February 7, 2019 | Patient opioid risk scores for sale, without permission

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INDUSTRY NEWS

Implications explored for new PBM rebate rules

The administration’s new proposed rule that would essentially eliminate rebates from drug companies to pharmacy benefit managers has implications across health care. The move is designed to reduce prices for patients at the pharmacy counter. In a speech to the Bipartisan Policy Center, HHS Sec. Alex Azar said the administration envisions lower prices will enable sicker patients to buy and take needed medicines. The new rule is also estimated to reduce federal spending on government programs by $78-$98 billion. The PBM industry doesn’t support changing the status quo, but pharmaceutical companies applaud it. And patients simply want action from Congress and the administration to end the drug pricing “crisis.” (ForbesPCMA statementHealth AffairsRoll Call)

Trump's SOTU: Lower costs, increase transparency, protect patients

The president’s State of the Union Address didn’t focus on health care as his highest priority, but lowering prescription drug costs may be one area where he can gain bi-partisan support and move forward. He reiterated the administration’s call for price transparency for both hospital and prescriptions. President Trump also announced expansion of funding for childhood cancer and HIV/AIDS treatment and prevention. Interestingly, the president said protecting patients with pre-existing conditions was also priority, an aspect of the Affordable Care Act many critics say would disappear if the law is overturned by the courts. (SOTU transcript ; Kaiser Health News)

Goal to defeat AIDS is "very doable"

The administration’s campaign to end the HIV epidemic by 2030 involves “hot-spotting,” or targeting services to 48 counties where half of new cases occur. In a briefing before the State of the Union address, HHS Sec. Alex Azar said new funding in the president’s proposed budget will use current resources to provide medical and support services in focused areas. The goal, which is to reduce new HIV infections by 75 percent in five years is “very doable,” according to Williams McColl of AIDS United. (Associated Press)

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INNOVATION & TRANSFORMATION

Innovators share insight from school of hard knocks

Health care innovators would be wise to attend to some lessons learned from this closed-door presentation by Aenor Sawyer, who steers UCSF’s healthtech innovation efforts. First, get involvement early in the process from “frontline innovators” who are actively engaged in the problem to be solved and have first-hand insight, as well as “lead users” who are keen to apply the innovation. Another key takeaway: Be aware of the “value-to-nuisance ratio,” a measure of the likeliness a new device or approach will be used, or if adoption is more trouble than it’s worth. (Forbes)

Governors set health care agenda

Innovation at the state level to improve health care delivery is evident in a range of proposed initiatives. Medicaid expansions in Idaho, Nebraska and Utah are moving forward. Wisconsin is expanding Medicaid coverage to more residents; Kansas’s governor has proposed expansion as well. New Mexico and Colorado are considering proposals for Medicaid “buy-in” by consumers, and Washington is considering allowing consumers to purchase Medicaid coverage in its insurance marketplace. States are also looking at prescription drug pricing initiatives as well as laws to keep at-risk provisions of the ACA, such as guaranteed coverage for pre-existing conditions and an insurance mandate. (Health Affairs)

CONSUMERS & PROVIDERS

Patient opioid risk scores for sale, without permission

Data drawn from insurance claims, digital health records, housing records and even from friends and relatives is being sourced to create individual “risk scores” for potential opioid addiction or overdose. The data is peddled to doctors, insurers and hospitals, but isn’t subject to review by the patient for accuracy, and there’s no law against using it to influence prescribing practices. Safety advocates fear provider use of the unreviewed data could prevent patients from getting medications they genuinely need. (Politico)

“Package prices” lure self-pay patients

Hospitals catering to communities who don’t carry health insurance for conscience reasons—such as the Amish—have been able to determine and guarantee package prices for common services, although they don’t publish those prices. The Surgery Center of Oklahoma also offers all-inclusive surgery packages—and posts the prices online. Bundled prices for procedures like joint replacements and gallbladder removals can be 55 to 85 percent lower than insured-allowed charges. Meanwhile, most hospitals continue to push back against the Centers for Medicare & Medicaid Services' requirement to publish meaningful pricing information for patients; a review of "list" prices reveals huge differences between hospitals. (Modern HealthcareKaiser Health News)

NEW & NOTED

Judge throws out bid to protect ACA : Maryland’s attempt to protect the Affordable Care Act in court failed to win over U.S. District Judge Ellen Hollander, who threw the case out last week because it lacked evidence. “In effect, the state proclaims that the sky is falling. But, falling acorns, even several of them, do not amount to a falling sky,” Hollander said. (Reuters)

Oregon adds cost data to Compare Your Care : The tool allows Oregon residents to compare how their primary care provider performs across nine quality areas with datafrom as recent as 2017 . Cost data has been recently added, but it’s from 2015-2016 reporting years. (NBC affiliateCompare Your Care)

CHI, Dignity finalize merger : Catholic Health and Dignity Health are now CommonSpirit Health, with 142 hospitals and 700+ care sites in 21 states. The new not-for-profit plans to save money by “reducing redundancy” in IT and workforce, and will emphasize expanding access and preventive care. (Modern Healthcare)

MULTI-MEDIA

New Mexico weighs physician-assisted death

Twenty years after Oregon passed its physician-assisted death law, New Mexico is poised to become the eighth state to pass such a law. The current governor has agreed to sign the bill if it’s passed. One element that raised concern among opponents was a reference to using telemedicine for a doctor to prescribe a lethal dose of medication, but that provision was stripped from the bill. However, the waiting period between patient request and when the physician can provide the lethal dose is only two days.  (WBUR Here and Now)

MARKETVOICES...QUOTES WORTH READING

“I think they should post those prices publicly, so we can compare them to chargemaster prices. You can't be a little bit pregnant or transparent.”—Jeanne Pinder, founder of Clear Health Costs, about hospitals that provide package prices for patients who agree to pay in full before leaving the hospital, as quoted by Modern Healthcare.

Jorden Gunessever