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What We're Reading: Investigating PBMs; A Guide to Medicare-for-All; Reality of Precision Medicine
Not only do pharmacy benefit managers profit thousands of percent using spread pricing, but the spreads are growing; support for Medicare for all is growing among Democrats in Congress, but it's still unclear how such a drastic chage would impact the complex American healthcare system; while precision medicine has great potential, it still has far more failures than successes, but that isn't usually discussed.
How PBMs Use Spread Pricing
Pharmacy benefit managers (PBMs) make part of their profit on spread pricing, in which companies mark up the difference between the amount they reimburse for a drug and what they charge clients. A new investigation from Bloomberg showed that not only do PBMs profit thousands of percent using this tactic, but the spreads are growing. Spread pricing is most common with generic drugs that cost pennies compared with brand-name drugs. While use of generic drugs has been promoted to control rising drug costs, spread pricing may be undercutting those expected savings, according to critics of the tactic.
Questions Remain for Medicare-for-All Idea
Senator Bernie Sanders, I-Vermont, does not stand alone—more Democrats are embracing his idea of Medicare for all. While the idea is gaining momentum among Democrats in Congress, as well as the general public, it’s unclear how such a drastic change would impact the complex American healthcare system. Politico pulled together a guide to Medicare for all that answered questions as simple as “what does it actually mean?” as well as more complex ones, such as “what happens to doctors?”
How Precise is Precision Medicine?
The future of healthcare is a system in which doctors can match patients with the best drug for them and their disease by targeting genetic mutations. While future potential is far from the reality of today, that isn’t always explained. An opinion piece in The New York Times explained that the number of people who can currently be helped with precision medicine is still very small, and successes remain rare. One study found that precision medicine failed to help 93% of 1000 patients treated, while 2 others reported failure to shrink tumors 92% and 95% of the time. Unfortunately, the failures are not always discussed or covered, which can paint a misleading picture of precision medicine.
Hospital Participation in Medicare ACOs: No Change in Admission Practices and Spending
August 19th 2025Hospital accountable care organization (ACO) participation did not impact emergency department admission rates, length of stay, or costs, suggesting limited effectiveness in reducing spending for unplanned admissions and challenging hospital-led ACO cost-saving strategies.
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Laundromats as a New Frontier in Community Health, Medicaid Outreach
May 29th 2025Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.
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Care Quality Metrics in Medicare During COVID-19 Pandemic
August 12th 2025Medicare Advantage outperformed traditional Medicare on clinical quality measures before and during the COVID-19 pandemic; mid-pandemic, however, traditional Medicare narrowed the gap on some in-person screenings.
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