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The article reports that Health law is slow-moving accretive, but it also shapes the landscape of health care delivery in powerful ways. Since implementation of the law requires democratic deliberation, administrative oversight, and judicial enforcement, health law is often a lagging indicator of the norms of health care practice.

The article presents a reprint of the article "Prescription Drug Coupons: No Such Thing as a Free Lunch," by Joseph S. Ross and colleagues, posted at NEJM.org on August 28, 2013. The article analyzes the effect of drug coupons on health care costs in the U.S. The study involving coupons from the online drug coupon repository www.internetdrugcoupons.com shows that median monthly manufacturer subsidy was 60 dollars. It asserts that coupons cannot offset higher long-term costs due to time limits.

The article discusses a class lawsuit wherein physicians alleged that their patients' insurance companies had schemed to restrain compensation for the physicians' services. The case has revealed issues surrounding the managed-care revolution. Physicians are charged with forcing medical costs to rise. Managed-care organizations are charged with systematically hindering and deferring payment for legitimate services to improve their final statements. The insurers argued that varied billing practices among the insurers and the varying contracts each had with providers made it improper to integrate the physicians into a single class.

The authors discuss the transparency legislation on medication costs in U.S. Topics include the view of the policymakers and the opponents of the transparency bill, requirement for pharmaceutical companies to disclose research and development costs, and drug prices. They also mentioned factors that could limit the efficacy of state initiatives.

The article discusses the access to injectable generic drugs, with focus on bacille Calmette-Guérin for bladder cancer. It notes the prospect of a sustained shortage or substantial price increase after a BCG manufacturer announces in November 2016 to exit the market in mid-2017. It illustrates the price increase of mitomycin, thiotepa, and valrubicin during the BCG shortage beginning in 2014. Also noted is payment reforms which could further stabilize the generic injectable agents market.

The authors discuss the challenges and developments regarding follow-on biologics. The authors agree about the major advances of biologics in treating rheumatologic diseases and cancers while forecasts on their use and costs are expected to rise sharply. Also discussed are approval of the U.S. Food and Drug Administration (FDA) for filgrastim-sndz (Zarxio) from Sandoz, the 1984 Hatch-Waxman Act and other follow-on biologics including versions of epoetin alfa, infliximab and pegfilgrastim.