4 changes that could reshape US health care
Strides made in mental health and weight loss treatment
This year has been a major turning point in American health care. Notable developments in 2023 included the end of the COVID-19 public health emergency, the beginning of a CRISPR gene-editing “revolution” and a new reckoning with drug prices.
Health care officials expect 2024 to bring a wave of innovation and change.
Long-awaited weight loss
Many think 2024 could be the year more people have the tools to follow through on New Year’s resolutions about weight loss: a new generation of remarkably effective weight-loss drugs, GLP-1s, which offer the potential for substantial weight loss – if people can afford and tolerate them.
Along with lifestyle changes, Wegovy has been shown to help people shed as much as 16% of their weight and Zepbound 27%. More GLP-1 drugs are on the way, and in more forms.
Although long-term data isn’t available, these
drugs also appear to be the safest to date. A large number of people suffer from gastrointestinal distress, but more serious side effects have been extremely rare.
However, suppliers have had trouble meeting skyrocketing demand. And many insurers haven’t covered the cost of the drugs, which can run to over $1,300 a month. That might change in 2024 if supplies crank up and insurers agree to cover more of the cost.
There’s a major unknown factor with these drugs, which could become better understood in the coming years: Experts can’t say if people will be able to keep the weight off if they stop taking the drugs.
Mental health, psychedelics
Mental health issues are among the nation’s most deadly, costly and pervasive health crises. While health agencies and the Biden administration have made progress, experts say there isn’t enough funding or programming.
The dearth of remedies has paved the way for an unexpected class of drugs. Psychedelics are being used to treat an array of mental health issues: a ketamine derivative for depression, MDMA (ecstasy) for post-traumatic stress disorder and psilocybin (mushrooms) for addiction.
In 2024, MDMA could become the first true psychedelic to win FDA approval. Psilocybin is also working its way through the federal approval process, said Matthew Johnson, an expert in psychedelics at Johns Hopkins University.
Under supervision, some psychedelics have dramatically transformed people’s mental health. Johnson hopes FDA approval would mean that more people would be helped by psychedelics and use of them in a medical setting would become “normalized.”
New price limits
Pharmaceutical companies typically roll out price increases for hundreds of drugs in the first weeks of the year. But new constraints could limit increases.
Under the Inflation Reduction Act, if drug companies increase Medicare drug prices above the rate of inflation, they must pay Medicare a rebate.
Those penalties have already lowered prices on some drugs. In December, Medicare officials released a preliminary list of 48 drugs including blood thinners, antibiotics and chemotherapy medicines that could be subject to an inflation penalty in January. If those penalties were levied, enrollees would likely pay less.
Other factors could influence prices in 2024, as Congress continues to scrutinize the role drug pricing middlemen play in the prescription drug market. The U.S. House passed legislation limiting markups, and there’s legislation to bolster oversight of these practices in the Senate.
The federal government has empowered Medicare to negotiate lower drug prices for the first time, but those lower prices won’t take effect until 2026. Drug companies and their industry allies have challenged the process, filing several lawsuits aimed at halting price negotiations.
In reaction to these pressures, pharmaceutical companies might try to launch new drugs at ever-higher prices, some analysts say. This could include Eli Lilly’s donanemab, a drug that slowed cognitive decline in people in the early stages of Alzheimer’s disease. The FDA will review the drug by the end of March and it could hit the market shortly after.
Medication abortion access
In December, the Supreme Court agreed to hear two cases that rolled back access to mifepristone, an oral drug that is used jointly with another drug, misoprostol, to end a pregnancy in the first trimester. Medication abortions are the most common form of abortion in the U.S.
The high court’s ruling could further restrict access to abortion, especially through telemedicine and the mail for people in rural areas, including in states where abortion remains legal.
Also to come: the ongoing impact of abortion restrictions in some states.
The case of Kate Cox highlighted the fact that Texas doctors who provide abortions outside state law may be sentenced to life in prison. Restrictions like these have resulted in a brain drain of doctors leaving or skipping out on jobs in Texas – and other states with strict limits on abortion – because of the limits on medical practice.