Role of supply chain intermediaries in steering hospital product choice: Group Purchasing Organizations and biosimilars.

Over 95% of hospitals in the United States use pooling alliances, known as Group Purchasing Organizations (GPOs), to purchase medications, devices, and supplies. While GPOs create savings for hospitals through lowered prices and reduced administrative burden, critics allege that these supply chain intermediaries reduce competition, particularly if GPOs concentrate purchasing from larger, dominant manufacturers. Using a mixed-methods design, we studied whether GPOs influence hospital purchasing behavior and explored the contracting mechanisms used by GPOs. Focusing on 4 high-cost biologic molecules that face competition from generic-like biosimilars between 2015 and 2019, we found that biosimilar uptake was 16%-23% higher among Traditional Medicare patients in hospitals associated with 2 of the 3 top GPOs as compared with smaller GPOs. The increase in biosimilar use was driven by single biosimilar brands that varied by GPO. Based on qualitative interviews, these 2 GPOs used more aggressive contracting strategies to steer member hospitals to specific biosimilar brands. To date, the use of GPOs and these aggressive contracting strategies appear to have increased biosimilar use, suggesting savings for payers and patients. However, single-source GPO contracting could inhibit competition or create shortages in the long term. Transparency on GPO practices and pricing strategies is needed for further GPO evaluations.

Trends in Health Care Utilization and Expenditures in the United States Across 5 Decades: 1977-2017.

BACKGROUND: Health care expenditures in the United States are high and rising, with significant increases over the decades. The delivery, organization, and financing of the health care system has evolved over time due to technological innovation, policy changes, patient preferences, altering payment mechanisms, shifting demographics, and other factors. OBJECTIVE: The objective of this study was to examine trends over time in health care utilization and expenditures in the United States. RESEARCH DESIGN: This analysis employs descriptive statistics to examine 5 decades of health care utilization and expenditure data from the Agency for Healthcare Research and Quality (AHRQ) for 1977-2017. MEASURES: Measures include utilization and expenditures (not charges) for inpatient, emergency department, outpatient physician, outpatient nonphysician, office-based physician, dental, and out-of-pocket retail prescription drugs. RESULTS: We demonstrate that while health care expenditures have increased significantly overall and by type of care, utilization trends are less pronounced. The population of the United States grew 53% between 1977 and 2017, while annual total expenditures on health care increased by 208%. Amidst attention to out-of-pocket exposure for unexpected medical care bills, out-of-pocket payments for care have declined from 32% in 1977 to 12% in 2017 but increased in amount. CONCLUSIONS: This article provides the first extended snapshot of the dynamics of health care utilization and expenditures in the United States. Aspects of health care are much different today than in previous decades, yet the inpatient setting still dominates the expenditures.

Physician, Practice, and Patient Characteristics Associated With Biosimilar Use in Medicare Recipients.

Importance: Biosimilars, or highly similar versions of complex biologic drugs, have the potential to slow drug spending growth; however, biosimilar uptake in the United States has been slow. Little is known about barriers to biosimilar uptake following drug launch. Objective: To examine the patient, physician, and practice characteristics associated with biosimilar use in the Medicare population. Design, Setting, and Participants: This cross-sectional study used regression analysis to estimate the association between biosimilar use and various characteristics. Medicare fee-for-service beneficiaries who received a filgrastim product or an infliximab product between the launch of a class's first biosimilar (quarter 3 2015 for filgrastim-sndz and quarter 4 2016 for infliximab-dyyb) and December 2018. Data analysis was conducted from March to November 2020. Exposures: Patient demographic characteristics and product clinical indications; physician demographic characteristics, specialty, and volume of filgrastim or infliximab biologic administration; hospital size, ownership, 340B status, academic medical center status, and system affiliation; physician office size and multispecialty status. Main Outcomes and Measures: Administration of a filgrastim or infliximab biosimilar. Results: The final filgrastim sample included 25 870 patients (11 857 [45.8%] men; 14 224 [55.0%] aged 65-74 years; 22 617 [87.4%] White individuals) who had 259 178 administrations (79 017 [30.5%] biosimilar administrations), and the final infliximab sample included 14 786 patients (4765 [32.2%] men; 8773 [59.3%] aged 65-74 years; 13 467 [91.1%] White individuals) who had 174 973 administrations (9012 [5.2%] biosimilar administrations). In adjusted analyses, no patient demographic characteristics and 2 of 9 clinical indications (22.2%) were associated with biosimilar use (filgrastim, neutropenia: adjusted difference, -2.0 [95% CI, -3.9 to -0.2] percentage points; P = .03; infliximab, Crohn disease: adjusted difference, -1.8 [95% CI, -2.9 to -0.8] percentage points; P = .001). Several physician characteristics were associated with biosimilar administrations, including high filgrastim or infliximab prescribing volume (high vs low volume, filgrastim: adjusted difference, 3.6 [95% CI, 1.5 to 5.8] percentage points; P = .001; infliximab: adjusted difference, 1.2 [95% CI, 0.3 to 2.2] percentage points; P = .007) and specialty (eg, hematologist-oncologists vs primary care, filgrastim: adjusted difference, -3.0 [95% CI, -5.4 to -0.5] percentage points; P = .02). Numerous practice characteristics were associated with biosimilar use, including practice setting (outpatient hospital department vs office practice, filgrastim: adjusted difference, -16.1 [95% CI, -18.1 to -14.1] percentage points; P < .001; infliximab: adjusted difference, 3.0 [95% CI, 2.2 to 3.7] percentage points; P < .001) and hospital outpatient department ownership status (for-profit vs not-for-profit, filgrastim: adjusted difference, -17.4 [95% CI, -21.6 to -13.3] percentage points; P < .001; infliximab: adjusted difference, 10.8 [95% CI, 6.7 to 14.9] percentage points; P < .001). Conclusions and Relevance: In this study, practice setting and hospital ownership status had the largest associations with biosimilar usage, suggesting practices play a role in steering physicians toward certain medications. However, the types of practices with high biosimilar use differed by drug class. Further research is needed to understand the reasons for these differences across drug classes.

Changes in Medicare Part B Spending for Biologic Drugs After Biosimilar Entry Into the Market.

This cross-sectional study describes changes in annual Medicare Part B spending for biologic drugs after biosimilar entry, focusing on the first 4 products to experience biosimilar competition: filgrastim, infliximab, epoetin alpha, and pegfilgrastim.

Food insecurity, health care utilization, and health care expenditures.

OBJECTIVE: To disentangle the relationships among food insecurity, health care utilization, and health care expenditures. DATA SOURCES/STUDY SETTING: We use national data on 13 465 adults (age ≥ 18) from the 2016 Medical Expenditure Panel Survey (MEPS), the first year of the food insecurity measures. STUDY DESIGN: We employ two-stage empirical models (probit for any health care use/expenditure, ordinary least squares, and generalized linear models for amount of utilization/expenditure), controlling for demographics, health insurance, poverty status, chronic conditions, and other predictors. PRINCIPAL FINDINGS: Our results show that the likelihood of any health care expenditure (total, inpatient, emergency department, outpatient, and pharmaceutical) is higher for marginal, low, and very low food secure individuals. Relative to food secure households, very low food secure households are 5.1 percentage points (P < .001) more likely to have any health care expenditure, and have total health care expenditures that are 24.8 percent higher (P = .011). However, once we include chronic conditions in the models (ie, high blood pressure, heart disease, stroke, emphysema, high cholesterol, cancer, diabetes, arthritis, and asthma), these underlying health conditions mitigate the differences in expenditures by food insecurity status (only the likelihood of any having any health care expenditure for very low food secure households remains statistically significant). CONCLUSIONS: Policy makers and government agencies are focused on addressing deficiencies in social determinants of health and the resulting impacts on health status and health care utilization. Our results indicate that chronic conditions are strongly associated with food insecurity and higher health care spending. Efforts to alleviate food insecurity should consider the dual burden of chronic conditions. Finally, future research can address specific mechanisms underlying the relationships between food security, health, and health care.