The 340B Drug Pricing Program (340B Program) and the Medicaid Drug Rebate Program require manufacturers to provide discounts on outpatient drugs in order to have their drugs covered by Medicaid. These discounts take the form of reduced sales prices for covered entities participating in the 340B Program--eligible hospitals and federal grantees--and rebates on drugs dispensed to Medicaid beneficiaries, shared by states and the federal government. This book looks at important issues pertaining to the 340B Drug Pricing Program.

Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.

Rising health care costs are a central fiscal challenge confronting the United States. National spending on health care currently accounts for 18 percent of gross domestic product (GDP), but is anticipated to increase to 25 percent of GDP by 2037. The Bipartisan Policy Center argues that "this rapid growth in health expenditures creates an unsustainable burden on America's economy, with far-reaching consequences". These consequences include crowding out many national priorities, including investments in education, infrastructure, and research; stagnation of employee wages; and decreased international competitiveness.In spite of health care costs that far exceed those of other countries, health outcomes in the United States are not considerably better. With the goal of ensuring that patients have access to high-quality, affordable cancer care, the Institute of Medicine's (IOM's) National Cancer Policy Forum convened a public workshop, Delivering Affordable Cancer Care in the 21st Century, October 8-9, 2012, in Washington, DC. Delivering Affordable Cancer Care in the 21st Century summarizes the workshop.

A compassionate act drives a young single mother in Arkansas to the forefront of America’s fight against AIDS in this “powerful” memoir (Library Journal). In 1986, twenty-six-year-old Ruth visits a friend at the hospital when she notices that the door to one of the hospital rooms is painted red. She witnesses nurses drawing straws to see who would tend to the patient inside, all of them reluctant to enter the room. Out of impulse, Ruth herself enters the quarantined space and immediately begins to care for the young man who cries for his mother in the last moments of his life. Before she can even process what she’s done, word spreads in the community that Ruth is the only person willing to help these young men afflicted by AIDS, and is called upon to nurse them. As she forges deep friendships with the men she helps, she works tirelessly to find them housing and jobs, even searching for funeral homes willing to take their bodies—often in the middle of the night. She cooks meals for tens of people out of discarded food found in the dumpsters behind supermarkets, stores rare medications for her most urgent patients, teaches sex-ed to drag queens after hours at secret bars, and becomes a beacon of hope to an otherwise spurned group of ailing gay men on the fringes of a deeply conservative state. Throughout the years, Ruth defies local pastors and nurses to help the men she cares for: Paul and Billy, Angel, Chip, Todd and Luke. Emboldened by the weight of their collective pain, she fervently advocates for their safety and visibility, ultimately advising Governor Bill Clinton on the national HIV-AIDS crisis. This deeply moving and elegiac memoir honors the extraordinary life of Ruth Coker Burks and the beloved men who fought valiantly for their lives with AIDS during a most hostile and misinformed time in America. Praise for All the Young Men A Finalist for the Lambda Literary Award One of Library Journal’s Best Biographies and Memoirs of 2020 “Burks’s spirited, straightforward prose balances the heartbreak of her story with just enough humor and toughness. A must-read for anyone interested in narratives of front-line responses to the early AIDS crisis as well as personal accounts of kindness and determination.” —Library Journal (starred review) “Burks’ vivid memories of ‘my guys’ and the trials she endured fighting against prejudice offer a portrait of courageous compassion that is both rare and inspiring . . . [A] deeply moving, meaningful book.” —Kirkus Reviews “Anecdotes of small-town gay bars and drag queen rivalries add levity to tales of hardship and sacrifice—crosses set ablaze on her lawn, her young daughter ostracized at school. . . . This worthy account offers as much bitter as sweet.” —Publishers Weekly

Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide. The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the second of two, builds off the conclusions of the first report and outlines a strategy for hepatitis reduction over time and specific actions to achieve them.

One in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. In light of this, the Centers for Disease Control and Prevention, through the National Association of County and City Health Officials, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although significant scientific advances have been made since that time, many of the problems and barriers described in that report persist today; STIs remain an underfunded and comparatively neglected field of public health practice and research. The committee reviewed the current state of STIs in the United States, and the resulting report, Sexually Transmitted Infections: Advancing a Sexual Health Paradigm, provides advice on future public health programs, policy, and research.