USA TODAY International Edition

Four changes in 2024 that could reshape US health care

- Adrianna Rodriguez, Ken Alltucker, Eduardo Cuevas and Karen Weintraub

This year has been a major turning point in American health care and patients can anticipate several major developmen­ts in the new year.

Notable developmen­ts in 2023 included the end of the COVID- 19 public health emergency, the beginning of a CRISPR “revolution” and a new reckoning with drug prices that could change the landscape of the U. S. health care system for decades to come.

Health care officials expect 2024 to bring a wave of innovation and change in medicine, treatment and public health.

As the presidenti­al election kicks into gear, here are four of the biggest health stories to watch for in 2024.

A year of long- awaited weight loss

This month Oprah Winfrey announced that she is taking weight- loss medication along with exercise and careful eating to finally “quiet the food noise” and overcome the sense of shame she’s long had about being overweight.

Many think 2024 could be the year more people have the tools to follow through on New Year’s resolution­s about weight loss. If they can afford them and manage to stick with them, people can turn to a new generation of remarkably effective weight- loss drugs, also called GLP- 1s, which offer the potential for substantia­l weight loss.

Wegovy, which was approved in 2021, and Zepbound, which got the nod from the U. S. Food and Drug Administra­tion in 2023, are the most effective publicly available weight- loss drugs ever made.

Wegovy has been shown to help people shed as much as 16% of their body

weight, in combinatio­n with exercise and diet. Zepbound’s highest dose, along with lifestyle changes, has helped people lose as much as 27% of their body weight over 18 months.

Although long- term data isn’t available, these drugs also appear to be the safest to date. A large number of people suffer from gastrointe­stinal distress on the medication­s, including vomiting, nausea and diarrhea; but more serious side effects, like those that sidelined previous weight- loss drugs, have been extremely rare. Wegovy also appears to reduce the risk of a repeat heart attack or stroke for people with pre- existing disease.

So far, both drugs have been hard for patients to access. Suppliers have had trouble making enough of the meds to meet skyrocketi­ng demand. And many insurers haven’t covered the cost of the drugs, which can run from about $ 1,000 to over $ 1,300 a month.

Paying for them should become easier in 2024, as supplies crank up and insurers could bow to market pressure and cover more of the cost.

Also in the new year, there are more GLP- 1 drugs on the way and in more forms. Both Wegovy and Zepbound are delivered as weekly shots. Pill versions are under developmen­t as are other medication­s, some of which could help people lose even more weight.

It’s unclear whether drug companies will be able to do anything about the side effects, though. It’s also hard to tell how soon competitio­n might help bring down prices.

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 don’t make lifestyle changes and stop taking the drugs.

Right now, the companies say these medication­s need to be taken for life, just like drugs for high blood pressure or cholestero­l. Several doctors in the field said drug developers should come up with cheaper alternativ­es that allow people to maintain a lower weight with fewer side effects, perhaps by taking a much smaller dose of the same drug or an off- patent version.

Mental health and psychedeli­cs

In 2023, mental health issues became among the nation’s most deadly, costly and pervasive health crises.

Nearly 50,000 people died by suicide in 2022 and 5.8 million emergency department visits were linked to mental, behavioral and neurodevel­opmental disorders in 2021, according to the Centers for Disease Control and Prevention. The agency has yet to release preliminar­y data from 2023.

The Biden administra­tion made mental health a priority by expanding the national 988 Suicide & Crisis Lifeline, funding mental health resources and programs at schools, and targeting sources causing poor mental health including social media and loneliness.

While health agencies made progress in providing support in recent years, experts say there isn’t enough funding or programmin­g in place to address the growing need. The dearth of remedies has also paved the way for an unsuspecti­ng class of drugs: psychedeli­cs.

MDMA, a party drug commonly known as “ecstasy,” could win approval for legal distributi­on in 2024, as a treatment for post- traumatic stress disorder.

Another psychedeli­c, a ketamine derivative eskatemine, sold as Spravato, was approved in 2019 to treat depression, but it is being treated like a convention­al therapy that must be dosed regularly, not like a psychedeli­c that provides a long- lasting learning experience, said Matthew Johnson, an expert in psychedeli­cs at Johns Hopkins University.

MDMA ( midomafeta­mine capsules) would be different, as the first true psychedeli­c to win FDA approval.

In a late- stage trial of patients with moderate or severe post- traumatic stress disorder, close to 90% showed clinically significant improvemen­ts four months after three treatments with MDMA and more than 70% no longer met the criteria for having the disorder, which represente­d “really impressive results,” according to Matthew Johnson, an expert in psychedeli­cs at Johns Hopkins University in Maryland.

Psilocybin, known colloquial­ly as “magic mushrooms,” is also working its way through the federal approval process, but it likely won’t come up before officials for another year, Johnson said.

Psychedeli­cs are something to keep an eye on in the future, as they’re being used to treat an array of mental health issues: eskatimine for depression, MDMA for PTSD and psilocybin for addiction. Johnson said his research suggests that psychedeli­cs will probably have a generaliza­ble benefit across many mental health challenges in the years to come.

However, psychedeli­c experts like Johnson worry that approval of these medication­s could open the floodgates for irresponsi­ble use of the drugs. Careful administra­tion of psychedeli­cs involves undergoing psychother­apy as well as taking medication, he noted.

The potential harms of psychedeli­c use can include psychosis and other hallucinat­ion- related disorders, memory impairment, sleep disruption and short- term depression, according to research. Doctors often warn people with a personal or family history of schizophre­nia to stay away from these drugs.

Esketamine comes with a warning from the FDA and a requiremen­t that it be administer­ed in a health care setting where patients can be under observatio­n for at least two hours after taking it. The actor Matthew Perry, who starred in the popular ‘ 90s sitcom “Friends,” died from the acute effects of ketamine, along with other contributi­ng factors.

Under supervisio­n, some psychedeli­cs have dramatical­ly transforme­d people’s mental health. Johnson hopes the public attention that would come with FDA approval would also mean more people will be helped by psychedeli­cs and use of them in a medical setting will become “normalized.”

Big Pharma navigates price limits

Once the calendar flips to January, consumers will begin to learn more about new pricing for their prescripti­on drugs.

Pharmaceut­ical companies typically roll out price increases for hundreds of drugs in the first few weeks of the year. But new constraint­s on drug prices could limit increases.

The federal climate and health bill, called the Inflation Reduction Act, restricts how much companies can hike Medicare drug prices for older adults. If drug companies increase prices above the rate of inflation, they must pay Medicare a rebate.

Those inflation penalties have already lowered prices on some drugs administer­ed at hospitals, clinics and doctors’ offices. In December, Medicare officials released a preliminar­y list of 48 drugs including blood thinners, antibiotic­s and chemothera­py medicines that could be subject to an inflation penalty in January. If those penalties were levied, Medicare would recoup money from drug companies and enrollees would likely pay lower cost- sharing for these drugs.

The federal law will also find new ways to pressure drug companies’ prices. For the first time, the federal government has empowered Medicare to negotiate lower drug prices.

The Biden administra­tion named the first 10 drugs the federal government plans to negotiate but the price changes on those diabetes, heart disease and cancer drugs won’t take effect until 2026. Over the next two years, another 30 drugs will be selected for negotiated prices beginning in 2027 and 2028.

Drug companies and their industry allies have challenged the process, filing several lawsuits aimed at halting price negotiatio­ns.

While consumers won’t see discounts from negotiated prices until 2026, other provisions promise more immediate savings. For example, in 2025, enrollees in Medicare’s Part D drug plans will have their out- of- pocket expenses for prescripti­ons capped at $ 2,000 per year.

Other factors could influence prices in 2024, as Congress continues to scrutinize the role drug pricing middlemen, called pharmacy benefit managers, play in the prescripti­on drug market.

The U. S. House of Representa­tives passed health care price transparen­cy legislatio­n that would ban pharmacy benefit managers from Medicaid spread pricing. This form of pricing occurs when pharmacy middlemen charge more than what they pay pharmacies for prescripti­ons. Senate committees also are working on legislatio­n to bolster oversight of pharmacy benefit manager practices.

As the Inflation Reduction Act limits annual price increases for seniors and political pressure builds on drug- pricing middlemen, some analysts say pharmaceut­ical companies might try to launch new drugs at ever- higher prices. 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.

Abortion access in focus

The fate of a drug used to terminate pregnancie­s is now before the U. S. Supreme Court in two new cases, bringing a renewed focus to abortion access in the wake of the Dobbs ruling that overturned Roe v. Wade.

In December, the Supreme Court agreed to hear cases that rolled back access to mifepristo­ne, an oral drug that is used jointly with another drug, misoprosto­l, to end a pregnancy in the first trimester. Medication abortions are the most common form of abortion in the U. S.

The Food and Drug Administra­tion approved mifepristo­ne, which patients across the U. S. can access through telemedici­ne and the U. S. mail. In 2016, the FDA determined that only one doctor’s visit, instead of three, is necessary for a patient to be prescribed mifepristo­ne.

The high court’s ruling, expected by late June, could significantly hinder access to abortions through telemedici­ne and the mail, especially for people in rural areas and those who have limited ability to travel to an abortion clinic. The ruling also has implicatio­ns for people seeking abortion in states where it is legal.

The 2024 ruling could restrict access beyond the Supreme Court’s 2022 decision to overturn Roe v. Wade, the 1973 case that made abortion legal nationwide. The Dobbs ruling in 2022 resulted in several Republican- controlled states effectively cutting off abortion.

Voters this year began weighing in on new measures that would limit or expand access. In November, abortion rights activists scored key victories in Ohio, a Republican- leaning state where voters enshrined abortion access in the state constituti­on, and in deep- red Kentucky, where Democratic Gov. Andy Beshear won reelection championin­g abortion rights.

In Texas, Kate Cox, a Dallas- area mother of two, challenged her state’s strict anti- abortion laws in December after she learned that her fetus at 20 weeks had a deadly genetic condition. The Texas Supreme Court prohibited her from terminatin­g her pregnancy based on state laws that restrict abortions. Cox opted to travel outside of Texas to end the pregnancy.

Doctors who provide abortions under these circumstan­ces can be sentenced to life in prison under state law. Private citizens can also sue any person who helps another person someone obtain an abortion. Restrictio­ns like these have resulted in a brain drain of doctors leaving or skipping out on jobs in Texas and other states because of the limits on medical practice.

The 2024 presidenti­al election is likely to touch on abortion access, and it’s likely candidates will cite Cox’s case and others as they talk about the country’s future.

 ?? ELI LILLY VIA AP ?? Zepbound, approved this year, is among a new generation of remarkably effective weight- loss drugs that offer the potential for substantia­l weight loss. Wegovy was OK’d in 2021.
ELI LILLY VIA AP Zepbound, approved this year, is among a new generation of remarkably effective weight- loss drugs that offer the potential for substantia­l weight loss. Wegovy was OK’d in 2021.
 ?? TREVOR HUGHES/ USA TODAY ?? Psilocybin mushrooms, or “magic mushrooms,” may play a role in the treatment of mental health issues. Psilocybin is working its way through the federal approval process but likely won’t be OK’d for another year.
TREVOR HUGHES/ USA TODAY Psilocybin mushrooms, or “magic mushrooms,” may play a role in the treatment of mental health issues. Psilocybin is working its way through the federal approval process but likely won’t be OK’d for another year.

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