July 8, 2019

HHS OIG Adds Fuel To 340B Fire
The HHS’ Office of Inspector General found in a new report out last week that tens of millions of dollars in rebates could have been generated had manufacturers and sponsors agreed that eligible prescriptions filled at 340B contract pharmacies would receive rebates. The report determined that if the Part D prescriptions  reviewed by the OIG had been filled at non-340B pharmacies, manufacturers would have paid rebates of up to $74.7 million for 554,549 claims in 2014. The manufacturers did not pay these rebates since rebate agreements did not require manufacturers to pay rebates for Part D drugs filled at a 340B contract pharmacy. While the OIG did not make any recommendations on the issue, they did send the report to Congressional and Administration officials. To read the full report, click here.

Senate Leaders Target Advocacy Groups with Ties to Opioid Manufacturers
Senate Finance Committee Chairman Chuck Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) last week sent letters to ten tax-exempt advocacy and advisory groups requesting information about their financial relationship with opioid manufacturers and other medical entities. Grassley and Wyden requested information about their donors, their involvement with federal advisory groups and other government entities, and their awareness of any information distributed to physicians and patients about prescription pain medications. The Senators state that they, “acknowledge that the answer to the opioid epidemic continues to be anything but simple. However, we believe that it is important to shed light on these financial relationships to ensure transparency and accountability in matters that affect Federal healthcare programs and the patients that participate in them.” To read the letters, click here.

As Rx Prices Increase, HHS Secretary, White House Policy Chief Pen Op-Ed Touting Initiatives to Lower Drug Prices
HHS Secretary Alex Azar and White House Domestic Policy Chief Joe Grogan last week co-authored an op-ed in the New York Post to laud the efforts by the Administration to lower the cost of drugs. They state that the increase in transparency of health care costs, direct to consumer discounts, and new quality measures will put patients in the driver seat and ultimately force the market to lower costs. Click here for the op-ed.

  • According to a new study in Health Affairs, Medicare beneficiaries who purchase generic drugs may end up paying more out-of-pocket than if they were to purchase brand name drugs due to how Medicare’s prescription drug benefit is structured, click here.
  • New data from Rx Savings Solutions shows that prices for both brand name and generic drugs rose an average 13 percent over the past year, click here.

Air Ambulances Charge Four to Nine Times as Much as Medicare Pays: Study
Air ambulances charged between 4.1 and 9.5 times more than Medicare paid for these services in 2016, depending on the type of ambulance and type of charge, according to a new report. Generally, air ambulances charge higher rates relative to Medicare than most other services, and these rates have increased over time, plus insurers often do not contract for the services leaving patients with big bills for the emergency transportation regardless of whether they have insurance. The Senate committee’s price transparency-surprise billing legislation would require air ambulance companies to separate transportation from medical charges, prohibit them from balance billing patients, and establish a payment benchmark for out-of-network care. Click here for the report in Health Affairs.

CMS Finalizes Coverage Policy for ABPM
CMS has finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM).  ABPM is 
a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles, allowing a doctor to assess a patient’s blood pressure during routine daily living, instead of when they are sitting nervously on an examination table.  ABPM may measure blood pressure more accurately and lead to the diagnosis of high blood pressure in patients who would not otherwise have been identified as having the condition. Click here for details.

Mental Illness Contributes to Increased ER Visits: Study
Mental illness combined with the physical conditions of patients can lead to a higher likelihood for a person to visit the emergency department, according to a new study. The researchers reviewed more than 5 million adults in Quebec from 2012 to 2016, using the Quebec Integrated Chronic Disease Surveillance System, and found each mental illness combined with physical issues resulted in a higher likelihood of visiting the ED. Patients diagnosed with bipolar disorder or other serious mental disorders and were dealing with four or more physical conditions, were 16-percent more likely to visit the ED versus 11-percent of those with no mental illness. To read the report, click here.

Some Common Medical Advice Is Often a Myth; Here Are Some Good Ones
Of more than 3,000 studies published from 2003 through 2017 in JAMA and the Lancet, and from 2011 through 2017 in the New England Journal of Medicine, more than one of 10 amounted to a “medical reversal”:a conclusion opposite of what had been conventional wisdom among doctors. A new report looks at 10 commonly held beliefs by health practitioners that have been dispelled by studies over the years, but are still held to by many clinicians. Issues related to babies and peanuts, consuming fish fats to prevent heart trouble, and using ginkgo biloba to stave off memory loss. To view the report, click here.

Progress on Diabetes Complications Slowing Down
Prior to 2010, rates of complications associated with diabetes such as amputations and high blood sugar hospitalizations fell significantly. However, from 2010-2015, those rates reversed course. Researchers at the Commonwealth Fund point a few reasons why this is happening, such as greater number of younger people being diagnosed with the disease and higher rates of obesity, smoking and hypertension. The authors also point to high out-of-pocket costs for chronic conditions, like diabetes, from high deductible plans and the rise in the price of insulin. To read more, click here.

In a Shift Towards Alternative Medicine, Medicare May Cover Acupuncture
Medicare is considering covering acupuncture for beneficiaries as part of a push to provide more alternative pain management for people dealing with chronic pain in light of the opioid crisis. For now, the coverage would only be approved for chronic lower back pain, leading many proponents to applaud the option as an effective way to treat pain. Click here for the Washington Post article.

A New Study Successfully Eliminated HIV in Mice
Scientists from Temple University and The University of Nebraska successfully used a combination of LASER ART and CRISPR gene technology to completely eliminate the HIV virus in mice. Although they still need to go through primate and eventually human testing, this development is very promising as the first treatment that could completely eradicate HIV in a person. As of right now, people with HIV are treated with retroviral drugs their entire life. This new treatment offers the possibility of an actual cure. Click here for the study.

The World Health Organization Plans on Delivering Quality-Assured Medical Products for All
The WHO just released its 5-year agenda to help build effective and efficient regulatory systems. This action plan is set to be put into effect immediately and remain in effect through 2023. The plan outlines four priorities: strengthen existing regulatory systems in line to drive towards universal health care, increase preparedness for public health emergencies, strengthen and expand WHO product risk-assessment, and increase the scope of WHO regulatory support. To review the full action plan, click here.

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