Latest Morning Briefing Stories
Pancreatic cancer is the third-leading cause of death from cancer in the United States, following lung and colorectal cancers. Meanwhile, new research from the University of California-Davis shows that Californians are faring better against most types of cancer because of early detection and more effective treatments. CNN explores one scenario that plays out when insurers won’t pay for care.
The National Association of ACOs signals that the Health and Human Services plan will cause affordable care organizations to leave Medicare’s Shared Savings Program. News outlets also report on industry news surrounding a heart valve procedure that is saving lives, a Q2 drop in bankruptcies and a “tidal wave of change” predicted from Colorado companies.
Teva gets approval from the Food and Drug Administration to sell its version of the epinephrine auto-injector, but hasn’t yet revealed its pricing. Mylan, the manufacturer of the brand-name EpiPen, has faced public criticism and congressional investigations for raising the price of its lifesaving drug 450 percent since 2004.
Sen. Elizabeth Warren (D-Mass.) and Sen. Tina Smith (D-Minn.) are seeking a response from the secretary of Health and Human Services about his answers in recent congressional testimony.
Experts are wary because while the therapies have provided some miraculous success, there have also been spectacular failures. Health officials, however, say that the FDA can provide enough oversight and extra supervision from the NIH is no longer needed.
The beneficiaries have to log hours through other programs, so officials know that they’re meeting them and simply just not reporting them. Critics warned of this scenario before work requirements were instituted because, according to analysts, one in three Medicaid adults never use a computer or the internet and four in ten do not use email. Medicaid news comes out of Ohio, as well.
News outlets report on stories related to pharmaceutical pricing.
Media outlets report on news from Illinois, D.C., Ohio, California, Tennessee, Maryland, New Jersey, Arizona, Louisiana, Georgia, New Hampshire, Minnesota and North Dakota.
In the midst of criticism that pharmacy benefits managers are not doing enough to drive down costs, CVS has announced that it will let its clients exclude from their formularies any new drugs that exceed the threshold of $100,000 per quality-of-life years.
Oscar’s focus is on health plans and helping consumers pick out the right coverage for them. The company announced that the investment will help it expand into Medicare Advantage space in the coming years.
The advocacy groups suing the Trump administration had previous success blocking Kentucky’s Medicaid work requirement in court. In June, Arkansas became the first state where Medicaid work requirements took effect.
The researchers are now building a website that will allow anyone to upload genetic data. Users will receive risk scores for heart disease, breast cancer, Type 2 diabetes, chronic inflammatory bowel disease and atrial fibrillation. But scientists emphasize that DNA is not destiny, and that the results don’t account for a healthy diet and exercise.
When patients go to an in-network facility, they can still be treated by an out-of-network medical professional–anesthesia or pathology claims being among the most common.
Right now, the RNAi drug is limited to cells that go through the liver, which is — in relative terms — easy to target. Getting the drug to other tissue, like the skin or brain, is more challenging. “It’s always been the same problem. And it’s delivery, delivery, delivery,” Steven Dowdy, a cancer biologist at the University of California, San Diego’s school of medicine, tells Stat. “It’s always been the 800-pound gorilla in the room.”
Slicing genes with drugs is the latest in a wave of hot new treatments geared toward fighting diseases in unique ways. But the price on innovation is steep. In other news, the FDA plans to streamline drug safety evaluations and a super PAC goes after Rep. Anna Eshoo (D-Calif.) over the money she’s taken from the pharmaceutical industry.
Industry players who usually don’t work together are bonding over the potential push for a single-payer system, which has become a litmus test among progressive Democrats.
A deep dive into prices at Minnesota’s hospitals reveals wide disparities in what procedures cost, but leaves more questions than answers in its wake.
The new guidance, which officials say will cut back on the companies’ “abusive behavior,” concerns the rebates that drug makers have to pay back to states when a patient receives one of their medicines. In other pharmaceutical news: the administration is preparing to put action behind its rhetoric on drug pricing; some say Medicare’s new negotiating powers could lead to increased hospitalizations; and more.
The state would pay a fixed amount of money for the drugs for a certain amount of time. While some are praising the effort, other experts say that because costs are coming down already, that it’s unclear whether that type of deal would really save the state money.
“Drug manufacturers want you to believe that increasing drug prices are a result of them happy to pay rebates and that PBMs are retaining these rebates. And this is simply not true,” said Larry Merlo, the CEO of CVS, which owns Caremark, one of the biggest pharmacy-benefit managers. Meanwhile, the American Medical Association speaks out against CVS’ attempts to acquire insurer Aetna. And Rite Aid and Albertsons call off their merger.