September 17, 2018

Pharma Wins Ad Fight in Congressional Spending Package; Health Care GDP Drops

House and Senate Appropriators put together the final details of a spending package that would allocate more than $850 billion for the departments of Defense, Labor, Education and Health and Human Services. The Appropriations package also includes a stopgap funding measure running through Dec. 7 to avert a partial shutdown of agencies without full-year appropriations by Oct. 1, including the departments of Homeland Security, State, Justice and Commerce, among others. Among key provisions:

  • Conferees dropped a provision that provided $1 million for HHS to develop regulations to require drug makers to include prices in their advertisements.
  • The final compromise also rejected proposed House cuts to a $286 million family-planning program known as Title X, and a $100 million teen pregnancy prevention program.
  • It includes $1.5 billion for grants for states responding to the opioid epidemic.
  • Click here for a committee summary of the bill.  To read the complete funding bill released by the Conference Committee, click here.

According to economic analysis performed by Altarum Institute, health care’s percentage of the GDP has dropped from 18 percent in 2017 to 17.8 percent this year, click here.  The report says overall economic growth has outpaced the health care segment of the economy.


Hospital Associations File Another 340B Lawsuit 

A group of hospital associations filed a law suit against HRSA stating that the agency has unreasonably delayed a rule laying out 340B ceiling prices and penalties for manufacturers, noting the Administration has pushed back implementing the rule on five separate occasions. The suit alleges the postponement of the most recent proposed rule under the Obama Administration is unreasonable, noting that HHS’ most recent delay would cause it to go into effect more than two years after its original 2017 start date. The providers ask the court to force the HRSA to take action within 30 days of a court ruling. House and Senate lawmakers also have raised concerns with the delay of the rule and suggested HRSA is not using its rulemaking authority by sending a letter at the end of August. Click here for the lawsuit and here for the Congressional letter.

  • HHS Sec. lays out top priorities to lower drug prices through the markets – “more robust competition, and more effective, market-driven negotiation,” click here.

AMA Opposes CMS’ Proposed 2019 Physician Fee Schedule Rule

The American Medical Association is warning CMS of ‘serious concerns’ about the agency’s physician pay proposal – the 2019 Physician Fee Schedule rule. The organization formally pushed back on CMS’ proposal to change payments for physicians’ evaluation and management services, submitting a comment on the agency’s proposed physician fee schedule. CMS is proposing to simplify what it pays doctors for office visits, moving away from tiered payments based on a patient’s level of illness and toward flat fees.  AMA says the proposal will force them to de-prioritize more complex patients.  Click here to read the AMA’s comments to CMS.


Meth and Marijuana Use Is Up; Fewer Start Using Heroin: National Survey

Far fewer people in the United States started using heroin last year, but the decline among young new 18- to 25-year-old heroin users was almost imperceptible – and that age group saw a big jump in methamphetamine and marijuana use, a new survey finds. The 2017 National Survey on Drug Use and Health emphasizes what it calls these “transitional aged youth” because they have higher rates of cigarette use, alcohol abuse and heroin use disorder, and they use more cocaine, meth and LSD, than people both younger and older.  Click here for the report released Friday.


Opioid Use Disorder Growing: Report

Up to 6 million Americans could have opioid use disorder, which is nearly triple the government’s estimate of 2.1 million, according to new research from McKinsey and Co. The report found undiagnosed opioid use disorder in 82 percent of Medicaid beneficiaries in Massachusetts who received high-dosage treatments of opioids. Click here for the report.


Senate Opioid Package Vote this Week; Cannabis Initiatives Increase

The Senate Leadership announced that it will vote on its version of the opioid package this week. The Senate will take up the House-passed package, H.R. 6, “SUPPORT for Patients and Communities Act,” with an amendment from Sen. Lamar Alexander (R-TN). The Senate package includes:

  • The STOP Act—Stop illegal drugs, including fentanyl, from coming across the border through the mail
  • New non-addictive painkillers, research and fast-track
  • Support for comprehensive opioid recovery centers
  • Help for babies born in opioid withdrawal
  • Prevention of “doctor-shopping” by improving state prescription drug monitoring programs
  • Expansion of the use of telehealth services for the treatment of opioid use disorder and other substance use disorders

To read the section-by-section of the Senate Opioid Package, click here.

  • The House Judiciary Committee approved a bill that would expand the number of federally approved facilities manufacturing cannabis for medical research, click here.
  • Singer Jimmy Buffet starting a new medical marijuana company with a line of cannabis products, including edibles, lotions and vape pens, click here.

FDA May Offer Hospitals Antibiotic “Subscriptions” To Encourage Production

FDA Commissioner Scott Gottlieb said in a speech that the agency is discussing offering hospitals the option to buy “subscriptions” of antibiotics, rather than purchasing them individually, to incentivize drug makers to develop new antibiotics for resistant bacteria by ensuring them more money upfront. Gottlieb said that the initiative, which he has discussed with CMS Administrator Seema Verma, could include private organizations like the Bill and Melinda Gates Foundation.  Click here for Gottlieb’s speech.  Click here for the news report.


Senate Passes Bill Prohibiting Rx Gag Clauses

The Senate approved a bipartisan bill that aims to make it easier for patients on all private health plans including Obamacare to get the lowest possible price on prescription drugs. The Patient Right to Know Drug Prices Act (S. 2554 – click here to read the bill) passed by unanimous consent this afternoon, prohibits “gag clauses” that prevent pharmacists from telling customers that they could save money by paying cash out-of-pocket rather than using their insurance benefit.  The House is moving similar legislation.


ACOs Dispute CMS Report, Say They Save More Money

The National Association of Accountable Care Organizations last week released a report showing that they saved Medicare $1.8 billion between 2013 and 2015. This contradicts the recent CMS report that ACOs saved about half as much. The Dobson DaVanzo study looked at ACO performance using Medicare claims data from approximately 25 million beneficiaries found that the “ACO model is a market-based solution to fragmented and costly care that begins to align financial incentives to encourage local physicians, hospitals, and other providers to work together and take responsibility for improving quality, reducing waste to help keep care affordable, and enhancing patient experience.” Click here to read the study.


Patient Groups Sue Government Over Short-Term Insurance Plan Rule

Several patient advocacy groups including – Association for Community Affiliated Plans, National Alliance on Mental Illness, Mental Health America, the American Psychiatric Association, AIDS United, and the National Partnership for Women & Families – sued the Trump Administration last week over a new rule that expands the availability of short-term insurance plans. Claiming that the rule was illegally written in an “arbitrary and capricious” way to create a parallel market and siphon young, healthy consumers from the ACA exchanges, the groups requested that U.S. District Court for the District of Columbia to set aside the rule, arguing it undercuts the health care law, particularly protections for people with preexisting conditions. To view the suit, click here.

  • Immigrants use fewer healthcare services and account for less spending by public and private insurance than people born in the U.S., suggesting immigrants may be subsidizing care for other patients, click here.
  • According to the Census, the percentage of Americans with health insurance declined in six of the nation’s 25 most populated metropolitan areas between 2016 and 2017, click here.

House Passes Bill To Expand Enrollment Period for Certain MA Plans

The House last week passed legislation changing Medicare rules that allow more enrollees to use a special enrollment period for certain plans. The bill would allow enrollees in Medicare Cost Plans that are ending after 2018 to switch their coverage outside the typical open enrollment period. The option in the statute applies to individuals who are deemed as enrolled in Medicare Advantage (MA). The bill would clarify that the option applies to other MA-eligible enrollees too, as allowed under current rules, according to a news release from the House Ways and Means Committee. Click here for the bill. Click here for the summary.


Cancer Rate is Dropping Because of New Therapies

According to the American Association for Cancer Research’s annual progress report, the cancer death rate has dropped 26 percent among adults between 1991 and 2015. The report states that the new ways to prevent, detect, diagnose, and treat cancer — such as 22 cancer treatments approved by the FDA for the first time and new discoveries of cancer types between August 2017 and July 2018, including CAR T-cell therapies — are the reason for the dramatic drop. The report estimates the number of new cancer cases in the U.S. is expected to rise from more than 1.7 million in 2018 to almost 2.4 million in 2035, due to the large aging population. Click here to read the report.

  • More and more, cancer patients are choosing less intensive treatments and finding success, click here.

FDA: E-Cigarettes Usage Among Teenagers is an Epidemic
The FDA has reported that the use of e-cigarettes among teenagers is at an epidemic level. FDA administrator Scott Gottlieb announced that strong regulations are needed to ensure manufacturers are acting in the best interest for the overall health of their consumers. Gottlieb took aim at Juul and other e-cigarette manufacturers, warning that they must show in the next two months how they’ll keep the devices out of the hands of young people. Click here for the FDA press release. Click here for the CNN story.


Emergency Department Overuse in Rural Areas Leads Patients to Wal-Mart for Care
Rural hospital CEOs who are noticing trends of emergency department overuse are pressed to find more appropriate and affordable alternatives for patient care in their communities. By increasing the availability and convenience of urgent care, these rural hospital leaders hope to make urgent care a patients’ first stop for non-emergency medical needs, including outposts at Wal-Mart. Reducing the overuse of emergency departments should reduce their financial loss as uninsured or underinsured patients can receive more affordable care in their urgent care clinic. Click here to read more.

  • The Critical Access Hospital Coalition advocates for the financial viability of rural hospitals in Washington, D.C.. Read more about the CAH Coalition here.


Dairy Consumption Improves Cardiovascular Disease Risk (Really?)
New research show that dairy is good for your heart health. Throughout the years, dietary guidelines have recommended that consumers should choose non-fat or low-fat products over full-fat products. This is because the full-fat products contain more saturated fats which are believed to have adverse effects, for instance a higher risk of cardiovascular disease. However, a new study published in The Lancet researched the connection between dairy and cardiovascular disease. This study found that all dairy consumption led to a lower risk of major cardiovascular disease as well as a lower risk of mortality from a cardiovascular disease. The lower risk was not dependent on the level of fat in the dairy. To read the study, click here.

New Video Game Designed to Teach Children Empathy
A research team from the University of Wisconsin-Madison developed a video game that teaches kids pro-social values. The game is called “Crystals of Kaydor” and the premise includes a distant planet, a damaged spaceship, and the need to communicate with local alien life, despite the existing language barrier. The children playing the game can only go off of the alien’s facial expressions to build relationships. The study showed that some kids playing the game exhibited greater connectivity in brain pathways dedicated to empathy. Researchers say that it did not work for all of the participants but there does appear to be a potential for video games to increase social awareness. Click here for the published study.

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