October 22, 2018

HHS Rule Mandates Posting of Drug Prices; Could Be a Game-Changer

Are consumers ready to see the price of their prescription drugs in TV ads?  How will they react?  HHS has released a proposed rule to require pharmaceutical manufacturers to disclose drug prices in their television ads. The proposed rule would require drug makers to post the Wholesale Acquisition Cost (WAC) for drugs covered in Medicare or Medicaid in direct-to-consumer advertisements. It would require prices to be posted for a typical course of treatment for an acute medication like an antibiotic, or a thirty day supply of medication for a chronic condition that is taken every month. The posting would take the form of a legible textual statement at the end of the ad. Despite opposition from drug companies, HHS officials compared it to government requirements for auto makers to post their car prices. A Wall Street Journal article said the rule could create sticker shock for consumers and push drug makers to rethink their marketing strategies. Click here for the policy brief on the rule, here for the rule, and here for the WSJ article.

  • According to STAT, five drug makers with the most expensive drugs will be hit the hardest, click here.
  • The FDA announced that it plans to release a proposed rule next summer to allow more drugs to be available over-the-counter. Click here.
  • If Democrats take over the House of Representatives in the mid-term election, big Pharma fears they will work with President Trump to cut a deal to reduce drug prices.  Click here.


Most Medicare Advantage Denials are Wrong, Providers Biggest Losers: OIG Report

A new HHS Inspector General’s report details how most coverage denials from insurers and plans in the Medicare Advantage program were flat-out wrong, leading to major loses for providers. After reviewing hundreds of MA contracts, the OIG discovered that the plans “overturned 75% of their own denials during 2014-16, overturning approximately 216,000 denials each year.” The study also found that 82% of the wrongful denials arose from appeals by the providers themselves for payment for services already rendered. The OIG’s key takeaway from the study: “High numbers of overturned denials upon appeal, and persistent performance problems identified by CMS audits, raise concerns that some beneficiaries and providers may not be getting services and payment that MAOs are required to provide.” To view the report, click here.

  • Nearly half of all Medicare Advantage plans are offering additional supplemental benefits to members in 2019 under new rules meant to provide greater flexibility in what’s covered, according to an analysis of plan filings. Click here for details.

Anthem ER Policy Could Invalidate 17% of Visits: Study 

Nearly 1 in 6 emergency room visits could be deemed inappropriate, and therefore ineligible for coverage, if insurers nationwide adopt a controversial policy implemented by Anthem of retroactively reviewing such claims, according to a study published in JAMA Network Open. The policy is currently in place in six states where Anthem is the main Blue Cross Blue Shield plan. Providers have expressed outrage about the policy, arguing that patients will be endangered if they’re required to self-diagnose, and the Medical Association of Georgia is suing Anthem.  Click here for the report.


Serious Illness for Insured Causing Financial Ruin

Even with health insurance, a serious illness can not only be expensive, it could wipe out a person’s life savings to pay for care.  A new national survey showed that 36% of seriously ill patients with insurance stated that they had used up all or most of their savings to pay for their care; 29% had a bill referred to a collection agency; and 21% said they had been unable to pay for basic necessities. Additionally, of the seriously ill patients without insurance, 57% declared that they had spent all of their life savings on health care and 51% stated that they are unable to afford basic necessities like food and housing. To read the report, click here.

  • Analysis by NPR shows that there is very little oversight of private insurance companies that run Medicaid programs, leading to skimping on beneficiaries care, click here.
  • According to GAO, low-income adults in Medicaid expansion states were less likely to report having any unmet medical needs compared with those in non-Medicaid expansion states, click here.


President Expected to Sign Opioid Legislation This Week; CDC Reports Overdose Increase

President Trump is expected to sign this week – likely Wednesday – the comprehensive opioid legislation aimed at combating the crisis. The wide-ranging legislation includes a variety policies from expanding access to drug treatment and prevention programs to providing more funds for law enforcement to fight the drug epidemic. This comes as the Centers for Disease Control reports a 10% increase in drug overdoses or 72,000 Americans in 2017. Data from 2018 so far shows that drug-related deaths remain high, estimated at 115 everyday. Click here for the legislation, and here for the CDC report.

  • According to a survey by the American Society of Anesthesiologists, surgery patients perceive opioids as the most effective form of pain relief and want prescriptions after surgery despite the risk of addiction, click here.
  • Following the FDA Advisory Committee’s approval of new powerful opioid, AcelRx Pharmaceuticals’ Dsuvia, in a rare move, the chair of the Committee sent a letter urging FDA’s rejection of the drug, click here.
  • Smuggled fentanyl and similar illicit chemicals from China are going to customers in more than 25 countries and 35 U.S. states, click here.

Expansion Critic Named New CMS Medicaid Director

Mary Mayhew, a former Maine health official who fought against Medicaid expansion and looked to tighten eligibility requirements in traditional Medicaid for the state, was named as the new Deputy Administrator of CMS and Director of the Center for Medicaid and CHIP Services (CMCS), succeeding Brian Neale, who left that position in January. Mayhew, whose appointment was quietly announced internally last week, joins the agency after her failed bid for the republican nomination to succeed Maine Gov. Paul LePage. Mayhew served as Maine’s health commissioner for six years under LePage, leading efforts to tighten the state’s Medicaid eligibility standards, add work requirements to the food stamp program and implement other reforms. For more on Mayhew from the Bangor Daily News, click here.


Time Magazine Releases First Health Care 50 List

Time Magazine has launched its first ever “Health Care 50” list naming physicians, scientists, and business and political leaders whose work is transforming health care though innovation. Time’s health care team nominated people who significantly changed the state of U.S. health care this year and evaluated their work on key factors, including originality, impact, and quality. Click here for the full list.


HHS Awards $293 Million to Primary Health Care Providers

HHS’ Health Resources and Services Administration awarded a total of $293 million to primary care clinicians and students through the NHSC and Nurse Corps programs. The funds will be used for training, student financial assistance and grants promoting primary health care work among doctors, nurses and dentists. About 13 million patients receive care from more than 12,500 NHSC and Nurse Corps clinicians, and 1,725 primary care students are either in school or in residency preparing for future service with the Corps programs, many with scholarships from the programs. To view the list of recipients, click here.


HHS Inspector General: Hospitals More Prepared for Public Health Emergencies

A recent study comparing hospital preparedness during the 2014 Ebola outbreak and 2017, after HHS provided guidance to hospitals and revised requirements for hospital emergency preparedness, shows that only 14 percent of hospitals reported their facilities were still unprepared for threats such as Ebola. The OIG study found that hospital actions to improve preparedness included updating emergency plans, training staff to care for patients during emergencies, purchasing additional supplies, and conducting focused drills. Additionally, hospitals used a wide range of resources provided by HHS to become ready for possible emergency health events. Click here for the study.


Raging Measles Outbreak in Europe Could Occur in U.S.

A raging measles outbreak in Europe may be a warning sign of what could occur in the U.S. if something doesn’t change soon, experts say.  So far this year, there have been 41,000 cases in Europe and 40 deaths, according to the World Health Organization. The European experience may offer a window on how quickly things can go awry when parents choose not to vaccinate their children, doctors caution. Click here for details.


Rural Americans Cite Access to Care as Urgent Problem Facing their Community
A new poll of 1,300 rural Americans found that 57% say opioid addiction is a serious problem in their community. When asked about the biggest problem facing themselves and their families, financial problems and health or healthcare concerns ranked at the top. Drug addiction, cancer, and access to health care were ranked as most urgent health problems facing rural communities. Given the inter-connectedness of these issues, properly funding health care providers in rural areas can make a big difference. To read more, click here.

  • The Critical Access Hospital Coalition advocates for the financial viability of Critical Access Hospitals. Read more about the CAH Coalition here.

Larger Families Could Mean Lower Cancer Risk

That’s according to a study supported by the Mäxi Foundation, Zurich, Switzerland, where researchers found that countries with greater family size have lower cancer risk in both females, and especially males. Researchers analyzed data from 178 countries and found a correlation between family size and cancer risk, independent of income, urbanization, and age. The researchers believe that the association is due to the positive, emotional, and supportive environments that families can provide, which can lead to a healthier lifestyle. For the full study, click here.


Groups Spending Big on California Dialysis Ballot Measure

California ballot measure (Proposition 8) capping dialysis clinic profits is getting a lot of attention from health care groups and dialysis providers. The biggest spenders on the ballot campaign are dialysis providers DaVita and Fresenius Medical Care, spending almost $95 million campaigning against the measure. On the other side,  the Service Employees International Union-United Healthcare Workers West, which represents more than 95,000 health care workers in California that sponsored the measure, have put about $15 million in a push for Proposition 8, which would cap dialysis clinic profits at 115 percent of the costs of patient care, with revenue above that amount to be rebated primarily to insurers. For more, click here.


Gluten-Free Craze is Not Helpful to Those with Celiac
A new study looks at how the increase of gluten free diets has affected celiac disease patients. The gluten-free fad diet has pushed for more gluten free food options and the prices to be more affordable. However, a stigma has developed against those who choose gluten-free because they are considered higher maintenance or difficult. This creates a misconception about the severity of celiac disease as well as more anxiety for those with the autoimmune disorder triggered by the ingestion of gluten. Click here for the study.


More Sunlight In-doors Helps Kill Germs
According to a new study, rooms exposed to more sunlight have fewer germs. Scientists tested dollhouse-size rooms exposed to daylight through a regular window, ultraviolet light, and those kept in the dark. To analyze the results they also used dust samples from actual homes in the Portland, Oregon area. They found that sunlit rooms had about half the bacteria compared to dark rooms. Researchers were surprised to find that visible and UV light had similar results given that most window glass filters out most UV light. Read more here.

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