthly out-of-pocket spending on insulin across all insulin products. The Inflation Reduction Act (IRA) recently passed by Congress includes a $35 p...

 The Affordable Care Act (ACA) requires insurers to cover certain services without charging patients out-of-pocket. These services include routine preventive care, such as wellness visits, immunizations, contraceptive services, and cancer and other disease screenings. In September 2022, a federal court ruled portions of the law's preventive services provision unconstitutional. If the court de...

In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association, declared a National State of Emergency in Children's Mental Health associated with the COVID-19 pandemic, including the loss of caregivers, school closures, social isolation, and gaps in health care (see citations below). Understanding the effect of the COV...

Pre-exposure prophylaxis (PrEP) for HIV are medications that reduce an individual's chances of contracting HIV. The CDC estimates that 1.2 million people are at risk of HIV infection and may benefit from a PrEP prescription. We analyzed health insurance claims for 55 million Americans with employer-sponsored insurance in order to examine utilization and spending on these drugs between 2016 and 202...

Mammography screenings are recommended every 1-2 years for women aged 40 and older, as well as for younger women who are at high risk for breast cancer. These screenings are an essential tool for early detection and treatment of breast cancer. Using HCCI's data on people with employer-sponsored insurance as well as Medicare and Medicaid data, we examined mammography utilization patterns from 2018 ...

Biologic drugs include a range of life-saving medications to treat cancer, diabetes, rheumatoid arthritis, retinal diseases, and many other conditions. Unlike "small molecule" drugs (e.g., statins), which can generally be taken at home, biologics are typically infusions or injections which require administration by a physician or other clinician in a hospital or physician's office. While just...

Abstract The federal Anti-Kickback Statute prohibits biopharmaceutical manufacturers from directly covering Medicare enrollees' out-of-pocket spending for the drugs they manufacture, but manufacturers may donate to independent patient assistance charities and earmark donations for a condition treated by their drugs. To assess whether this law and its associated regulations prevent manufacturers fr...

A new, large study led by researchers at the American Cancer Society (ACS) and The University of Texas MD Anderson Cancer Center shows rising costs of cancer treatments led to increases in total costs of care, and when compounded with greater cost sharing, increased out-of-pocket (OOP) costs for privately insured, patients under 65 years old. The research is one of the first to comprehensively exa...

The population with employer-sponsored health insurance (ESI) includes individuals who receive health insurance coverage from an employer, including employees and their dependents, such as spouses and eligible children. Half of the children in the U.S. are covered by ESI, making this form of coverage the largest source of insurance for American children. In this report, we present data on health c...