Rx Savings Solutions is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in prescription savings for members. Rx Savings Solutions is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.
Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2026 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. ECN0011541 (0126)
HorizonBlue.com
Encouraging Coordinated Care
Addressing Rising Pharmacy Costs
Member Education
Negotiating/Renegotiating Provider/Hospital Contracts
Understand the importance of having a primary doctor.
Learn more about our patient-centered programs and ask your doctor if they participate in one of these programs.
Stay up to date on your preventive care (e.g., screenings, immunizations, annual physicals) to avoid the need for complex care and prevent chronic diseases.
Care for your mind as well as your body by using your behavioral health coverage.
Enroll in case management/chronic care programs, if appropriate.
Get wellness discounts that can help you stay active, while saving money at popular retailers and companies nationwide.
We have a number of important initiatives and programs designed to help you get the most of your health care coverage and make sure you:
We are currently engaged with 18 health systems that include onsite pharmacists to drive outcomes and strategy. This collaboration resulted in more than 1,000 pharmacy gaps closed in 2024, which yielded $3.3 million in annual savings that can eventually be passed on to members in the form of lower premiums.
Encourage the use of generic drugs – Research shows that using generic drugs can save consumers between 30 to 80 percent over brand name drugs.1 Over 90% of Horizon members taking prescription medicines were given generics in 2024.
Find lower-cost options that are just as effective – Rx Savings Solutions is a vendor that identifies eligible members, and provides lower-cost prescription drug options for them (from January 2022 to May 2024, this saved members more than $5.5 million).
Increase convenience of access to care – Make it possible for members to get certain injectable medicines at their doctor’s office or in their home at a lower cost.
Offer home delivery of medicines – For many members, home delivery offers 90-day supplies of medicines at one copay, delivered to their homes at no additional cost.
Help members understand their prescribed medicines and make sure they are taking them correctly. This includes:
Sending targeted letters and emails with specific guidance from Horizon and Prime Therapeutics (our Pharmacy Benefits Manager)
Sending broad letters, emails and digital newsletter articles that speak to the dangers of opioid abuse
Providing members with pill boxes and reminder packaging to help them establish routines for taking their medicines
Offering nurse coaching
Working with our network prescribers to ensure they’re prescribing practices are in line with appropriate guidelines, and offering training/education, as appropriate.
We manage more than $5 billion in annual drug spend for 3.3 million members. We’re constantly looking for ways to manage pharmacy-related costs through programs that:
We offer programs and resources to help you get the information you need to access quality care while managing your out-of-pocket costs.
Visit our Education Center to learn more about:
Seeing Results. In 2025, we successfully negotiated new agreements with many health systems, hospitals and doctor groups that share our goal to make health care more affordable.
Encouraging our network providers to deliver quality, appropriate care. We're eliminating wasteful care that doesn’t deliver good results, controlling administrative costs and working to keep price increases down.
Continuing to expand the state’s largest networks. With a 13% increase in network participation from 2002, Horizon members now have more than 87,600 options for care, and in-network access to 103 hospitals in NJ, NY, PA and DE.
We expect to face difficult decisions when it comes to hospital and doctor reimbursement rates, but will continue to negotiate contracts that include rates that protect you from unreasonable cost increases. We’re committed to making sure that cost is not a barrier to you getting the care you need by:
Click each box below to learn more.
What Horizon Is Doing
Health insurance is among the most heavily regulated industries, and many state and federal requirements drive up health care costs, particularly in New Jersey.
Click here for more information.
State and Federal Requirements
Health care disparities, or differences in preventable health care burdens based on race, socio-economic status and where someone lives, can be a major cause of unnecessary health care spending.
Click here for more information on how Horizon is addressing health care disparities.
Lack of Access to Quality Care
The increasing frequency and costs of avoidable Emergency Room visits, as well as the costs associated with out-of-network (OON) care, are also significant drivers of overall health care costs.
Click here for more information.
Avoidable ER Usage and Out-of-Network Care
Nearly one quarter of every dollar Americans pay for health care premiums now goes to prescription drug costs.1 Unfortunately, prescription drug costs are expected to continue to increase year-over-year by as much as 8%.2
Click here for more information.
Increasing Rx Costs
Studies show that hospitals often charge multiples of their costs for services and supplies, such as medicines, with markups of 500% or more widely cited. This practice ultimately results in higher health care costs for patients and the broader system.
Click here for more information.
Hospital Upcharging
Like many other health plans nationwide, we are facing difficult discussions with providers about their unreasonable requests for high reimbursement rates, with many of these providers threatening to go out of network. As New Jersey’s largest health insurer, we are committed to working with doctors and hospitals to make sure that cost is not a barrier to our members getting the care they need.
Click here for more information.
Double-Digit Provider Rate Increase Requests
Is the average annual deductible for employees with single coverage through employer-sponsored health insurance.3
Is the average annual premium for employees in New Jersey with single coverage through employer-sponsored health insurance. This is the highest average annual premium rate in the nation.2
$1,787
$2,057
The timing and pace of regulatory change can also lead to rising costs, as it often results in wasted efforts and time away from patients to understand and follow the regulations and then create new processes throughout the organization, as necessary.
All of these state and federal requirements contribute to New Jersey ranking 16th in the nation in the cost of health care.1
The amount of full-time employees an average-sized hospital dedicates to regulatory compliance, with over one quarter of these FTEs being doctors and nurses.
59 FTEs
The average national spend to comply with the administrative aspects of regulatory compliance. That means that the federal regulatory burden costs $1,200 every time a patient is admitted to a hospital.
$38.6 billion
An average-sized community hospital with about 160 beds spends this annually on administrative activities to support compliance with federal regulations – and that figure rises to $9 million for those hospitals with PAC beds.
$7.6 million
Health systems, hospitals and post-acute care (PAC) providers must comply with 629 discrete federal regulatory requirements across nine domains.
629
New Jersey is the third most heavily regulated state in America, behind just California and New York. And the number of regulations has increased by about 2% from 2019.1
State and federal regulation is largely intended to ensure that patients receive safe, high-quality care. However, clinical staff — doctors, nurses and caregivers — often find themselves devoting more time to regulatory compliance, taking them away from patient care. Some of these rules do not improve care, yet can significantly raise costs.
Offering training for clinicians on cultural competency, health literacy and implicit bias.
Educating employees on Health Equity.
Reducing unnecessary Emergency Room usage and promoting the use of alternative settings like primary, virtual, urgent and ambulatory care.
Coordinating with community partners to offer resources and support throughout New Jersey.
Cancer Screenings
Diabetes
Asthma
Prioritizing access to care for key diseases identified by the Healthy New Jersey State Health Improvement Plan. These include, among others:
As part of Our Pledge, Horizon is focused on:
It's up to all of us to address social factors that affect health equity. Everyone deserves a fair opportunity to get care.
Health Equity: A Shared Responsibility
Health disparities in the U.S. are projected to cost us $230 billion by 2050*, due to $150 billion in excess costs and $80 billion in lost productivity.
The Cost of Doing Nothing is High
You may also see a significant increase in your cost sharing (e.g., deductible, copay and/or coinsurance) when you use OON providers.
**For illustrative purposes only
Doctor is not allowed to bill you the difference
Your plan will cover $20,000, the contracted rate
Doctor charges $30,000
You choose an in-network doctor for a surgery
Doctor bills you for the $10,000 difference
Your plan covers $20,000
Doctor charges $30,000
You choose an OON doctor for a surgery
In addition to avoidable ER usage, patients choosing to use OON care also drives up health care costs. OON costs add up quickly, even for routine care, and if you have a serious illness or injury, it can mean paying thousands of dollars more.
For example**:
Hospital facility fees increase the cost of an average ER visit by more than $1,000 over the same care in a doctor’s office, while lab, pathology and radiology services are 10 times more costly than when performed at a doctor’s office.
*Represents the average cost for an ER visit in the U.S. in 2024.
Source: talktomira.com, 1WTIAA.org
$217
Cost for same care in primary care setting
$271
Cost for same care in urgent care setting
$2,715*
Avoidable ER visit cost
The average cost for an avoidable ER visit is 12 times higher than for the same care at a doctor’s office and 10 times higher than at an urgent care center.1
Strep throat
Upper respiratory infection
Mild headache
Low back pain
Nausea
Sore throat
Bronchitis
Cough
Dizziness
Flu
An avoidable hospital ER visit is a trip that is not an actual emergency, and is for a condition that could have been treated in a primary care or urgent care center setting. This includes common primary care treatable conditions such as:
Lack of governance – The average prices for prescription drugs are driven by demand, and have, at times, increased at a rate higher than U.S. inflation.
Lack of competition – Prices have increased for even widely used, older, generic drugs.
Specialty drugs – These high-cost drugs that are used to treat rare, complex and chronic health conditions continue to be a significant driver of health care costs. While they represent less than 2 percent of all drugs being prescribed, they are more than 50 percent of the total spend for prescription drugs.3 In 1990, there were only 10 approved specialty drugs, while today there are more than 400.
Drug spend grew $50B in 2024 driven by increased demand for GLP-1 weight loss medicines and other specialty drugs.
12% of Americans report having used a GLP-1 for weight loss.
The U.S. Food and Drug Administration (FDA) approved 53 new specialty drugs in 2024 alone.
About three in 10 adults report not taking their medicines as prescribed at some point in the past year because of the cost. This includes about one in five who say they have not filled a prescription (21%) or took an over-the counter drug instead (21%), and 12% who say they have cut pills in half or skipped a dose because of the cost.1 Here are some other reasons why:
Mergers and partnerships between medical providers, as well as the acquisition of physician practices by private equity firms, are reducing individual market competitiveness, allowing providers to drive up their prices unopposed and control much of a geographic market and specialty. When physician practices are acquired by private equity firms, their charges increase by an average of 20% and their prices by an average of 11%.1
Facility fees are also a key cost drivers resulting from consolidations. When doctor practices are bought by large health systems, they are then considered outpatient departments of their parent hospital, even if they keep their separate office location. The costs for services provided at those practices can then include facility fees – even for routine services.
Factors That Contribute to the Rising Costs of Health Care
The United States spent nearly $5 trillion on health care in 2023. So where did it go?
Why We Must Act Now
The Importance of Having Coverage
Rising U.S. Health Care Costs
Identifying opportunities to lower our members’ out-of-pocket costs (through innovative programs, care coordination, outreach, etc.).
Encouraging patient-centered care – One way we reduce costs is by reimbursing doctors and hospitals based on the results they deliver for our members. Rather than paying them to deliver more care, we reward them for delivering better care. A study showed that 64% of people polled like the idea of patient-centered, pay-for-performance care.1
Looking in the mirror – reducing our operating costs (where possible) without sacrificing the quality of care and services our members receive. While still achieving the highest customer satisfaction ratings of any health insurer in New Jersey, we have worked hard to improve the cost of our own operations, saving $84 million last year with an expected $75 million in additional savings over the next year.
Making sure everyone does their part to find collaborative, strategic solutions that address rising costs.
We are working with our network providers and other partners to address the rising costs of health care. This requires:
Source: KFF.org
Most important factors for people when selecting coverage:
Total costs
Coverage for specific services (anything from maternity care and mental health services to physical therapy and major surgeries).
Network size
Prescription drug coverage
48%
Monthly health insurance premium
55%
Prescription drug costs
51%
Affording housing costs
61%
Paying down debt
48%
Food
49%
Monthly utilities like electricity
50%
Gasoline or other transportation costs
62%
The cost of health care services
61%
Unexpected medical bills
Americans understand that health care is valuable and are increasingly concerned with the affordability of health care services and coverage.
In fact, the cost of health care services and unexpected medical bills top the list of people’s financial worries. About six in 10 Americans say they are more worried about affording the cost of health care services or unexpected medical bills for themselves and their families than they are about other routine expenses.
Source: Altarum Healthcare
0
20%
40%
60%
80%
100%
65+
10%
55-64
11%
45-54
22%
35-44
33%
25-34
30%
18-24
29%
65+
29%
55-64
28%
45-54
50%
35-44
59%
25-34
61%
18-24
60%
RATIONED MEDICINE
WENT WITHOUT CARE
Percentage Who Went Without Care or Rationed Medicine Due to Cost in Prior 12 Months, by Age Group
A broken leg can cost you $7,500 to treat.
Three days in the hospital can cost more than $30,000.
Comprehensive cancer care generally costs hundreds of thousands of dollars.
Uninsured patients have the least negotiating power when hit with a full charge for medical services.
Uninsured patients are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.
Most insurance plans provide prescription drug coverage (critical in the care and management of chronic conditions and illnesses).
Nobody plans to get sick or hurt, but bad things happen – even to healthy people. Some things to consider when you don’t have health insurance include:
Simply put, if you're paying for every medical service yourself, you may make some health care decisions based on money instead of what's best for your health. This can limit your options for care and quickly translate into medical debt, more sickness and higher costs.
Source: Kff.org
Family Coverage
Single Coverage
Average Annual Premium for Single and Family Coverage, 1999-2024
It’s no secret that as inflation goes up, so does the cost of everything – including health care. According to the Centers for Medicare & Medicaid Services, health care costs topped $5.3 trillion in 2024, an 8.2% increase from the prior year. Hospital services, doctor visits and prescription drugs accounted for the majority of these costs.
According to the Consumer Price Index, medical care costs rose 4.2% in August 2025 alone, compared to an overall inflation rate of 2.9%, and are now at the highest level in three years. This is making it harder for individual consumers to afford coverage, and is setting the stage for what could be the largest increase in health-care spending by large employers in 15 years.
Click each box below to learn more.
We understand how challenging managing rising health care costs can be for you and your family. That’s why, as New Jersey's largest health insurer, we are committed to addressing those challenges, and ensuring that quality health care remains accessible to all.
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Increased demand – Costs are driven by dramatic increases in prescription drug use, which is partly attributable to the number of patients with chronic health conditions. Today, more than 60% of U.S. adults have at least one chronic condition that requires prescription drugs, while four in 10 adults in the US. have two or more.2
1 kff.org
2 Healthinsureance.org
3 American Action Forum
4 Fierce Pharma
Approximately 90 percent of your health plan premium goes directly to pay for medical care such as doctor visits, hospital stays, prescription drugs and outpatient services. The remaining money is used to pay for things like taxes, government fees, administrative costs and broker commissions, and establish Horizon’s reserves. Horizon reserves are used to protect our members and ensure that there are sufficient funds to pay claims in the event of a natural disaster or public health emergency.
Horizon Reserves
0.7¢
PREMIUM TAX, ACA FEES AND OTHER TAXES
4¢
ADMINSTRATIVE SERVICES
7.3¢
INPATIENT COSTS
18¢
PRESCRIPTION DRUGS
21¢
OUTPATIENT COSTS
22¢
PHYSICIAN SERVICES
27¢
Nearly 90¢ of Every Horizon Premium Dollar Goes Directly to Pay for Medical Care
Source: Gallup poll; Commonwealthfund.org
Approximately 11% of U.S. adults are unable to afford or access quality health care, a new high since 2021.
Rising Costs Threaten Access to Care
Information based on Horizon BCBSNJ insured markets (2023 data).
1 Fiercehealthcare.com
1 nih.gov
2 moneytalksnews.com
1 mercatus.org
Source: Nj.Gov/dobi
Source: AHA.org
Information based on Horizon BCBSNJ insured markets (2023 data).
Approximately 90 percent of your health plan premium goes directly to pay for medical care such as doctor visits, hospital stays, prescription drugs and outpatient services. The remaining money is used to pay for things like taxes, government fees, administrative costs and broker commissions, and establish Horizon’s reserves. Horizon reserves are used to protect our members and ensure that there are sufficient funds to pay claims in the event of a natural disaster or public health emergency.
Horizon Reserves
0.7¢
PREMIUM TAX, ACA FEES AND OTHER TAXES
4¢
ADMINSTRATIVE SERVICES
7.3¢
INPATIENT COSTS
18¢
PRESCRIPTION DRUGS
21¢
OUTPATIENT COSTS
22¢
PHYSICIAN SERVICES
27¢
Nearly 90¢ of Every Horizon Premium Dollar Goes Directly to Pay for Medical Care
Rising Costs Threaten Access to Care
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Rx Savings Solutions is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in prescription savings for members. Rx Savings Solutions is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.
Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2024 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. ECN0011541 (0624)
HorizonBlue.com
Plan options that best meet your needs
Understanding your OOP costs
Knowing your care options (telemedicine, urgent care, retail health centers, at-home care, etc.)
Minimizing unnecessary medical care
Our care management programs
Rising U.S. Health Care Costs
Addressing Rising Costs
Why We Must Act Now
The Importance of Having Coverage
Addressing Rising Costs
Why We Must Act Now
The Importance of Having Coverage
Rising U.S. Health Care Costs
Addressing Rising Costs
Why We Must Act Now
The Importance of Having Coverage
Rising U.S. Health Care Costs
Addressing Rising Costs
Why We Must Act Now
The Importance of Having Coverage
Rising U.S. Health Care Costs
Addressing Rising Health Care Costs
Encouraging Coordinated Care
Addressing Rising Pharmacy Costs
Member Education
Negotiating/Renegotiating Provider/Hospital Contracts
Encouraging Coordinated Care
Addressing Rising Pharmacy Costs
Member Education
Negotiating/Renegotiating Provider/Hospital Contracts
Encouraging Coordinated Care
Addressing Rising Pharmacy Costs
Member Education
Negotiating/Renegotiating Provider/Hospital Contracts
Encouraging Coordinated Care
Addressing Rising Pharmacy Costs
Member Education
Negotiating/Renegotiating Provider/Hospital Contracts
Reimbursing doctors and hospitals based on the care outcomes they deliver for our members. We reward them for giving our members better care.
How Costs Compare
*Costs for Common Health Care Procedures Significantly Higher When Performed in Hospital Outpatient Departments. BCBSA. September 14, 2023. (April 2024) https://www.bcbs.com/about-us/association-news/costs-for-common-health-care-procedures-significantly-higher-when-performed-in-hospital-outpatient-departments
Getting the Right Care at the Right Place
That’s why we ask doctors to give us information about why they’re requesting to perform a procedure or treatment in a hospital.
Ensuring care is provided at the right time and place not only helps members get quality care, but it can reduce member out-of-pocket costs with more convenient options.
As always, members should work with their doctor when it comes to making decisions about their health and where they get care.
These amounts are for illustrative purposes and not inclusive of all procedure/location agreed upon amounts. Members may pay a percentage of these costs based on their plan.
1 Robinson, J., Whaley, C., & Dhruva, S. (2024, April). Prices and Complications in Hospital-Based and Freestanding Surgery Centers [Review of Prices and Complications in Hospital-Based and Freestanding Surgery Centers]. AJMC. https://www.ajmc.com/view/prices-and-complications-in-hospital-based-and-freestanding-surgery-centers.
2 Information based on Horizon BCBSNJ data (2025 data)
3 Ofri, D. (2024, June 17). “Even Doctors Like Me Are Falling Into This Medical Trap”. New York Times.
Knee MRI
Gallbladder Laparoscopy (general surgery)
Cataract Removal
Hospital: $2,128
Here are a just a few examples of how procedure costs can vary in different locations.
ASCs have been shown to have no differences in complication rates after procedures or treatment when compared to a hospital outpatient department.1
Patients treated in ASCs are less likely than those treated in a hospital outpatient department to be admitted to a hospital or visit an emergency room a short time after outpatient surgery.2
The infection rate after surgeries in an ASC are six times lower than that of hospital outpatient departments.3
1American Academy of Orthopedic Surgeons, Sep 2019
2Journal of Health Economics, Jan 2018
3California Ambulatory Surgery Association, Aug 2017
Procedures can cost
when they take place at a hospital compared to a physician office or ASC
58% more
in a hospital than in an office
32% more
Mammograms can cost
in a hospital than in an ASC and 2x the cost compared to a doctor's office
32% more
Colonoscopies can cost
Hospital: $4,880
Ambulatory Surgical Center:
$6003
Care can cost about 50% more in a hospital than an office or ASC.*
We work with doctors and hospitals to help our members find care at a lower cost without compromising quality — whether that’s at a hospital, an ambulatory surgical center (ASC), a doctor’s office or even at home.
Hospital:
Ambulatory Surgical Center: $2,128
$1,6761
Hospital:
Ambulatory Surgical Center: $4,880
$3,9742
Hospital:
Ambulatory Surgical Center: $900
$6003
Ambulatory Surgical Center: $1,6761
Ambulatory Surgical Center: $4,8002
Ambulatory Surgical Center: $6003
Hospital: $900
Seeing Results. In 2024, we successfully negotiated new agreements covering 33 hospitals, 60 professional groups and 22 ancillary facilities.
Maternal Health
Obesity
Cancer Screenings
Asthma
Immunizations
Maternal Health
Nearly four in 10 Americans have recently been unable to pay for either needed care or medicine.
About one in three working-age Americans are saddled with medical debt.
1 AHIP
2 AHIP.org
Popularity of GLP-1 medicines – The three medicines for weight loss helped drive a 1.7% increase in U.S. prescription medicine use in 2024, and a significant spending rise, with the U.S. market growing 11.4%, up from the 4.9% increase recorded in 2023.4
1 commonwealthfund.org
3 kff.org
Hospitals often inflate the prices of services and supplies beyond the actual cost of providing the care - a practice driven by large hospital systems, facility fees and the negotiation power they have with insurance companies. This results in exorbitant hospital bills, particularly for uninsured or out-of-network patients, and contributes to high medical debt.
Click here for more information.
Wasteful practices are a major contributor to high health care costs, with estimates suggesting that such waste accounts for approximately 25% of total health care spending in the U.S., equating to hundreds of billions of dollars annually.
Wasteful Practices
1 The New England Journal of Medicine
2 Health Care Cost Institute
3 Commonwealth Fund
4 JAMA
5 Agency for Healthcare Research and Quality
Unnecessary Care and Procedures – 30% of all health care spending goes toward unnecessary services.1 In addition, low-value care, including excessive imaging, inappropriate prescriptions and unnecessary surgeries, accounts for $75 billion to $100 billion annually in waste.2
Extreme Cost Variation – The cost of the same procedure can vary by over 500% depending on the hospital or provider — often without any difference in quality.2 In addition, employers pay two to three times more for care in the U.S. than in comparable high-income countries, despite similar or worse outcomes.3
Administrative Complexity and Billing Waste – Excessive paperwork, billing errors and administrative layers inflate costs, with billing-related waste alone costing approximately $265 billion annually, driven by complex coding, claim denials, and redundant approvals.4
Poor Care Coordination and Readmission – Disjointed care leads to medical errors, avoidable complications and higher long-term costs. Up to 12% of hospital readmissions are preventable, costing employers about $25 billion per year.5 In addition, patients receiving conflicting advice from multiple specialists increases the risk of medicine errors and redundant tests, while their difficulty understanding complex referral systems can delay care and lead to worse outcomes.
Lack of Use of Benefits and/or Rewards – Employees not taking full advantage of their benefits due to a lack of awareness, complicated processes or their mistrust of the system can lead to their poorer health, and higher eventual costs.
The Five Biggest Sources of Waste in Health Care
The difference between what insurers like Horizon collects in premiums and the amount paid in benefits.2
6.2%
2 Includes all administrative costs associated with insuring individuals in health insurance programs.
3 This includes administrative costs, additions to reserves, rate credits and dividends, premium taxes and fees, and net underwriting gains or losses.
Source: American Medical Association
Hospital care 31%
Physician services 15%
Clinical services 5.3%
Prescription drugs 9.2%
Nursing care facilities 4.3%
Home health care 3%
Other personal health care costs 16.5%
Government administration11.2%
Government public health activities 3.3%
Investment spending 4.9%
H
Addressing Rising Costs
Addressing Rising Health Care Costs
51% of working-age Americans struggle to afford their health care and about one in three (32%) are saddled with medical debt.
Studies show that hospitals often charge multiples of their costs for services and supplies, such as medicines, with markups of 500% or more widely cited. This practice ultimately results in higher health care costs for patients and the broader system.
Source: PhRMA.org
Click here for more information.
Nearly one quarter of every dollar Americans pay for health care premiums now goes to prescription drug costs.1 Unfortunately, prescription drug costs are expected to continue to increase year-over-year by as much as 8%.2
Source: PhRMA.org
Mergers and partnerships between medical providers, as well as the acquisition of physician practices by private equity firms, are reducing individual market competitiveness, allowing providers to drive up their prices unopposed and control much of a geographic market and specialty. When physician practices are acquired by private equity firms, their charges increase by an average of 20% and their prices by an average of 11%.1
Facility fees are also a key cost drivers resulting from consolidations. When doctor practices are bought by large health systems, they are then considered outpatient departments of their parent hospital, even if they keep their separate office location. The costs for services provided at those practices can then include facility fees – even for routine services.
H
Source: PhRMA.org
2 moneytalksnews.com
Mergers and partnerships between medical providers, as well as the acquisition of physician practices by private equity firms, are reducing individual market competitiveness, allowing providers to drive up their prices unopposed and control much of a geographic market and specialty. When physician practices are acquired by private equity firms, their charges increase by an average of 20% and their prices by an average of 11%.1
Facility fees are also a key cost drivers resulting from consolidations. When doctor practices are bought by large health systems, they are then considered outpatient departments of their parent hospital, even if they keep their separate office location. The costs for services provided at those practices can then include facility fees – even for routine services.
The increasing frequency and costs of avoidable Emergency Room visits, as well as the costs associated with out-of-network (OON) care, are also significant drivers of overall health care costs.
Click here for more information.
Avoidable ER Usage and Out-of-Network Care
Source: Kff.org
Family Coverage
Single Coverage
Average Annual Premium for Single and Family Coverage, 1999-2024