What are Peptides?

Television is overflowing with advertisements for GLP-1, Ozempic, and others. GLP-1 is a glucagon-like peptide,

HRT & Peptide Evidence Compendium

This link will take you to a complete list of peptide products. Only some of them are FDA approved.

Peptides are a sequence of amino acids, which are a short chain of amino acids, smaller than a complete protein.

Many of these peptides signal the production of other hormones, such as testosterone or estrogen. 

Some of them are prescribed as anti-aging compounds.

Users must use due diligence for a specific product.  The peptides are frequently promoted by anti-aging clinics, naturopaths, and/or functional medicine clinics.

TruthTides — HRT & Peptide Evidence, Source-Locked

Are you ready for Private Equity ?

 

Private equity firms now account for a large percentage of all physician practice transactions in the United States (NICHM Foundation). 

Cardiology, dermatology, gastroenterology, and pediatrics are seeing the heaviest activity, and the pace is accelerating heading into 2027. Most physicians I talk to have one of two reactions when they hear this. Either they see PE as a threat: outside investors squeezing more work for less pay, eroding physician autonomy, turning medicine into a transaction. Or they see it as a windfall: a potential exit that could set them up for life if the timing is right. 

 Regardless of your stance on PE in medicine, one of the biggest learning lessons is turning your clinic from a "glorified job" into a true asset that can be sold, even if you never want to exit it. The first diagnostic question every clinic owner needs to answer is whether their practice is supply-constrained or demand-constrained. A demand-constrained clinic does not have enough patients. The schedule has gaps, new patient volume is inconsistent, and revenue is limited by how many people know about the practice and choose to come in. The fix is marketing and conversion: getting the right patients to find you, trust you, and book an appointment. A supply-constrained clinic has the opposite problem. Demand exists, but the physician is the bottleneck. The schedule is full because every slot requires the owner, which means growth is capped by how many hours that one person can work. The fix is capacity: adding providers, systems, or both. Most clinic owners assume they have a demand problem when they actually have a supply problem, and vice versa. Diagnosing this correctly determines everything about where you focus your energy and investment next. Regardless of which constraint you are facing, the first practical move is the same: audit where your time actually goes. Take one full month and track every clinical and administrative activity you personally perform. Then ask three questions about each one. Can this be automated using software or AI? Can this be delegated to someone else on the team? D oes this actually need to happen at all? That last question is the most valuable one. A significant portion of what most clinic owners do every week falls into the category of tasks that do not need to happen, have never been questioned, and are consuming hours that could go toward the three or four activities that actually drive the practice forward. When you identify your highest-value activities — the ones that are Easy, Lucrative, and Fun, and that generate the most income per hour — those are the activities worth protecting aggressively. Everything else is a candidate for automation, delegation, or elimination. This is the most direct path to recovering time that can be reinvested into building the practice rather than just running it. 

 A clinic that functions as a real asset, rather than a well-paying job, is built on developing consistency within three functions: marketing, conversion, and operations. 

 Marketing means getting the right potential patients to find out about you consistently. Not episodically, not when you remember to post on Instagram, but through a repeatable system that generates new patient inquiries week after week. For most clinic owners, this means a combination of a clearly differentiated brand, a search presence for the specific procedures they do best, and a referral system built around their existing patient base and physician network. 

 Conversion means getting the patients who find you to choose you. This is where most clinics leave significant money on the table. A patient who finds your clinic and has a poor experience with the front desk, a confusing booking process, or a long wait for a consultation is a lost patient. 

 The difference between a clinic converting 10% of inquiries and one converting 50% is not clinical quality. It is communication, follow-up, and the experience a patient has before they ever meet the physician. 

Operations means delivering care at a level that makes patients come back, refer others, and leave reviews that bring more patients in. This is the flywheel. Strong operations turn each patient into a marketing asset, which means your marketing budget buys less of the growth over time because your patient base does more of the work for you. A practice built on these three foundations does not just command a better valuation when PE comes knocking. It generates more income, demands less of the owner personally, and provides more optionality across the board. The physician who built it can choose to sell at a meaningful multiple of EBITDA. They can choose to stay independent and continue collecting the income. They can choose to reduce their clinical hours without the practice collapsing. Every one of those options exists because the asset was built deliberately rather than left to develop on its own. 

 The physicians who feel most trapped by their clinics almost always built them around their own personal production. The ones who feel most free built something that can run and grow without requiring everything from them personally. 

 The PE firms know which kind of practice they are looking at within about thirty minutes of due diligence. So does the physician who owns it. Be Phenomenal, Dr. Vikram Raya

Michigan hospitals sue CVS for $95M over alleged drug savings scheme

Michigan hospitals say CVS improperly kept $95M in drug savings scheme

Michigan hospitals sue CVS for $95M over alleged drug savings scheme

The System is Undeniably Broken

 

‘The system is undeniably broken’:    

More insurers sue CMS over Medicare Advantage stars.   SCAN Health Plan and Alignment Healthcare both filed lawsuits against the CMS last week after regulators refused to recalculate industry-wide MA scores using the same methodology as for Clover Health.

Doctor pay to drop in 2027 under proposed Medicare pay rule Physician groups said the sweeping rule is a double-edged sword, given that it includes an unwelcome fee cut but positive changes to Medicare’s value-based and quality payment programs. Behind the Outcomes Advances in medicine have shifted oncology care beyond the traditional one-size-fits-all model of chemotherapy and radiation managed in the clinic. Patients are increasingly navigating more complex treatment regimens, often at home, while making care decisions outside of doctor visits. HHS watchdog says it’s targeting Medicaid, Medicare Advantage fraud

The HHS watchdog unit said it had kicked over 1,200 people and entities off federal programs as the Trump administration ratchets up oversight into what it says is rampant healthcare fraud.

Health systems charged for MyChart messages. The inbox kept growing anyway

When hospitals and health systems started charging patients for MyChart messages amid the pandemic, the reasoning was straightforward: Give clinicians a way to be compensated for the growing volume of medical advice flowing through patient portals, and perhaps slow that traffic down in the process.

Years later, health systems that adopted the practice say the second half of that bet hasn’t panned out — though nearly all say they’d do it again anyway.

Cleveland Clinic launched its MyChart Medical Management initiative in November 2022. Like most systems that bill for portal messages, it charges only for messages that require new medical evaluation or treatment decision-making, not for routine communications such as prescription refills or follow-up questions.

Message volume dipped the following month briefly, then resumed climbing: up 5% in 2023, 15.94% in 2024 and 18.56% in 2025, according to Sarah Hatchett, senior vice president and CIO.

“We are not changing patients’ behavior around messaging,” Ms. Hatchett said. “I think [the program] is valuable because it supports an alternative care pathway for patients while enabling providers to be reimbursed for care delivered through messaging.”

Houston Methodist has processed more than 53,000 billed messages since it began charging for certain portal communications in 2022. But the program was never designed as a standalone fix for inbox volume, said Aroub Khleif, PhD, senior director of innovation, access, billing and ambulatory clinical systems.

“We have not observed a significant change in overall message volume,” Dr. Khleif said. The benefit, she said, has been helping patients “better understand when portal messaging is appropriate and when a virtual or in-person visit may be the best option.”

At Winston-Salem, N.C.-based Novant Health, MyChart enrollment has grown 37% since the policy took effect, with overall messaging volume rising 5% year over year, according to a system spokesperson.

Seattle-based UW Medicine has seen a similar pattern. Crystal Wong, MD, a family medicine physician and associate medical director at UW Medicine Primary Care, said billing has not meaningfully changed inbox volumes, and the system hasn’t seen evidence that patients are rewording messages to avoid a charge.

The pattern lines up with limited published research on the subject. A study of San Francisco-based UCSF Health’s e-visit billing found only a 2% decline in average weekly messages after the system began charging in 2021. A separate study, also published in 2024, concluded that billing for portal messages has become more of an ongoing revenue stream for health systems than a tool for easing inbox burden.

Not every system that considered billing adopted it. Christopher Sharp, MD, chief medical information officer at Stanford Health Care in Palo Alto, Calif., said the system decided against charging for messages after watching how the policy played out elsewhere.

“We have been happy with this approach based on what we are seeing from others’ published experience to date,” Dr. Sharp said.

At Ann & Robert H. Lurie Children’s Hospital of Chicago, the goal was to create a clear pathway for clinical interactions that are better categorized as e-visits, alongside phone, video and in-person care. “As MyChart adoption has grown, messaging volume has continued to increase, so billing alone has not eliminated In Basket burden,” a Lurie Children’s spokesperson said.

None of the health systems that bill for messages reported an increase in patient complaints or help desk calls tied to the policy, and none said patients appeared to be rewording messages to avoid charges. Dr. Wong said UW Medicine would implement the policy again, though she said she would want more workflow readiness from ambulatory leadership before rolling it out a second time.

For Cleveland Clinic, the response to rising volume hasn’t been more billing. It’s been a separate set of inbox management projects, including improved message triage, prioritization tools and AI-drafted responses for clinicians to review. Ms. Hatchett said those efforts, not the billing policy itself, are where the health system expects its next real reduction in clinician burden.

The reason given for messaging is to increase patient access.  The actual fact is it is designed to decrease physician workload.  Messages actually increase physician loads because there is no decrease in their face-to-face patient encounters

Health systems charged for MyChart messages. The inbox kept growing anyway

The UK’s Long COVID Triple Treatment Trial (Not Surprisingly) Bombs

 

The UK’s Long COVID Triple Treatment Trial (Not Surprisingly) Bombs

Finally, another blog! The UK's big shot at uncovering treatments for long COVID failed dismally, as all three drugs/drug combos failed. This extends a rather unsettling streak of at least a dozen large long COVID treatment trials that have gone belly up. A closer look at the UK trial left one asking, however, if it ever really had much chance of succeeding. Similarly, an overview of the large long COVID trials done so far, makes one wonder if we could have ever expected much from them. The good news is that the long COVID field is learning, and the newer trials feature better options, are more targeted, more interested in uncovering subsets and in exploring mechanisms. In short, we can expect more of them. Check it out https://www.healthrising.org/blog/2026/07/23/uk-triple-treatment-long-covid-trial/

U.S. Medicine Use Trends 2026

 

Summary

The U.S. healthcare system is undergoing a significant transformation, shaped by shifting patterns in medicine use, evolving patient cost burdens, changing benefit designs, and rising spending driven by innovation. At the same time, structural barriers in access and affordability continue to present persistent challenges for patients, often leading to patients who may need medicines the most not receiving them. Together, these dynamics define a market that is expanding in complexity while also signaling important opportunities for system-level improvements. As discussions continue around access and affordability, policymakers, payers, and manufacturers have an opportunity to implement meaningful change to ensure the sustainability of the U.S. healthcare system and that patients are able to benefit from the full potential of medical advances.

Areas of focus in this year’s report range from looking at how medicine usage patterns have shifted, to the impact of out-of-pocket costs and benefit designs on patients, to the complex nature of drug pricing. Evolving trends in 2025 and recent policies have driven significant revisions to the outlook, and in this report, the drivers of change in medicine spending over the next five years are deconstructed to enable a better understanding. This examination includes the impact of novel obesity and diabetes medicines and the uptake of other innovative brands that are driving medicine spending.

Health Train Express reports on the IQVIA Institute symposia (online) on July 15,2026.

The complete report can be ACCESSED Here.  (full disclosure, )

Key Findings

Medicine use has increased:

Total prescription medicine use increased 1.5%, reaching 210 billion days of therapy in 2025

Vaccinations have had mixed trends, with seasonal vaccines seeing significant declines in the latest season, while many routine vaccines increased in 2025

Some patients see out-of-pocket cost reductions:

Patient out-of-pocket costs reached a record $110Bn in 2025, increasing by $6Bn

Implementation of the Medicare Part D out-of-pocket cap reduced overall spending by Medicare beneficiaries, offset by increases in other pay types driven by GIP/GLP-1s

Patients continue to see barriers to medicine access:

Nearly two-thirds of prescriptions for newly launched drugs go unfilled in the first year on the market, and limited coverage persists for several years

Spending on medicines has accelerated:

The U.S. market at net prices grew 10.6% in 2025 and an average of 9.3% annually over the last five years

GIP/GLP-1 agonists and COVID-19 medicines have had significant impacts on spending growth since 2020

Growth will slow through 2030:

U.S. medicine spending at net prices is forecast to grow 4.5 to 7.5% through 2030, while 6 to 9% at list prices

Pricing pressures and patent expiries will slow growth through 2030 offset by continued uptake of innovative therapies

Other Findings

The use of prescription medicines in the U.S. — based on defined daily doses — has grown 13% in the last five years to 210 billion days of therapy across both retail and non‑retail settings, although growth slowed beginning in 2024.

Retail drugs currently represent 84% of medicine use in the U.S., with only 16% in non‑retail settings, and non‑retail growth exceeded retail growth in 2025.

The use of prescription drugs dispensed from retail pharmacies has continued to grow at an average annual rate of 2.4% over the last five years, with much slower growth in 2024 and 2025, reducing total market growth.

Out‑of‑pocket costs rose in aggregate for commercially insured patients, Medicaid beneficiaries, and those who paid cash, while Medicare out‑of‑pocket costs declined, largely driven by the Medicare Part D out‑of‑pocket cap implemented in 2025.

Commercial insurance out‑of‑pocket costs, which account for 52% of total patient out‑of‑pocket costs, rose 5% in aggregate in 2025 and 37% over five years due to increased volume and a shift towards higher‑cost prescriptions.

Medicare out‑of‑pocket costs declined by $638 million (2.2%) in aggregate in 2025 following the implementation of the Medicare Part D out‑of‑pocket cap; however, costs remain more than $5.3 billion (23%) higher than in 2020, driven by increased volume and shifts in prescription mix.

Between 2020 and 2024, 99 novel medicines were launched in retail and mail channels in the U.S., often providing benefits over standard of care or addressing unmet needs. For these medicines, 7 million new prescriptions were written in the first year of availability, with 64% related to RSV vaccines alone.

On average, 35% of these prescriptions were filled, while 65% went unfilled, including an average of 49% rejected by payers and 17% abandoned by patients after payer approval, likely due to high out‑of‑pocket costs.

During the first four years a new medicine is on the market, fill rates improve; however, by year four, more than half of new prescriptions still go unfilled, significantly higher than the 29% unfilled rate across all brands and branded generics.

Net medicine spending increased by $58 billion (10.6%) in aggregate, rising from $548 billion in 2024 to $606 billion in 2025, with most growth driven by protected brands outside GIP/GLP‑1 agonists and COVID‑19 vaccines and therapeutics.

GIP/GLP‑1 agonists across diabetes and obesity contributed $14 billion in growth, with $9.6 billion concentrated in products approved for obesity and related comorbidities.

COVID‑19 vaccines and therapeutics, which contributed to spending growth in 2024, declined by $4 billion in 2025.

Other evolving issues include artificial intelligence, pharmacy benefit managers, and authorization procedures.

Total net spending on medicines in 2030 is expected to increase by $200 billion compared with 2025, as volume growth and innovation adoption are partly offset by lower‑price drivers such as patent expiries and policy effects.

Over the next five years, medicine spending is projected to grow between 6–9% on a list‑price basis and 4.5–7.5% after discounts, rebates, and other price concessions.

Growth will be driven by the adoption of newly launched innovative products, with an average of 50–55 new medicines expected to launch annually over the next five years, including therapies in oncology, immunology, and other specialty areas, as well as more traditional treatments in diabetes, obesity, and neurology.

Research Brief | U.S. Medicine Use Trends 2026

A concise overview of the latest trends in U.S. medicine use, spending, and patient access in 2025. This video highlights continued growth in prescription use, the impact of innovative therapies such as GIP/GLP-1 agonists, and shifting dynamics across therapy areas and care settings. It also examines persistent affordability and access challenges, including rising out-of-pocket costs, payer restrictions, and evolving insurance design.

Author's Addendum:

Artificial intelligence (LLM) has been touted for the past several years. Although great things are predicted for its use in healthcare, the ultimate outcome is cloudy.

There are thousands of models. Many of the current LLM generation are expensive, and each use requires tokens.

AI model costs vary widely depending on whether you are paying for an end-user subscription or API usage (paying per million tokens). 

1. Consumer Subscriptions

Most flagship platforms (e.g., ChatGPT Plus, Claude Pro, Perplexity Pro) share a standard rate of $20/month. Premium models and creative platforms (e.g., Midjourney, Google AI Ultra) range from $30 to $250/month, depending on image limits and advanced reasoning access. 

2. API Usage (Pay-per-Token)

For developers and businesses, costs scale with token usage (text chunks). Output tokens typically cost 3 to 8 times more than input tokens: 

Budget/Mini Models: (e.g., GPT-4o Mini, DeepSeek V4 Flash, Gemini 2.5 Flash). Rates average $0.15 to $1.00 per million tokens. Ideal for high-volume, simple tasks. 

Standard Tier: (e.g., Claude 3.5 Sonnet, GPT-5 series). Rates range from $3 to $15 per million tokens. These offer the best balance of reasoning and cost. 

Premium/Reasoning Tier: (e.g., Claude Opus, o1 Pro, Gemini 2.5 Pro). Rates can exceed $20 to $600+ per million tokens. Reserved for highly complex coding or research. 

3. Open-Source vs. Proprietary

For large-scale enterprise needs, open-weight models (e.g., Llama 3, Muse Spark) are free to use if you host them yourself, though they require paying for cloud infrastructure like AWS or specialized GPU servers.