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Daily Archives: February 12, 2018

Trump’s Budget Proposal Swings At Drug Prices With A Glancing Blow

President Donald Trump™s new budget proposal flirts with combating high prescription drug prices, but industry watchers say the tweaks to Medicare and Medicaid do little more than dance around the edges of lowering the actual prices of drugs.

The White House’s proposal, which comes after Congress passed a two-year spending deal last week, though, sets the tone for the administration’s focus on prescription drugs.

“Drug costs are a populist issue for the president,” and he’s made it clear to his staff that progress needs to be made this year, said Dan Mendelson, president of Avalere Health, a health care consulting firm.

The proposal targets billions of drug spending cuts in the federal Medicare program, which provides health care for about 60 million people age 65 and older or younger patients with disabilities, and alters drug spending in Medicaid’s safety-net program for nearly 70 million Americans.

And the sheer size of the federal government’s Medicare and Medicaid programs means any drug pricing tweaks that do get made are meaningful — just not necessarily groundbreaking.

“The main question is, how far are they actually going to go in dealing with the underlying problem?” said Paul Van de Water, who spent nearly two decades in the Congressional Budget Office and is now a senior fellow at the Center on Budget and Policy Priorities. Most of the proposals for Medicare, for example, move money around rather than force decreased prices, Van de Water said.

Alex Azar, the newly appointed secretary of Health and Human Services, said the proposed budget supports the work his agency is already doing to reduce the high cost of prescriptions, “especially for America’s seniors.”

Just last month, the former Eli Lilly executive told Congress during his confirmation hearings that “all drug prices are too high in this country.”

Highlights from the proposals include:

— Passing on the discounts and rebates negotiated by pharmacy benefit managers, the financial middlemen between insurers and drugmakers, to seniors who buy drugs through Medicare Part D. The seniors would pay less out-of-pocket when buying their drugs but the proposal could potentially raise premiums because insurers wouldn’t be getting the discounts.

— Ensuring that low-income seniors in Medicare don’t pay for generics and capping out-of-pocket costs for beneficiaries who pass through the so-called doughnut hole, or coverage gap, and hit the catastrophic stage. Beneficiaries typically pay a 5 percent coinsurance in the catastrophic phase, but under the plan it would be decreased to zero.

— Moving some of the drugs paid for under Medicare Part B, which covers drugs administered in the doctor’s office such as chemotherapy and rheumatoid arthritis infusions, into the Part D part of the program to foster price negotiations. While the government pays sticker price for drugs under the Part B program, the Part D program allows insurers and pharmacy benefit managers to negotiate formularies.

— Creating a five-state pilot project to allow state Medicaid programs to negotiate prices with manufacturers and create their own drug formularies.

Trump entered office with blustering promises to bring drug prices “way down. But critics have charged that the White House has failed to engage Congress on cost-cutting ideas, and that a leaked draft of an executive order last summer read like a wish list for the industry.

With the new budget, the administration is trying to recast that narrative at a time when Republicans in Congress may be willing to compromise.

“Americans want Washington to lower prescription drug prices, and our paper provides policy options that would make drugs more accessible to Americans, today and in the future,” wrote D.J. Nordquist, chief of staff for the president’s Council of Economic Advisers, in an email late Friday after the council released a 28-page report on reforming drug prices.

The CEA paper and the president’s budget come on the heels of Congress passing a spending pact Friday that includes a big benefit to Medicare enrollees at the expense of the pharmaceutical industry. The budget proposes closing the doughnut hole in Ǵ19, a year earlier than expected.

Republicans “just showed a propensity to sort of take on the industry,” said Jayson Slotnik, a policy consultant and partner at Health Policy Strategies. And there is political upside for doing more since Republicans are concerned about this year’s November midterm elections approaching, Slotnik said: “They can run and [say] it’s something they have accomplished.”

Yet James Love, director of the nonprofit Knowledge Ecology International, said Trump’s proposals are not “insightful or original” and, referring to the council’s report, said it “could have been written by PhRMA,” the powerful D.C. lobbying firm for pharmaceutical manufacturers.

PhRMA released a statement late Monday applauding the provision to pass on rebates to Medicare beneficiaries but also raising concerns about other elements of the budget proposal, saying they would “limit access to innovative medicines.”

Experts from the academic and think-tank world said the district has seen several of these policies before. For example, the rebate and discount pass-through proposal has been a topic of discussion within the Centers for Medicare & Medicaid Services for more than a year and is already in the rulemaking process.

Another proposal that lowers reimbursement for Medicare Part B drugs that are new to the program is reminiscent of an Obama-era pilot that never got off the ground.

Tara O’Neill Hayes, who focuses on health policy at the conservative American Action Forum, said several Medicare proposals were also similar to those found in a June 2016 report by the Medicare Payment Advisory Commission. If all the Medicare proposals took effect including one that calls for more flexibility in drug formularies — O’Neill Hayes said overall premiums could go up slightly for all Part D beneficiaries, but that would be offset by lowering out-of-pocket payments for the beneficiaries with the highest drug costs.

“Youâre going to have winners and losers, she said. âThe real winners here are going to be the incredibly high-cost patients.”

Trump’s budget requires hospitals to provide a minimum level of charity care to get an additional payment adjustment under the 340B program, which requires pharmaceutical manufacturers to provide drugs at steep discounts to hospitals and clinics with a high ratio of low-income patients.

The administration lowered reimbursement amounts for hospitals earlier this year, and Mendelson at Avalere said he expects more changes.

In reviewing Trump’s budget and the council report, Allan Coukell, senior director of health programs at the Pew Charitable Trusts, said several of the proposals “have the potential to reduce out-of-pocket costs, several have the potential to increase competition within the programs and/or move people toward lower cost drugs. None of it changes the overall trajectory” of rising sticker prices.

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KHN On NPR: The Uniquely American Problem Of High Prescription Drug Costs

Kaiser Health News Editor-in-Chief Elisabeth Rosenthal discussed drug costs with Scott Simon, the host of NPR’s Weekend Edition on Saturday, Feb. 10. This is a transcript of that conversation.

SCOTT SIMON, NPR: The new budget passed by Congress last week includes changes for Medicare patients. It will require drug companies to give deeper discounts to Medicare on expensive prescriptions. That should reduce the cost of drugs for patients. The skyrocketing cost of prescription drugs is something followed closely by Elisabeth Rosenthal, a veteran healthcare reporter and editor-in-chief of Kaiser Health News, who joins us from her offices. Thanks so much for being with us.

ELISABETH ROSENTHAL: Thanks for having me.

SIMON: Will this and other features you see in the budget help reduce the cost of prescription drugs?

ROSENTHAL: Well, to a small number of people, it will. I mean, this really targets the Medicare-age population and Medicare plans. And for people who have very high drug costs within Medicare, it will definitely help them. But it, of course, doesn’t solve the much larger problem of the very high prescription drug prices that everyone pays in this country. And P.S., what we’re talking about for Medicare patients, even, are discounts on these very high initial prices. So, you know, a discount of a really high price still isnt a very good deal.

SIMON: Why do we have a problem with this in the United States?

ROSENTHAL: Well, we’re the only country that doesn’t in some way directly negotiate prescription drug prices with manufacturers – the only developed country, that is. I mean, most other countries in some form either evaluate the cost-benefit ratio of a new drug and decide what they’re willing to pay or, you know, very aggressively negotiate with drug manufacturers, particularly for older drugs, as they age.

SIMON: Insulin in one form or another has been saving lives for – what? – 80 years.

ROSENTHAL: Yeah.

SIMON: Why has the price gone up in recent years?

ROSENTHAL: Prices will rise to whatever the market will bear, right? We see that uniquely in the U.S. One vial of insulin in the U.S. costs seven times what it does in Germany. So there’s a huge disparity there. Some of the reasons have to do with reformulations of insulin that are, in fact, better than some of the older ones. Although, when I’m talking about that 1 inŇ price comparison, that’s the same exact insulin.

In the U.S., what’s happened – and this is something that I know the Trump administration is looking at and many experts in the field have decried – the slow arrival of biosimilars or generic insulins onto the market, which are on the market in other countries. The problem in this country is the lowering of prices of insulin. And insulin patents have been held up in the courts for years now in suits and countersuits between the three big insulin drug makers, including by Eli Lilly, which is the former employer of our new HHS Secretary.

SIMON: That’s Alex Azar – has been appointed Secretary of Health and Human Services.

ROSENTHAL: Yes.

SIMON: Is he the kind of choice that gives you optimism that prescription drug prices will come down?

ROSENTHAL: Well, there’s a certain argument to be made that Alex Azar of all people on Earth understands how the games are played and how these suits and countersuits about making generics or making biosimilars have held up the arrival on the U.S. market and have raised prices for everyone. On the other hand, there’s ongoing concern about the revolving door between government and pharmaceutical companies such that you wonder, is their loyalty to the American people, or is their loyalty to the pharmaceutical world from which they came?

SIMON: I don’t think I can think of any politician who says, and if you elect me, I promise prescription drugs will cost more.

ROSENTHAL: (Laughter).

SIMON: I mean, on the contrary, every politician says, elect me, and I’ll do something to bring down the cost of prescription drugs. Why doesn’t that get done?

ROSENTHAL: Yeah. Everyone agrees that our prescription drug costs are too high â both right and left – you know, Democrat, Republican. It’s one of the few points of information, points of fact that everyone agrees on. The problem is everyone disagrees on how best to tackle that. And there are a lot of forces that are resisting any change at all.

The bipartisan solution which Senator Klobuchar and Senator John McCain have proposed is allowing prescription drug imports from other countries, so we allow for a global competition in the sense of, you know, if everyone else is getting a better deal than us, why can’t we buy our prescription drugs from there the same way we buy our, you know, refrigerators and cars?

SIMON: Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and author of “An American Sickness: How Health Care Became Big Business And How You Can Take It Back.” Thanks so much for being with us.

ROSENTHAL: Thanks for having me.

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Viewpoints: Regardless Of Fiscal Issues, Don’t Underfund CDC; Trump’s Health Care Agenda Is ‘Robust’

Opinion writers expressed views on health care topics.

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State Highlights: Anti-Vaccine Groups Gear Up In Texas; 73% View Crisis in Iowa’s Mental Health System

Media outlets report on news from Texas, Iowa, California, Hawaii, Washington, Maryland, Minnesota, Georgia, Oregon, New Orleans, Ohio, Wisconsin, Arizona and New Hampshire.

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Our Smartphones Are Training Us To Expect Rewards Just Like Pavlov’s Dogs

Researchers look at the brain chemistry behind our addiction to smartphones. In other public health news: the common cold and the Olympics, a new malaria drug, the dreaded hospital gown, sugar cravings, superbugs, and more.

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‘We Were Hoping To Have Better News’: Flu Continues To Get Worse For Yet Another Week

The latest weekly report shows 1 out of every 13 doctor visits last week was for fever, cough and other symptoms of the flu, matching the peak levels during the 2009 swine flu pandemic, and 1 in 10 of all deaths reported in the United States were caused by flu or pneumonia. Meanwhile, the severity of the season is driving up profits for those in the health industry.

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In Effort To Reduce Number Of Opioid Deaths, NYC Weighs Pros And Cons Of Safe Injection Sites

“What’s most important to us is saving lives,” says Kassandra Frederique, the New York director of the Drug Policy Alliance. Nearly four overdose deaths occur daily in New York City. While the U.S. has not opened any official centers yet to monitor safe drug use, dozens are being funded across Canada.

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Under Intense Fire For Role In Opioid Epidemic, Purdue Announces It Will Stop Marketing OxyContin

The company also cut its sales force in half and plans to send a letter Monday to doctors saying that its salespeople will no longer come to their clinics to talk about the company’s pain products. Purdue is facing numerous lawsuits from counties, cities and states for its aggressive marketing tactics.

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A Look At Amazon’s Health Benefits Administrator Gives Hints Of What’s To Come With New Initiative

Making better use of patient data is at the heart of Amazon’s effort.

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Health Provisions In Congress’ Budget Touted As ‘Beacon Of Light’ In The Legislation

Health providers were pleasantly surprised by some of the health care wins that were achieved through the budget deal that was hammered out last week.

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