This article describes how the Washington State Prescription Drug Affordability Board (PDAB) identifies high-cost prescription drugs for affordability review and potential price regulation. Using claims and pricing data, the board found 290 drugs eligible for review and selected four because they imposed the greatest financial burden on patients and payers. The authors conclude that affordability reviews and potential upper payment limits could help reduce prescription drug costs and improve access while balancing the sustainability of the healthcare system.

This case study uses the Washington State All-Payer Claims Database (APCD) linked with a trauma registry to analyze the utilization of physical therapy services among firearm injury survivors.

This study quantifies a major shift in locus of VA critical care, a likely outcome of expanded non-VA health insurance coverage that was previously called out, but the study was not designed to address the many issues raised by outsourcing so much ICU care, including questions about the coordination and continuity of post-ICU care for these patients with high-acuity conditions. The study adds to concerns about VA’s ability to oversee the quality of community care and gaps in the integration of VA-delivered and VA-purchased care.

Colorado, Maine, Connecticut, and Washington—have collected and analyzed data on outpatient facility fee billing within their borders. This growing interest reflects several converging trends. Hospital outpatient utilization has increased substantially over the past few decades, and care delivered in HOPDs has generally become more expensive compared to similar care provided in non-hospital settings.

The Washington APCD has created a searchable dashboard using behavioral health-specific claims to better understand the cost of mental health services and how they're used. The article includes key findings as well as a section that explains how to use the dashboard using different types of searches, such as cost driver and network analysis.