JAMA Health Forum最新文献

{"title":"Cardiovascular Health at the Intersection of Race and Gender in Medicare Fee for Service.","authors":"Gray Babbs, Kendra Offiaeli, Jaclyn M W Hughto, Landon D Hughes, Theresa I Shireman, David J Meyers","doi":"10.1001/jamahealthforum.2025.3014","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3014","url":null,"abstract":"<p><strong>Importance: </strong>Transgender and gender diverse (TGD) people have significantly higher rates of cardiovascular-related conditions than cisgender people, and Black and Hispanic people have higher rates of cardiovascular-related conditions than non-Hispanic White people. However, little is known about the prevalence of cardiovascular-related conditions among racial and ethnic subgroups of TGD people.</p><p><strong>Objective: </strong>To compare the prevalence of cardiovascular-related conditions across racial and ethnic groups for TGD and cisgender people using quantitative intersectional methods.</p><p><strong>Design, setting, and participants: </strong>Medicare enrollment and claims data were used from TGD and cisgender beneficiaries from 2011 to 2020. Using an established algorithm, likely TGD people were identified based on their diagnosis codes and care utilization. The 10 nearest-neighbor cisgender matches for each TGD beneficiary were identified based on propensity scores estimated from the original basis of eligibility, years of enrollment, age, and hospital service area.</p><p><strong>Exposure: </strong>Race, ethnicity, and gender modality (TGD and cisgender). These data were analyzed from November 7, 2023, to October 31, 2024.</p><p><strong>Main outcomes and measures: </strong>Rate of cardiovascular-related conditions (peripheral vascular disease, congestive heart failure, diabetes, hypertension, and chronic obstructive pulmonary disease) among Asian and Pacific Islander, Black, and Hispanic TGD beneficiaries compared with non-Hispanic White cisgender counterparts using generalized estimating equations, cardiovascular diseases and their risk factors. Attributable proportions for TGD Asian and Pacific Islander, Black, and Hispanic beneficiaries were calculated.</p><p><strong>Results: </strong>Of the 36 004 TGD beneficiaries, 714 Asian and Pacific Islander (2%), 4518 Black (13%), and Hispanic 2545 (7%) had higher rates of cardiovascular-related conditions than 28 227 non-Hispanic White (78%) beneficiaries and higher than the 323 613 cisgender beneficiaries (5981 Asian and Pacific Islander [2%]; 40 781 Black [13%]; 22 417 Hispanic [7%]; 254 434 White [79%]). Black TGD beneficiaries had a 74% higher prevalence of peripheral vascular disease, 76% higher prevalence of congestive heart failure, and 50% higher prevalence of diabetes than similar non-Hispanic White cisgender beneficiaries. Overall, 6.3% of the excess peripheral vascular disease among Black TGD beneficiaries and 19.9% of the excess peripheral vascular disease among Asian and Pacific Islander TGD beneficiaries were associated with being at the intersection of gender, race, and ethnicity.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that Asian and Pacific Islander, Black, and Hispanic TGD beneficiaries had a high prevalence of cardiovascular-related conditions and had an elevated prevalence of several conditions, attributable to th","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253014"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Treatment Landscape of Depression, Suicidality, and Substance Use Disorder in the US.","authors":"Dennis Lee, Stacie B Dusetzina, Stephen W Patrick, John A Graves, Carrie E Fry","doi":"10.1001/jamahealthforum.2025.2647","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2647","url":null,"abstract":"<p><strong>Importance: </strong>Recent trends in drug-related overdoses among adolescents have highlighted the need for mental health and substance use disorder (SUD) treatment. However, the extent of these treatment gaps is understudied.</p><p><strong>Objective: </strong>To characterize the factors associated with the diagnosis of and treatment for mental health and SUD for adolescents.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used survey-weighted descriptive statistics and χ2 tests to estimate differences in characteristics and treatment receipt and included US adolescents and young adults aged 12 to 20 years who participated in the National Survey on Drug Use and Health in 2021 and 2022. Data were analyzed from February 2024 to February 2025.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes included the prevalence of depression and suicidality-related mental health diagnoses, SUDs, and treatment rates for both conditions. Additional measures included treatment setting, socioeconomic and demographic characteristics, and health insurance-related factors.</p><p><strong>Results: </strong>From 2021 to 2022, 13% of participants had SUD and 24% had a mental health diagnosis during the previous year (mean [SD] age, 16.0 [2.5] years; 48.4% female individuals; 6.1% Asian, 13.9% Black, 25.7% Hispanic, and 49.9% White individuals). Only 10% of participants with SUD and 51% of adolescents with mental health diagnoses received treatment for their conditions, with higher rates of treatment among adolescents with comorbid SUD and mental health diagnoses. When comparing adolescents (aged 12-17 years) and young adults (aged 18-20 years) with SUD for treatment receipt, reductions were found in any mental health treatment (63% vs 51%; P = .03) and any SUD treatment (11% vs 8%; P = .01). Moreover, these lower rates were also found in more resource-intensive treatment settings, such as inpatient mental health care (14% vs 9%; P = .02) and specialty mental health facilities (47% vs 33%; P = .003). However, adolescents with opioid use disorder were less likely to receive medication treatment (11% vs 28%; P = .02). Treatment differences were associated with socioeconomic and insurance coverage factors. Compared with adolescents, young adults with SUD experienced increased poverty rates (20% vs 26%; P = .02), uninsurance rates (5% vs 10%; P = .05), and private insurance rates (49% vs 56%; P = .02) while receiving decreased Medicaid coverage (47% vs 33%; P < .001) and government assistance (34% vs 25%; P = .001).</p><p><strong>Conclusions and relevance: </strong>The results of this cross-sectional survey study suggest that adolescents and young adults with SUDs rarely received treatment. Adolescents are especially vulnerable to treatment gaps once reaching young adulthood, and medications for opioid use disorder are systematically underused, especially for adolescents.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252647"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance Drift in a Nationally Deployed Population Health Risk Algorithm in the US Veterans Health Administration.","authors":"Likhitha Kolla, Kristin Linn, Amol S Navathe, Craig Kreisler, Christopher B Roberts, Sae-Hwan Park, Harvineet Singh, Jean Feng, Jinbo Chen, Ravi B Parikh","doi":"10.1001/jamahealthforum.2025.2717","DOIUrl":"10.1001/jamahealthforum.2025.2717","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Clinical risk algorithms inform clinical decision support and system-level quality metrics. However, algorithm performance can drift over time and possibly promote misinformed decision-making and resource allocation. The Veterans Health Administration (VA) Care Assessment Needs (CAN) algorithm is a nationally deployed population risk algorithm used to predict risk of 90-day hospitalization and/or mortality and to allocate resources for more than 5 million veterans annually. However, drift affecting the VA CAN has not been assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the impact of drift in the VA CAN algorithm and the extent, mechanisms, and clinical consequences of performance changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a retrospective cohort study using electronic health records (EHRs) and administrative data from the VA Corporate Data Warehouse, which contains observations from more than 5 million veterans per study year. The data comprised 27 787 152 observations among 7 215 711 unique veterans receiving VA primary care from 2016 to 2021. Data analysis was performed from January 2023 and December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Two primary outcomes were change in model performance (true positive rate [TPR], false positive rate [FPR], positive predictive value [PPV], negative predictive value [NPV], F1 score, and accuracy); and a national quality metric (% of veterans with CAN ≥90th percentile with a palliative care visit).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study population included 7 215 711 eligible veterans, with a mean (SD) age of 62.1 (16.5); 91.2% were male and 18.2% were Black, 6.6% Hispanic, and 76.2% White individuals. From 2016 to 2021, PPV decreased by 4.0% (95% CI, -2.8% to -5.1%); F1 score decreased by 4.6% (95% CI, -6.1% to 3.0%); NPV increased by 0.43% (95% CI, 0.30% to 0.57%); and FPR increased by 0.34% (95% CI, 0.10% to 0.58%), which corresponds with 18 288 increased false positive results. TPR and accuracy remained stable. The 90-day hospitalization and/or death rates decreased from 3.8% in 2017 to 3.0% in 2021. Covariate shifts were observed in 19 covariates, with demographic characteristics, health care utilization, and laboratory covariates exhibiting the largest shifts. The palliative care quality metric was 2.9% (95% CI, 2.8% to 2.9%) in 2018, 2.6% (95% CI, 2.6% to 2.7%) in 2019, and 2.8% (95% CI, 2.7% to 2.8%) in 2020, with FPRs among metric-eligible veterans increasing from 81.6% (95% CI, 81.5% to 81.7%) in 2018 to 85.7% (95% CI, 85.6% to 85.8%) in 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cohort study found that CAN algorithm performance declined from 2016 to 2021 due to shifts in outcome prevalence and distributions of health care utilization and demographic covariates. Close surveillance of clinical risk algorithms and quality metrics derived from algorithm-generated risk scores could mitigate subo","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252717"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Pharmacy Turnover and Context of Openings and Closings by Ownership Type.","authors":"T Joseph Mattingly, Maitreyi Sahu, Kelly E Anderson","doi":"10.1001/jamahealthforum.2025.1988","DOIUrl":"10.1001/jamahealthforum.2025.1988","url":null,"abstract":"<p><strong>Importance: </strong>While community pharmacies provide many valuable prescription and professional services, they are also retail businesses. Evaluating pharmacy closures through the lens of a retail business framework may provide more context on what is happening in this industry and identify potential solutions to address closures and/or shortages.</p><p><strong>Objective: </strong>To evaluate community pharmacy turnover (openings and closings) in the US over time and by ownership type.</p><p><strong>Design and setting: </strong>This cross-sectional analysis of all community pharmacy openings and closings in the US from 2010 to 2023 used pharmacy-level data from the US National Council for Prescription Drug Programs database. National-, state-, and county-level turnover was assessed using economic indicators of business dynamics, such as total population, population growth, household income, total firm changes for all industries, and net job creation.</p><p><strong>Exposures: </strong>Pharmacy class type defined as either a chain pharmacy (4 or more pharmacies under common ownership) or an independent or franchise pharmacy using the US National Council for Prescription Drug Programs classifications.</p><p><strong>Main outcomes and measures: </strong>Pharmacy turnover rate from 2010 to 2023, calculated as the sum of pharmacy openings and closings over the full study period divided by the total pharmacies in the market at the beginning of the period (2010).</p><p><strong>Results: </strong>The analyses found that US pharmacy market turnover rate for this 14-year period was 86.8% (52 974 total openings and closures of 61 054 total pharmacies in 2010) or 6.2% annually. When comparing across pharmacy types, independent pharmacy turnover was substantially higher (152.7%) than chain pharmacy turnover (49.9%) across the entire US. Counties with high turnover were associated with net increases in pharmacies from more independent pharmacy openings over the period. Turnover rates for all businesses were higher in counties with both low and high pharmacy turnover, even when adjusting for population size.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that the community pharmacy market in the US has an annual turnover rate of approximately 6.2%, with independent pharmacies opening and closing more frequently than chain pharmacies.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e251988"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Model Drift and Its Impact on Health Care Policy.","authors":"Andrew Wong, Jeremy B Sussman","doi":"10.1001/jamahealthforum.2025.2724","DOIUrl":"10.1001/jamahealthforum.2025.2724","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252724"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Policy Changes and Unconditional Cash Transfers to Improve Maternal and Child Health.","authors":"Marian Jarlenski","doi":"10.1001/jamahealthforum.2025.2461","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2461","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252461"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Algorithms to Improve Fairness in Medicare Risk Adjustment.","authors":"Marissa B Reitsma, Thomas G McGuire, Sherri Rose","doi":"10.1001/jamahealthforum.2025.2640","DOIUrl":"10.1001/jamahealthforum.2025.2640","url":null,"abstract":"<p><strong>Importance: </strong>Payment system design creates incentives that affect health care spending, access, and outcomes. With Medicare Advantage accounting for more than half of Medicare spending, changes to its risk adjustment algorithm have the potential for broad consequences.</p><p><strong>Objective: </strong>To assess the potential for algorithmic tools to achieve more equitable plan payment for Medicare risk adjustment while maintaining current levels of performance, flexibility, feasibility, transparency, and interpretability.</p><p><strong>Design, setting, and participants: </strong>This diagnostic study included a retrospective analysis of traditional Medicare enrollment and claims data generated between January 1, 2017, and December 31, 2020, from a random 20% sample of non-dual-eligible Medicare beneficiaries with documented residence in the US or Puerto Rico. Race and ethnicity were designated using the Research Triangle Institute enhanced indicator. Diagnoses in claims were mapped to hierarchical condition categories. Algorithms used demographic indicators and hierarchical condition categories from 1 calendar year to predict Medicare spending in the subsequent year. Data analysis was conducted between August 16, 2023, and January 27, 2025.</p><p><strong>Main outcomes and measures: </strong>The main outcome was prospective health care spending by Medicare. Overall performance was measured by payment system fit and mean absolute error. Net compensation was used to assess group-level fairness.</p><p><strong>Results: </strong>The main analysis of Medicare risk adjustment algorithms included 4 398 035 Medicare beneficiaries with a mean (SD) age of 75.2 (7.4) years and mean (SD) annual Medicare spending of $8345 ($18 581); 44% were men; fewer than 1% were American Indian or Alaska Native, 2% were Asian or Other Pacific Islander, 6% were Black, 3% were Hispanic, 86% were non-Hispanic White, and 1% were part of an additional group (termed as other in the Centers for Medicare & Medicaid Services data). Out-of-sample payment system fit for the baseline regression was 12.7%. Constrained regression and postprocessing both achieved fair spending targets while maintaining payment system fit (constrained regression, 12.6%; postprocessing, 12.7%). Whereas postprocessing increased mean payments for beneficiaries in minoritized racial and ethnic groups (American Indian or Alaska Native, Asian or Other Pacific Islander, Black, and Hispanic individuals) only, constrained regression increased mean payments for beneficiaries in minoritized racial and ethnic groups and beneficiaries in other groups residing in counties with greater exposure to socioeconomic factors that can adversely affect health outcomes.</p><p><strong>Conclusions and relevance: </strong>Results of this study suggest that constrained regression and postprocessing can incorporate fairness objectives into the Medicare risk adjustment algorithm with minimal reduction in overall fit.","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252640"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2024.4966","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4966","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e244966"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Costs of Market Exclusivity Extensions For 4 Top-Selling Prescription Drugs in the US.","authors":"Dongzhe Hong, S Sean Tu, Reed F Beall, Massimiliano Russo, Benjamin N Rome, Aaron S Kesselheim, Ameet Sarpatwari","doi":"10.1001/jamahealthforum.2025.2631","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2631","url":null,"abstract":"<p><strong>Importance: </strong>Brand-name drugs in the US are sold at high prices during market exclusivity periods defined by their patents, before prices are lowered by generic competition. Drug manufacturers use several strategies to extend these market exclusivity periods and delay generic competition, including obtaining overlapping thickets of patents.</p><p><strong>Objective: </strong>To estimate excess US spending associated with delays in generic competition due to extended market exclusivity for 4 top-selling drugs.</p><p><strong>Design, setting, and participants: </strong>This retrospective serial cross-sectional study focused on 4 top-selling drugs that experienced new generic competition between 2014 and 2018 to allow enough time for determining postexclusivity price trajectories: imatinib (Gleevec, cancer), glatiramer (Copaxone, multiple sclerosis), celecoxib (Celebrex, arthritis), and bimatoprost (Lumigan, glaucoma). Drug monthly spending data from 2011 to 2021 were retrieved from a large commercial claims database (Merative MarketScan) and a random sample of Medicare beneficiaries with at least 1 month of Medicare Parts A, B, and D coverage and adjusted for estimated rebates obtained from SSR Health, LLC. The analysis was performed between March 2023 and January 2024.</p><p><strong>Exposures: </strong>Extended market exclusivity was calculated as the time between expiration of the key patent and first generic marketing.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was net monthly national drug spending in commercial insurance and Medicare Part D. Spending was estimated under 2 scenarios: (1) the status quo, reflecting observed spending trends, and (2) a counterfactual scenario, modeling spending in the absence of extended market exclusivity. Segmented linear regression analyses were used to assess level and slope changes in monthly spending following generic entry. Weights were applied to extrapolate sample-based estimates to the full US commercially insured and Medicare Part D populations.</p><p><strong>Results: </strong>Market exclusivity extensions beyond expiration of the key patent ranged from 7 (celecoxib) to 13 (glatiramer) months. In the absence of extended market exclusivity, and over a 2-year period following generic competition, net spending would have decreased by $3.5 billion, including $1.9 (95% CI, $1.3-$2.5) billion in commercial plans and $1.6 (95% CI, $1.1-$2.1) billion in Medicare-including $67 (95% CI, $22-$115) million for bimatoprost, $726 (95% CI, $516-$938) million for celecoxib, $1.7 (95% CI, $1.0-$2.4) billion for glatiramer, and $1.0 (95% CI, $0.8-$1.2) billion for imatinib.</p><p><strong>Conclusions and relevance: </strong>This study found that promoting timely generic availability and avoiding extending market exclusivity for top-selling drugs may result in substantial savings for US patients and payers, including both public and private health insurance programs.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252631"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Securing America's Pharmaceutical Innovation Edge.","authors":"Scott Gottlieb","doi":"10.1001/jamahealthforum.2025.4592","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.4592","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e254592"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}