- Kaiser Health News Original Stories 3
- Obamacare Premiums In California May Rise 8 Percent Next Year, State Predicts
- Questions Emerge About The Impact Of State Autism Insurance Mandates
- Sounds Like A Good Idea? Selling Insurance Across State Lines
- Political Cartoon: 'Cast An Eye'
- Quality 1
- NIH To Overhaul Leadership At Flagship Hospital Following Report On Patient Safety Failures
- Public Health And Education 4
- Opioid Epidemic Becomes Key Talking Point For Vulnerable Senate Candidates In Hard-Hit States
- Patients Saved By Naloxone Too Often Succumbing Quickly To Another Overdose
- Experimental Texas Clinics Treat Emotional And Physical Trauma Of Foster Kids
- Not Just Kids Being Kids: Panel Warns Of Serious Public Health Consequences Of Bullying
- State Watch 2
- Judge's Ruling Against FTC In Hospital Merger Case An 'Unexpected Twist'
- State Highlights: In Iowa, More Parents Seek Vaccination Exemptions; Tentative Conn. Budget Cuts Some Mental Health, Substance Abuse Treatment Grants
- Prescription Drug Watch 4
- Cigna To Get Price Discounts If Drugs Don't Perform As Well As Expected
- Study: Physicians' Failure To Recommend Generic Drugs Costs Americans $73 Billion
- CEO: Biotech Is About Innovation Not 'Repricing Drugs From The 1950s To Make A Profit'
- Perspectives On Drug Costs: To Lower Prices, Consumers Need To Walk Away
From Kaiser Health News - Latest Stories:
The projected increase in premiums is expected to draw national attention in an election year -- especially from foes of the Affordable Care Act. (Chad Terhune, 5/11)
New research finds that the impact of these mandates varies because of differences in states’ coverage requirements and the availability of treatment options. (Shefali Luthra, 5/11)
Republicans have long touted a proposal to allow insurers to sell across state lines as a way to help keep coverage costs down. But there are some significant obstacles to making such a system work, as this video points out. (Julie Rovner and Francis Ying, 5/11)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Cast An Eye'" by Milt Priggee.
Here's today's health policy haiku:
WAR ON DRUGS
Opiods and jail:
If you cannot do the time
Do not do the line.
- Beau Carter
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
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Summaries Of The News:
Among the issues officials are still trying to iron out are efforts to cut drug prices and improve primary care delivery. Nonetheless, Democrats are nervous that insurance premiums coming out in October could have an impact on the election. And industry and health experts are unsure what effect the proposed mergers in the insurance industry would have on the market.
As Time Runs Out, The Obama Administration Races To Reshape Health Care
As the clock ticks toward Jan. 20, 2017, the Obama administration is racing to burnish its health care legacy, introducing major new initiatives that will take full effect just weeks before the president leaves office. The ranks of the uninsured have dropped dramatically since the passage of the Affordable Care Act six years ago. But administration officials are now hustling to use other parts of the law to reshape how health care itself is delivered across the United States. They’re trying to tackle the biggest health care issue of the day — drug prices — and setting ambitious goals for revamping how primary care is provided. They have also undertaken significant new efforts when it comes to paying for surgeries and preventing disease. (Scott, 5/10)
Democrats Prepare To Win The Health Care Narrative
No one in Washington is going to be shocked if insurers request double-digit increases in premiums on exchanges. That’s partially because ahead of Wednesday’s filing deadline, Democrats are making a lot of efforts to control the narrative. Their talking point plan will take them through the November election, which coincidentally occurs right after final insurance rates will be posted for 2017. Even if there are large increases at that point, Democrats plan to argue they are still the party to go with on health care issues. They are up against heavy messaging from the right opposing the health care law. (Owens, 5/10)
How Will Health Insurer Mergers Hit Obamacare?
Investors got an update last week on the progress of two giant health insurer mergers that, if regulators approve, will shrink the number of major insurers in the U.S. from five to three. On Friday Cigna (CI), the nation's fourth-largest health insurance company, which agreed to be acquired by Anthem (ANTM), the No. 2 health insurer, announced that the deal, scheduled to close by the end of 2016, may be delayed into 2017. (5/11)
Meanwhile, in California —
Obamacare Premiums In California May Rise 8% Next Year, State Predicts
California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases. The projected rate increase in California, included in the exchange’s proposed annual budget, comes amid growing nationwide concern about insurers seeking double-digit premium hikes in the health law’s insurance marketplaces. Any increases in California, a closely watched state in the health law rollout, are sure to draw intense scrutiny during a presidential election. Republicans are quick to seize on rate hikes as further proof that President Obama’s signature law isn’t doing enough to hold down health care costs for the average consumer. (Terhune, 5/11)
As Hillary Clinton looks to wrap up the Democratic presidential primary, she is floating the idea of a Medicare buy-in option for those in their 50s.
The New York Times:
Hillary Clinton Takes A Step To The Left On Health Care
For months during the Democratic presidential nominating contest, Hillary Clinton has resisted calls from Senator Bernie Sanders to back a single-payer health system, arguing that the fight for government-run health care was a wrenching legislative battle that had already been lost. But as she tries to clinch the nomination, Mrs. Clinton is moving to the left on health care and this week took a significant step in her opponent’s direction, suggesting she would like to give people the option to buy into Medicare. (Rappeport and Sanger-Katz, 5/10)
The Wall Street Journal:
Hillary Clinton Says She’s Weighing Medicare For 50-Year-Olds
Hillary Clinton has spent months berating rival Bernie Sanders for proposing a single-payer, government-run health-care plan, sticking to her more modest proposals aimed at lowering costs and saying she has no interest in another nasty legislative battle over health care. Now, as she tries to close out her primary contest against the Vermont senator, she is floating a new idea: allowing people as young as 50 to buy into Medicare, the health plan that serves those ages 65 and up. (Meckler, 5/10)
Clinton Suggests Letting People In Their 50s Buy Into Medicare
Democratic presidential candidate Hillary Clinton unexpectedly floated the idea Monday of letting people in their 50s buy into Medicare as an alternative to her previous proposal to let states establish public health insurance plans to compete with private insurers. (Meyer, 5/10)
In other news, KHN has the first in a video series about candidates' ideas that sound good in theory, but might not work —
Kaiser Health News:
Sounds Like A Good Idea? Selling Insurance Across State Lines
Presidential candidates like to propose solutions to long-standing problems. Health care is no exception. But there’s a reason some problems are “long-standing.” They may have no easy solution. Or the solution is not politically feasible. Or there’s a solution that sounds good on the campaign trail but is not likely to actually work.In this first of a series of videos of health policy promises that “sound like a good idea,” Julie Rovner explores why increasing competition in health insurance by allowing sales of policies across state lines might not be such a good idea after all. (5/11)
The plan, which affects drugs such as cancer treatments given in outpatient settings, has drawn more than 1,300 comments.
Tension Mounts Over Medicare's Bid To Remove Profit Motive From Outpatient Drugs
The comment period closed this week on the Obama administration's bold proposal to rewire how Medicare pays for outpatient drugs, and the CMS is under intense pressure to scrap it. Providers across the board, not just those projected to receive the deepest cuts under the proposal, have misgivings about the initiative. That's because it's hard to truly know the implications until its second phase kicks in, said Thomas Barker, an attorney and co-chair of the health practice at Foley Hoag. “There is skepticism about CMS's projections because it's too soon to see how this will shake out,” said Barker, former acting general counsel at HHS. (Dickson, 5/10)
Rep. Brett Guthrie, R-Ky., says rising costs will force states and the federal government to look at the issue soon.
House GOP Eyes Medicaid Reforms In 2017, Depending On November Outcomes
A House Republican task force is weighing what types of Medicaid reforms could be possible in 2017, though the November election will play a major role in what can be done, its leader said Tuesday. Reauthorizing the Children’s Health Insurance Program and some Medicare extenders could provide opportunities for some additional reforms to the Medicaid program, Rep. Brett Guthrie (R-Ky.) said Tuesday at a Mercatus Center forum about policy reforms. But he conceded that which political party controls the Senate and the White House, and whether Republicans retain their House majority, will dictate how much can be done. (McIntire, 5/10)
Meanwhile, in North Carolina --
Democrat-Sponsored Medicaid Expansion Bill Submitted In House
A bill submitted Tuesday in the N.C. House would expand the state Medicaid program to cover an additional 500,000 North Carolinians. However, because key Republican legislative leaders have said expanding the program is a non-starter, the chances are slim that the bill will emerge from a House committee during this short session. (Craver, 5/10)
The cost of private nursing home rooms has increase nearly 19 percent since 2011, a new study finds. It's part of a trend of Americans paying more for long-term care.
The Associated Press:
Study: Costs For Most Long-Term Care Keep Climbing
Long-term care grew more expensive again this year, with the cost of the priciest option, a private nursing home room, edging closer to $100,000 annually, according to a survey from Genworth Financial. Americans also are paying more for other care options like home health aides and assisted living communities, while adult day care costs fell slightly compared to 2015, Genworth reported in a study released Tuesday. (5/10)
National Institutes of Health Director Francis Collins is recruiting for three new positions: a chief executive, a chief operating officer and a chief medical officer.
The Washington Post:
Patient Safety Issues Prompt Leadership Shake-Up At NIH Hospital
The National Institutes of Health is overhauling the leadership of its flagship hospital after an independent review concluded that patient safety had become “subservient to research demands” on the agency’s sprawling Bethesda campus. The shake-up at the NIH Clinical Center, which was announced to staff Tuesday, represents the most significant restructuring at the nation’s premier biomedical research institution in more than half a century. (Sun, 5/10)
The Wall Street Journal:
NIH Shakes Up Leadership At Its Research Hospital
The National Institutes of Health is overhauling the leadership of its renowned research hospital in the wake of what it termed “quality and safety gaps” in the production of sterile drugs used in clinical studies there. The federal agency, based in Bethesda, Md., said it would name a new physician chief executive to run the hospital, which is known as the NIH Clinical Center. This new official will report to a newly selected hospital board. The clinical center treats patients from around the U.S. who have rare and often fatal diseases. (Burton, 5/10)
NIH Shaking Up Hospital Leadership To Fix Patient Safety Problems
[NIH Director Dr. Francis Collins] said the months-long probe into the hospital’s practices — which found systemic problems with patient safety — marked “the darkest moments” of his seven years at the NIH, according to the [Washington] Post. (Ferris, 5/10)
Experts say the problem will get worse before it gets better.
Insiders: Health Care Is 'Being Held Hostage To Hackers'
A stolen credit card is worth about $2 on the black market. A stolen medical record? It's worth $25 or more — just one reason why hackers are stepping up their pursuit of privileged health care information, and why there's every sign the problem will get worse before it gets better. That's according to health care IT leaders and thinkers who participated in POLITICO's health IT advisory forum this week. The forum was convened ahead of POLITICO's Tuesday briefing on cybersecurity. (Diamond, 5/10)
However, sharing information online can be extremely helpful for some families —
Through Social Media, Family Connects To Rare Diagnosis – And Hope
If you are suffering from an illness fewer than a dozen people in the world are known to have, getting a proper diagnosis can start to feel like a hunt for something that doesn’t exist. That’s the position one family found themselves in before they turned to social media in search of an answer, managing to discover in one day an answer that had eluded doctors for years. (Snow, 5/10)
Republican senators such as Kelly Ayotte of New Hampshire, Rob Portman of Ohio and Pat Toomey of Pennsylvania have all run ads or talked about their experience in combating the issue. In other news, the House overwhelmingly passes the first three pieces of an 18-bill opioid package slated for consideration this week, and New York Gov. Andrew Cuomo appoints a task force to address the crisis.
Vulnerable GOP Senate Incumbents Talk Up Their Record Fighting Opioid Abuse
The opioid epidemic is playing a starring role in tight Senate races in Ohio, New Hampshire and Pennsylvania — communities hard-hit by addiction, where Republican incumbents are fighting to retain their seats in an anti-establishment year. With the control of the Senate at stake, the opioid battle has morphed into a large enough political issue that the Karl Rove-backed group, One Nation, weighed in by spending $1.12 million in March on an ad touting New Hampshire Sen. Kelly Ayotte’s role in passing bipartisan Senate legislation, known as the Comprehensive Addiction and Recovery Act. She’s in a tight contest with Gov. Maggie Hassan, who has her own record on opioid legislation to run on. (Cook, 5/10)
House Takes First Steps On Opioids Bill
The House on Tuesday easily cleared three bills aimed at reducing opioid addiction, the first of more than a dozen bipartisan bills up for consideration this week. Lawmakers voted overwhelmingly, 410-1, to approve legislation by House Majority Leader Kevin McCarthy (R-Calif.) and Minority Whip Steny Hoyer (D-Md.) which calls for a broad, five-year study into federal grants dedicated to preventing opioid abuse. Two other bills passed by voice vote earlier Tuesday. (Ferris, 5/10)
The Associated Press:
Cuomo Names Task Force To Address Ongoing Heroin Problem
Gov. Andrew Cuomo has appointed a task force aimed at ending what he called a crisis of heroin and opioid addiction continuing to plague families and communities in New York. The group is chaired by Lt. Gov. Kathy Hochul and Arlene Gonzalez-Sanchez, commissioner of the state Office of Alcoholism and Substance Abuse Services. The other 21 members include representatives of health care, drug treatment, advocacy, law enforcement and education. (5/10)
If Prince died from opioids, he follows a dangerous pattern that is a growing frustration for first responders: saving a life only to lose it shortly after to another overdose. Meanwhile, a warrant reveals that Prince was seeing a doctor in the month before his death.
The Wall Street Journal:
Prince’s Death Spotlights Overdose Antidote Dilemma
Prince’s death last month from a possible opioid overdose highlights the challenge for health officials using the overdose-reversal medication naloxone: getting people saved from overdoses into addiction treatment. Six days before he died, the 57-year-old musician overdosed on the painkiller Percocet while on a flight, forcing the plane to make an emergency landing in Moline, Ill., a law-enforcement official said. Hospital staff revived him with a dose of naloxone, also known as Narcan. ... Across the country, public health officials are embracing naloxone as a key life-saving tool in the opioid crisis. (Kamp and Campo-Flores, 5/11)
The New York Times:
Prince’s Doctor Arrived With Test Results Only To Find Him Dead
During his two visits, Dr. Schulenberg performed tests and prescribed medication for an undisclosed ailment, the affidavit said. Dr. Schulenberg said he had arrived at Prince’s compound to turn over the test results. The warrant sought medical records from the North Memorial Medical Center, which is part of the health system where Dr. Schulenberg used to work. Authorities have not released a cause of death, and have said that a determination might be weeks away. But Dr. Schulenberg’s visit makes clear that Prince was actively receiving medical treatment before his death on April 21. (Eldred and Eligon, 5/10)
The Associated Press:
Warrant: Minnesota Doctor Saw Prince, Prescribed Drugs
A Minnesota doctor saw Prince twice in the month before his death — including the day before he died — and prescribed him medication, according to contents of a search warrant that were revealed as authorities returned to the musician's suburban Minneapolis estate as part of their investigation into what killed him. Dr. Michael Todd Schulenberg treated Prince on April 7 and April 20, and he prescribed medications for the musician, according to the warrant, which was obtained Tuesday by at least two news outlets before authorities moved to ensure it was sealed. (5/11)
The models provide mental health services at every point of a child’s medical treatment, as well as guidance for caregivers. Meanwhile in Chicago, telehealth startup Regroup Therapy raises $1.8 million for virtual mental health services.
The Texas Tribune:
For Foster Kids, A Push To Make Medical Care Treat Psychological Pain
On most mornings these days, Bari Greenwood’s 4-year-old daughter wakes up in her bunk bed, gets dressed by herself and eagerly waits to be taken to daycare. For most 4-year-olds, these moments in a daily routine would hardly be worth mentioning. But Greenwood recounts them with the wide smile of a proud mother, for each is a hard-fought victory and a sign of remarkable progress. (Walters, 5/10)
The Chicago Tribune:
Chicago Startup Raises $1.8M For Virtual Mental Health Consultations
Chicago-based telehealth startup Regroup Therapy, which provides virtual mental health consultations to treat depression and a wide range of other issues, has raised more than $1.8 million in funding. (Graham, 5/10)
Bullies and their victims can suffer short- and long-term consequences, including anxiety, depression and a higher risk of suicide for those who are bullied, experts say.
Tribune Wire Service:
Report: Bullying Is A Serious Public Health Problem
Bullying is a "serious public health problem," and should no longer be dismissed as merely a matter of kids being kids, a leading panel of experts warned Tuesday. "Its prevalence perpetuates its normalization. But bullying is not a normal part of childhood," the National Academies of Sciences, Engineering, and Medicine said. (5/10)
In other public health news, Sen. Marco Rubio, R-Fla., speaks out again about Zika funding, and a new study reevaluates the death risk associated with a higher BMI —
The Associated Press:
Rubio Says Congress Needs To Approve Zika Virus Funding
Sen. Marco Rubio is pressing his congressional colleagues to approve nearly $2 billion to fight the Zika virus. In an interview Tuesday with CNN's Jake Tapper, the Florida senator said he's disturbed that members of his own party are standing in the way of fully funding a response to what's an emerging public health crisis. (Bustos, 5/10)
Does Putting On A Few Pounds Help You Cheat Death?
A body mass index under 25 is deemed normal and healthy, and a higher BMI that's "overweight" or "obese" is not. But that might be changing, at least when it comes to risk of death. The body mass index, or BMI, associated with the lowest risk of death has increased since the 1970s, a study finds, from 23.7, in the "normal" weight category, to 27, which is deemed "overweight." That means a person who is 5-foot-8 could weigh 180 pounds and be in that epidemiological sweet spot, according to the NIH's online BMI calculator. The results were published Tuesday in JAMA, the journal of the American Medical Association. (Shute, 5/10)
Providers say there is no science laying out how to administer anesthesia or painkillers to a fetus, as the state law now requires for any abortion at 20 weeks or later. In other reproductive health news, a Maryland law makes birth control less expensive and the national economy feels the pinch from lower birth rates.
The Associated Press:
Utah's First-In-Nation Fetal Pain Law Perplexes Doctors
Utah's first-in-the-nation requirement that fetuses receive anesthesia or painkillers before some abortions takes effect Tuesday, but doctors say it's unnecessary and impossible to comply with. The law requires pain relief for a fetus before any abortion at 20 weeks of gestation or later, based on the disputed premise that a fetus can feel pain at that stage. Doctors say such pain relief is futile, and there is no science or medicine laying out how they're supposed to administer it. (5/10)
The Washington Post:
Hogan Signs Bill To Make Birth Control Cheaper
Maryland Gov. Larry Hogan (R) signed 196 bills into law on Tuesday, including one that advocates say will provide “the most comprehensive insurance coverage for contraception in the country.” Many states have passed laws addressing some aspects of the bill that Maryland lawmakers approved, Planned Parenthood spokeswoman Heather Ford said. But no other state has a law that includes all the provisions in Maryland’s “Contraceptive Equity Act,” which prohibits insurers from charging co-payments for contraceptive drugs, procedures and devices approved by the federal government. (Wiggins, 5/10)
The Wall Street Journal:
Baby Lull Promises Growing Pains For Economy
The U.S. is experiencing a baby lull that looks set to last for years, a shift demographers say will likely ripple through the U.S. economy and have an impact on everything from maternity wards to federal social programs. U.S. births have edged up modestly since 2013, a trend likely to continue when last year’s official federal figures are scheduled to come out in June. That has stemmed a sharp drop in child bearing that started with the onset of the recession in 2007. ... The leveling-off in births is weighing on sales at children’s stores, prompting hospitals to rework their birth wards and putting pressure on builders of single-family homes, executives and economists say. (Adamy, 5/10)
However, speculation now surrounds whether the Federal Trade Commission will take the unusual tact of continuing its challenge to the proposed merger despite the federal judge's ruling. Meanwhile, in other hospital news, an Illinois state review board has approved the University of Chicago Medical Center's expansion plan, and a Georgia safety-net hospital is regrouping after Novant Health decided to back away from a possible partnership.
FTC May Not Take No For An Answer After Surprising Hospital Merger Defeat
A federal judge's unusual ruling Monday against the Federal Trade Commission might not be the last unexpected twist in the agency's case against a Pennsylvania hospital merger, experts say. (Schencker, 5/10)
The Associated Press:
Illinois Board Approves U Of Chicago Hospital Expansion
A state review board has approved a $269 million expansion proposal from the University of Chicago Medical Center that includes an adult trauma center. The Illinois Health Facilities and Services Review Board unanimously approved the plan Tuesday in Normal. (5/10)
Georgia Health News:
Collapse Of Novant Deal Leaves Memorial Health In A Quandary
The CEO of Memorial Health said Tuesday that the Savannah safety-net hospital system “has to do some regrouping’’ in the wake of Novant Health’s decision to back off a partnership. North Carolina-based Novant terminated negotiations Monday after months of talks, citing a conflict with the Chatham County Hospital Authority. (Miller, 5/10)
Outlets report on health news in Iowa, Connecticut, Colorado, Ohio, West Virginia, Virginia and Maryland.
The Des Moines Register:
More Iowans Are Seeking Vaccination Exemptions
The number of Iowa parents seeking religious exemptions to vaccination requirements continues to climb, despite efforts to dispel worries the shots cause health problems. (Leys, 5/10)
The Connecticut Mirror:
Nonpartisan Analysts: Tentative CT Budget Wipes Away Lots Of Red Ink
The final plan also calls for cutting grants for mental health and substance abuse treatment, but by less than Malloy sought. Still, these programs have been a frequent target of emergency cuts made by the governor over the past 18 months to close mid-year budget deficits. (Phaneuf and Levin Becker, 5/10)
The Denver Post:
Bill To Audit Colorado Nonprofits For Disabled Advances To Governor
A bill on its way to the governor's desk would require periodic audits of the nonprofit community boards that manage Medicaid and mill levy funds for Coloradans with disabilities. (5/10)
The Cincinnati Enquirer:
Who Runs The VA Here? UC, One Official Charges
Years of weak leadership at the Cincinnati VA Medical Center have allowed UC Health and the University of Cincinnati College of Medicine to muscle in on the management of the veterans' hospital, a career VA official says, wasting millions of taxpayer dollars and affecting health care for veterans in Greater Cincinnati. (Saker, 5/10)
The Associated Press:
More Heart Clinic Patients Notified About Hepatitis Risk
West Virginia health officials are notifying more patients at a heart clinic in Beckley who may have been exposed to hepatitis after four additional cases of hepatitis C were detected by the state Bureau of Public Health. (5/10)
The Associated Press:
Family Of Mentally Ill Man Who Died In Jail Files $60M Suit
The family of a mentally ill man who died in a Virginia jail cell after losing so much weight his heart stopped filed a $60 million wrongful death lawsuit Tuesday against several jail officials and health-care providers. (5/10)
The Columbus Dispatch:
Ohioans Largely Favor Legalizing Medical Marijuana, Poll Shows
Ohioans overwhelmingly favor legalizing medical marijuana but are still mixed on whether it should be OK to use recreationally, according to a poll released this morning. (Everhart, 5/11)
The Baltimore Sun:
Program Aims To Get Every Needy Student A Pair Of Glasses
Courtney Scott, a fourth-grader at Hampstead Hill Academy, didn't know she needed glasses until a couple of weeks ago. Baltimore City health officials estimate that 10,000 of 62,000 students from pre-K through eighth grade need glasses, but most don't get them. (Cohn, 5/10)
News outlets from across the country report on the pharmaceutical drug industry.
The Wall Street Journal:
Health Insurers Push To Tie Drug Prices To Outcomes
Health insurer Cigna Corp. will get extra price discounts from drugmakers if new cholesterol medications don’t help patients as much as expected, a significant step in a broader push to tie the cost of drugs to how well they work. Such “value-based” deals are becoming more common as rising costs spur customers to demand assurances they are getting what they pay for. U.S. prescription spending rose 12% to nearly $425 billion in 2015, following a 13% increase in 2014, according to research firm IMS Health. Cigna is set to announce on Wednesday that it is the first insurer to reach value-based contracts for an entire new class of cholesterol drugs: Praluent, which is co-marketed by Sanofi SA and Regeneron Pharmaceuticals Inc., and Amgen Inc.’s Repatha are the only two cholesterol-lowering drugs known as PCSK9 inhibitors currently on the U.S. market. (Loftus and Wilde Mathews, 5/11)
The Wall Street Journal:
U.S. Investigates Drugmaker Contracts With Pharmacy-Benefit Managers
Federal prosecutors are investigating drugmakers’ contracts with companies that manage prescription benefits in the U.S., the latest sign of government scrutiny of how drug companies and industry middlemen do business. The U.S. attorney’s office for the Southern District of New York has sent demands for information to at least three drug companies: Johnson & Johnson, Merck & Co. and Endo International PLC, according to recent company filings with the U.S. Securities and Exchange Commission. (Loftus, 5/10)
The Wall Street Journal:
From Endo To Allergan: The Sum Of Drug Pricing Fears
Generic drug investors can breathe a sigh of relief. Despite worries, not every company flunked its first-quarter earnings checkup. Generic pharmaceutical stocks sold off last week after Endo International shares plunged on lowered 2016 guidance. The reasons cited for the worsening outlook, including “greater than expected pricing erosion across the generics sector,” rattled investors in a number of stocks. This came after Perrigo cited similar reasons to cut guidance last month. And generic drug distributors had warned of lower prices back in January. But other first-quarter results this week suggest industry-wide fears might be overdone. Teva Pharmaceutical Industriesid Monday “nothing” about the pricing environment had changed since last fall. (Grant, 5/10)
Top Funds Said To Tell Pharma Leaders To Defend Drug Pricing
A group of major U.S. investors, spooked by the recent slump in biotech shares amid political bashing of drug prices, met with a lobbying group and executives last month to urge them to do a better job in defending their industry and take control of the conversation before lawmakers try to regulate prices. Representatives from Fidelity Investments, T. Rowe Price Group Inc. and Wellington Management Co. -- which all invest about a fifth or more of their U.S. stock holdings in health care -- were among those at the meeting, held at a Boston hotel, according to people familiar with the matter who asked not to be identified because the meeting wasn’t public. (Chen, 5/9)
A Failed Valeant Battlecry: ‘We’re Not Like Turing In Any Way, Shape Or Form’
Prior to purchasing a pair of important heart drugs used by hospitals, Valeant Pharmaceuticals closely studied the possibilities for large price hikes and the ability of the marketplace to sustain them, according to more than 800 pages of documents released during the weekend by a Senate committee. And to further justify its decision to jack up the prices after acquiring these medicines, Valeant relied on market research data showing most large hospital systems did not seem to react to large price hikes taken by the company that previously owned the medicines. (Silverman, 5/9)
The Daily Beast:
Future Pharmacies Will Never Run Out Of Drugs
If your pill had a passport, it might get more stamps than your own. To make the drugs you rely on, the ingredients may have been manufactured in China and India, then combined together in Germany, and pass through a half-dozen other countries before arriving at your local pharmacy. It’s really difficult to trace the path of any particular pill—even regulators struggle with this—but nearly all drugs are made in enormous batches, then divvied up and shipped around the world. (Ossola, 5/7)
The Columbus Dispatch:
Backers Push Lawmakers On Ballot Issue Regarding Drug Prices
Supporters of a prescription-drug price ballot issue are nudging state lawmakers to see if they intend to act on the proposal. Columbus attorney Donald McTigue sent a letter Monday to legislative leaders on behalf of the AIDS Healthcare Foundation, the California group backing the drug issue. "The General Assembly has taken no action on the proposed law in the more than three months since it was received," McTigue said in a letter to Ohio House Speaker Cliff Rosenberger, R-Clarksville, and Ohio Senate President Keith Faber, R-Celina. (Johnson, 5/9)
Keeping Drug Discounts Private Is Probably A Good Thing
Figuring out how rebates and discounts impact total drug spending is one of the biggest challenges to understanding prescription drug price trends. These deals between insurers and drugmakers often are private. Officials from both industry sectors think it should stay that way. (Owens, 5/5)
The new report shows reluctance of physicians to move away from brand-name drugs. Consumers paid nearly one-third of those additional costs through out-of-pocket payments.
What Generics? Americans Spent An Extra $73B For Brand-Name Meds
Doctors may be encouraged to prescribe lower-cost generics, but a new study found that Americans spent an extra $73 billion between 2010 and 2012 on pricier brand-name drugs because physicians failed to sufficiently recommend these copycat treatments to their patients. And consumers paid nearly one-third of those additional costs through out-of-pocket payments. Notably, the study found that the excess spending occurred when a generic version was not available for a specific brand-name drug, but a doctor could have prescribed a lower-cost, copycat for a similar brand-name medicine. For example, instead of prescribing a lower-cost generic for a brand-name cholesterol pill, a doctor might have prescribed a similar brand-name cholesterol medicine. (Silverman, 5/9)
Cutting Brand-Name Drug Use Could Save U.S. $73 Billion: Study
"We wanted to see how much patients and society as a whole could save through the use of therapeutic substitution, in terms of both overall and out-of-pocket expenses on brand drugs, when a generic drug in the same class with the same indication was available," said lead investigator Dr. Michael Johansen. He is a family medicine physician with the Ohio State University Wexner Medical Center, in Columbus. (Dallas, 5/10)
Prescribing Generic Drugs Could Have Saved $73 Billion
The new JAMA Internal Medicine study is among the latest to focus on reducing costs by curbing the over-prescription of brand-name drugs. Many clinicians have been reluctant to engage in the practice, especially when it comes to prescribing therapeutic substitutes, over fears the drugs could result in worse clinical outcomes for patients. The study also points to another clear incentive to prescribe pricier drugs. “Pharmaceutical companies frequently provide rebates to payers,” noted authors Dr. Michael Johansen of Ohio State University and Dr. Caroline Richardson of the University of Michigan. (Rice, 5/9)
The San Diego Union-Tribune:
Study: Expanding Generic Drug Use Could Save Billions
The most excess money was spent on statins to lower cholesterol, with an excess expenditure of $10.9 billion; and atypical antipsychotics for mental disorders, with a $9.9 billion excess. Proton pump inhibitors to reduce stomach acid incurred an extra expense of $6.12 billion; and selective serotonin reuptake inhibitors, for depression, $6.08 billion. ... Certain classes of drugs were omitted from the analysis, including some antibiotics and respiratory drugs and testosterone. Insulin was also omitted, because no generic form is available. (Fikes, 5/9)
Therapeutic Substitution Could Save Nearly 10% In Drug Costs
Therapeutic substitution, or swapping one drug for a generic or chemically different agent within the same class, could save the US healthcare system billions of dollars annually. And although a new survey shows physicians are warming up to generic drugs, some critics warn that the indiscriminate use of therapeutic substitution could come at the expense of patient health and safety. (Osterweil, 5/9)
Therapeutic Substitution Could Curb Skyrocketing Drug Costs
Patients prescribed and dispensed a brand-name drug instead of an equivalent generic version spent an estimated total of $24.6 billion in excess prescription drug costs between 2010 and 2012, a new study has uncovered. The study published in JAMA Internal Medicine sought to calculate the potential impact of therapeutic substitution—defined as when a brand-name drug is substituted for a generic within the same class but with different chemical compounds—on potential savings for both patients and the US health system. (Gilchrist, 5/9)
Alnylam Pharmaceuticals CEO John Maraganore and other executives and investors talk about their industry and the drug pricing debate.
No Stranger To Gambling, This Biotech CEO Is Going All-In On A First Drug Approval
Biotech is a risky business, where roughly 90 percent of grand ideas fall flat and billion-dollar failures are commonplace. So it’s fitting that the industry’s self-appointed spokesman is the blackjack-playing CEO of a fast-growing company, one about to find out whether its futuristic science can make an actual product. John Maraganore is unafraid of the spotlight. The 53-year-old head of Kendall Square’s Alnylam Pharmaceuticals is a regular on CNBC, appearing on camera in his characteristic designer glasses and colorful suits. Mostly he talks about his company’s efforts to develop gene-silencing drugs, but he doesn’t hesitate to defend the virtues — and condemn the sins — of his whole industry, even though his company has yet to win marketing approval for a single product. Last year, when Martin Shkreli’s Turing Pharmaceuticals raised the price of an old drug by more than 5,000 percent, Maraganore was one of the first biotech executives to castigate the move. (Garde, 5/5)
GlaxoSmithKline CEO On Why Drugs Cost So Much
GlaxoSmithKline is a British pharmaceutical company that's about the sixth largest in the industry. Sir Andrew Witty is the CEO. He's been with the company for 30 years and announced he would be retiring from the head post in 2017. Witty reflects on recent changes in industry and possible solutions. (Ryssdal, 5/10)
'Important Deals' On The Horizon For Gilead, New CEO Says
Gilead Sciences has said that it would only use its flush cash reserves for M&A if the right deal came along. Now, with a slowdown in the company’s hep C franchise and a new leader at the helm, it's getting more aggressive about its search. “It’s time for us to go out and do important deals,” CEO John Milligan told Bloomberg. “We need some other assets that can bolster our pipeline.” A new cancer product would be key, Milligan said, as Gilead looks to expand in cancer markets as well as liver diseases and inflammatory disorders. (Wasserman, 5/9)
Sarepta Investor: High Drug Prices Are A Good Thing
If you can't charge "hundreds of thousands" of dollars a year for drugs, there will be no drugs for orphan diseases, Joe Edelman, Perceptive Advisors CEO, told CNBC's "Fast Money: Halftime Report." "I think high drug prices are actually good," Edelman said Thursday. "And the reason they're good is, let's say you have a disease. I'll use an example of Alzheimer's. Very risky to develop a drug. You want the reward to be great. ... You're not going to spend a billion dollars and take all these risks to charge the typical $10,000 a year on a drug." Edelman's firm manages $1.3 billion in assets and was the best performing hedge fund last year, seeing a return of more than 51 percent. (Balakrishnan, 5/5)
A selection of opinions on drug costs from around the country.
Maybe We Are To Blame In Part For Rising Cancer Drug Prices
The prices of oral cancer drugs are rising. This will come as no surprise to anyone who has cancer or who knows someone who has it, but this excellent study documents that fact beyond a shadow of a doubt. Even after introducing a new cancer product at some price, the seller, protected by patents, increased the price by 5% a year on average. This is higher than price growth from economy wide inflation in the same period, while other medical prices also grew excessively, but not by as much, and total drug spending hardly grew at all. But cancer (and other “specialty” drugs) were the exception. Why did these prices increase at this pace? My visceral reaction, which I suspect is the same as yours, is to rail against “corporate greed,” something we have seen on display for even old drugs to a spectacular extent lately. (Mark V. Pauly, 5/9)
Big Drug Maker Presses For Money-Back Guarantee That Its Science Will Work
The next time you take a Merck medicine and it doesn’t work, don’t expect a refund. The drug maker doesn’t offer a money-back guarantee. But there are times, a high-ranking Merck official believes, when the company deserves to get its own money back. That’s when it licenses potential treatments from universities based on promising results from early clinical trials, and then can’t reproduce those results in subsequent experiments. (Ed Silverman, 5/10)
Meet The Middlemen Cutting Drug Prices
For all the uproar over U.S. drug pricing, you wouldn’t expect to hear that drug spending slowed for many last year. A big reason? An increasingly powerful group of medication middlemen called pharmacy benefit managers (PBMs), which negotiate drug prices on behalf of insurers, employers and the government.But their services carry high costs of a different sort, including fewer drug options for patients. The biggest of these firms, Express Scripts and CVS Health, say they held drug spending growth for their clients last year to 5.2 and 5 percent, respectively, from 13.1 and 11.8 percent in 2014. (Max Nisen, 5/5)
The New York Times:
Change Is In The Air For Pharmaceutical Mergers
Health care mergers and acquisitions have accelerated out of control. A record volume of deals were announced last year even after stripping out the $160 billion union of Pfizer and Allergan. Tax benefits overshadowed strategic sense. Valuations and premiums soared. Regulators then got worried. If the pace is indeed slowing, as Tuesday’s news implies, it could be an encouraging sign of a renewed commitment to developing drugs instead of just overpaying for them. (Robert Cyran, 5/10)
Why Is A Company That Makes A Drug For Blind People Spending Millions On TV Ads?
In a spot that has aired on TV more than 12,000 times, a blind woman embraces her daughter at the threshold of her elegant home. But the ad’s primary target audience can’t see it. They’re completely blind. Vanda Pharmaceuticals has bought more than $29 million worth of air time in the past two years for a TV ad blitz aimed at raising awareness of a rare sleep disorder for which Vanda makes the only approved drug. (Rebecca Robbins, 5/4)
Teva Fights Back At The Haters
It's not a good time to be generic. Firms such as Endo International have reported a worsening generic-drug pricing environment in the U.S., blaming it for softness in their business. Teva, the world's biggest generic-drug maker, said on its first-quarter earnings call on Monday that the wave of price erosion its competitors cite is not all that bad. The company -- which is trying to close a $40.5 billion deal for Allergan's generics business in June -- said its generic prices fell by 4 percent in the U.S. last year, and it expects another 4 percent decline this year.In contrast, AmerisourceBergen said on a call last week it expects its generic drug-price deflation to reach the "high single digits" this year alone. (Max Nisen, 5/9)
A selection of opinions on health care from around the country.
Lincoln Journal Star:
The Meaning Of 'Affordable'
News stories that insurers are seeking double digit increases in premiums next year under the Affordable Care Act are a reminder of how imperfect a solution the legislation is to what ails America’s health care system. The health care reform law does not do enough to address rising health costs, which dropped during the Great Recession but have started to rise again. (5/11)
New Orleans Times-Picayune:
Louisiana Gets Innovative To Catch Up On Medicaid Expansion
Louisiana is behind on expanding Medicaid because the state refused to accept the extra federal money until Gov. John Bel Edwards took office in January. But an innovative approach by the Department of Health and Hospitals could allow tens of thousands of eligible residents to be approved almost immediately. ... DHH officials are "highly confident" that federal Medicaid officials will approve their request to use food stamp records to add uninsured residents to the health care program for low-income residents. A half-dozen other states have been allowed to fast track their enrollment process, but Louisiana would be the first one to use food stamps. (5/10)
Los Angeles Times:
So What Does A Corporation Owe You After A Data Breach?
The most common response when a corporate database gets hacked is for the business to offer a year of free credit monitoring -- a better-than-nothing measure that will alert people to suspicious activity involving their credit files but will do nothing to prevent fraud, identity theft or other mischief. (David Lazarus, 5/10)
Clinton Suggests Letting People In Their 50s Buy Into Medicare
Democratic presidential candidate Hillary Clinton unexpectedly floated the idea Monday of letting people in their 50s buy into Medicare as an alternative to her previous proposal to let states establish public health insurance plans to compete with private insurers. (Harris Meyer, 5/10)
The Washington Post:
For Republicans In Congress, Does ‘Pro-Life’ Extend To Fighting Zika?
Rep. Vern Buchanan, a Florida Republican, has called himself “pro-life” since he came to Congress a decade ago. This month, he’s proving it. Buchanan last week announced his support for President Obama’s request for $1.9 billion to fight the Zika virus — a decision he based in part on “new research revealing that Zika eats away at the fetal brain and destroys the ability to think.” He’s right about that. The mosquito-borne virus is going to cause thousands of babies in this hemisphere to be born with severe birth defects, and Zika is on the cusp of devastating the U.S. citizens of Puerto Rico and of spreading to the southern United States. Untold numbers of the unborn are being irreversibly harmed. (Dana Milbank, 5/10)
Zika Threat Pales Next To 1964 Rubella Outbreak: Column
It is a virus that can spell disaster for a pregnant woman. It causes miscarriages or a fate many people view as far worse: congenital malformations of the newborn. It swept the globe. No, I am not referring to Zika; I am referring to rubella. (Amesh A. Adalja, 5/10)
The Washington Post:
The FDA Finally Steps Up On E-Cigarettes
Over the past several years, the e-cigarette business has boomed, tying public-health experts in knots. On one hand, the devices are far less dangerous than conventional cigarettes. It would be a public-health victory if every smoker stopped lighting up and chose to vape instead. On the other hand, e-cigarettes seem designed to appeal to children and teenagers. E-cigarette liquids come in a variety of candylike flavors that, according to federal health officials, have driven interest among young users. Some young people — it is unclear how many — would not have gotten hooked on nicotine without e-cigarettes. (5/10)
The Wall Street Journal:
Obesity: The New Hunger
Each May, private charities in Boston organize a “Walk for Hunger” to help the Massachusetts households—one out of every 10, we’re told—that require “hunger relief.” A national organization of food banks named Feeding America promotes its own work by asserting that “1 in 7 Americans struggle to get enough to eat.” A 2015 ad campaign sponsored by Great Nations Eat warned that “America Can’t Be Great on an Empty Stomach.” (Robert Paarlberg, 5/10)
Doctors Must Lead Us Out Of Our Opioid Abuse Epidemic
Veteran doctors don't need a blood test to tell when someone is on the verge of a drug overdose. They can even narrow down the culprit by observation alone. Dilated pupils mean cocaine, amphetamines, maybe LSD. Constricted pupils mean an opiate. (Sanjay Gupta, 5/11)
Lightening Nurses’ Loads
Hotel rooms have occupancy limits, as do elevators, and even taxi cabs in New York City, but few laws in the United States regulate or even monitor the number of patients that any one hospital nurse can be responsible for at a given time. This hit home for me after the publication of my book The Shift: One Nurse, Twelve Hours, Four Patients’ Lives. Many nurses reacted by reminding me that four patients is a cakewalk, not worth writing a book about—their usual load is eight patients or more. (Theresa Brown, 5/10)
Lexington Herald Leader:
McConnell, Legislature Can OK Bills To Improve Mental-Health Care
Mental illness impacts millions of Americans and hundreds of thousands of Kentuckians, but is largely undiagnosed and untreated. As citizens of the commonwealth, we must hold our federal and state leaders accountable so they can fix gaps in the mental healthcare system. With a basic knowledge of mental illness, who it impacts and the current inadequacies of treatment, Congress and the Kentucky General Assembly can enact legislation to correct these problems. (Michael Gray, 5/10)
The Dallas Morning News:
Cheaper Telehealth May Cost Parkland Even More
Telehealth usually costs much less than traditional treatment and could help bend the cost curve. But if Parkland Health & Hospital System goes all in on the emerging service, it figures to lose even more money. (Michael Schnurman, 5/10)
OHSU Follows Up Medical Negligence With Financial Indifference
The facts of Tyson Horton's case are simple. In 2009, doctors at OHSU Hospital mistakenly sliced through blood vessels to his liver as they removed a cancerous mass from the then 8-month old. The error – OHSU admitted its negligence – nearly killed him. (5/10)