Share of U.S. commercial claims spend that was shoppable in 2021

The source adds the following:

*"For this analysis, we define "shoppable" care as non-emergency medical care for which a patient can make a choice of physician, health system, or care setting (such as facility-based or at-home care). We also consider retail pharmacy spend on drugs for which therapeutic equivalents are available."

¹Includes all care billed alongside an ER claim, including ancillary expenses (e.g., labs and imaging) associated with an ER visit and hospital admissions originating in the ER.
²Spend on drugs for which no therapeutically equivalent alternatives exist and, as a result, for which member-driven shopping is limited.
³Includes spend on drugs for which therapeutically equivalent, lower-cost drugs (e.g., generics or biosimilars) are available.
⁴Includes care that members can choose to schedule across several sites of care (e.g. facility-based or at-home infusion therapy).
⁵Includes spend on scheduled care for which members can shop within a given site of care (e.g., physician office visits, labor and delivery).