Tagged Health Care Costs

Longer Looks: Shuttering Abortion Clinics, Obamacare In The Senate And A Lead-Poisoned Generation

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

Vox: The Obscure Senate Rule That Could Sink Obamacare Repeal, Explained
The fate of the Republican drive to repeal and replace Obamacare — and of the 24 million more Americans who could be uninsured if they succeed — now lies with obscure, complex Senate rules. One rule in particular will determine what Republicans can include in the bill, how much of Obamacare they can repeal, and perhaps whether the bill can pass at all. And the last-minute additions that got conservatives on board with the House version of the American Health Care Act might run into trouble, according to experts and recent legislative precedents. (Dylan Scott, 5/22)

FiveThirtyEight: The Obamacare Marketplaces Aren’t In A Death Spiral
Are the insurance marketplaces created by the Affordable Care Act really on the verge of collapse, as President Trump and GOP leaders have repeatedly claimed? Three months ago, this story would have started like this: It depends on where you look and who you ask. Today, it goes something like this: They are in a fragile state pretty much everywhere. (Anna Maria Barry-Jester, 5/19)

WIRED: Medicine Is Going Digital. The FDA Is Racing To Catch Up
When Bakul Patel started as a policy advisor in the US Food and Drug Administration in 2008, he could pretty much pinpoint when a product was going to land in front of the reviewers in his division. Back when medical devices were heavy on the hardware—your pacemakers and your IUDs—it would take manufacturers years to get them ready for regulatory approval. FDA reviewers could keep up pretty well. (Megan Molteni, 5/22)

The New Yorker: A Bipartisan Way To Improve Medical Care
The health-care crisis in the United States is in many ways a pricing crisis. Nearly all medical care is paid on a fee-for-service basis, which means that medical providers make more money if they perform more procedures. This is perverse. We don’t want an excess of health-care services, especially unnecessary ones; we want health. But hardly anybody gets paid when we are healthy. (Adam Davidson, 5/22)

The Atlantic: The Lead-Poisoned Generation In New Orleans
There is no safe level of lead in the human body. Even at low levels, chronic exposure can damage the brain and the central nervous system, and can cause symptoms from hearing loss to IQ deterioration to lack of impulse control. Over time, lead gets absorbed into the bones, making them brittle and stunted, and causes teeth to crack and rot. Exposure in young children with developing minds and growing bones is most destructive, and in times of serious stress and trauma—common in places like the New Orleans projects in the 1990s—those effects are magnified. (Vann R. Newkirk II, 5/21)

Vox: 45 Million Americans Rely On Food Stamps. Trump Wants To Gut The Program.
In the 1960s and 1970s, food stamps were rolled out in different counties at different times — and researchers have used this variation as a natural experiment to examine the health impacts of SNAP. From improving birth weight to reducing obesity, food stamps were associated with a number of positive health effects. (Julia Belluz, 5/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives: FDA Wades Into Pricing Controversy, But Doesn’t Have Authority To Actually Fix It

Read recent commentaries about drug-cost issues.

Morning Consult: Is The FDA Digging Its Own Hole On Drug Pricing And Opioids?
The Food and Drug Administration may be digging a huge hole for itself by singling out drug pricing and opioid abuse for priority and focused attention. These two highly-visible and highly-charged issues have been pushed into the political arena. The FDA has, unwisely, agreed to take them on. Both issues are mission impossible for the FDA, which has neither the authority nor the resources to solve either problem. The agency is setting itself up to be perceived as having failed. (Wayne Pines, 5/22)

Bloomberg: A Bipartisan Way To Lower Drug Prices
White House budget director Mick Mulvaney has floated an idea to bring down drug prices that’s both promising and — if other Republicans can be persuaded to go along — bipartisan. At a recent health-care forum, Mulvaney proposed that drugmakers be required to pay rebates to the government on drugs sold to Medicare beneficiaries, as they do with drugs sold to Medicaid patients. … In an ideal world, the secretary of Health and Human Services would negotiate on behalf of the 41 million people enrolled in Medicare’s Part D prescription drug plan. That kind of purchasing power — accompanied by the right not to cover a drug it deems too expensive — would give the department great leverage. Unfortunately, Congress not only forbids such negotiation, it requires that Medicare pay for all medicines approved by the Food and Drug Administration. (5/22)

Stat: Clinical Trial Participants Should Have A Say In New Drug Pricing
People who volunteer to participate in clinical trials of new drugs provide a valuable service to pharmaceutical companies and to the rest of us. In return, I think that they should have a say in how much these drugs will cost when they hit the market. Not only would that honor their service, but it would also provide a patient-centered mechanism to lower the price of new drugs. (Spencer Phillips Hey, 5/18)

Bloomberg: Amgen Can Shrug Off Its Bone-Drug Risks
With promising trial results and an FDA approval seemingly near, Amgen Inc.’s osteoporosis drug Evenity was expected to contribute at least something to the company’s top line this year. But Amgen on Sunday evening reported the drug raised unexpected heart-safety concerns. Now the best hope is that its FDA approval will only be pushed to next year and that its commercial opportunity will merely be limited, not eliminated. Otherwise, it may not be worth the effort to keep seeking approval. (Max Nisen, 5/22)

Forbes: New Taxes Won’t Lower Drug Prices
Prescription drug prices continue to be a hot political issue, with the Trump administration preparing to release an action plan as soon as repeal and replace legislation clears Congress. Mick Mulvaney, who heads the White House budget office and is participating in the talks, floated an idea last week that should quickly be crossed off the list of policy ideas. (Grace-Marie Turner, 5/18)

Stat: Will PhRMA’s New Membership Criteria Help?
Earlier this month, PhRMA — the trade group representing innovator pharmaceutical companies — announced a set of new membership criteria. Going forward, PhRMA members will need to meet certain standards regarding their investment in R&D. PhRMA may have felt it needed to take action to restore public confidence in the industry and to constrain the bad press its members have been receiving on the drug pricing front. In my view, the new rules miss the mark. (Rachel Sachs, 5/22)

Bloomberg: Amazon’s Long Shadow Falls On Pharmacies
It’s hard to think of an industry Amazon.com Inc. isn’t currently trying to conquer, or at least thinking of conquering. Pharmacies might be next. According to a CNBC report, Amazon is considering a leap into the prescription-drug business. It wouldn’t be easy, but the industry and its investors shouldn’t dismiss the threat. (Max Nisen, 5/17)

JAMA: Pharmaceutical Marketing For Rare Diseases
The US Food and Drug Administration (FDA) draws a distinction between direct-to-consumer advertising of specific drug products, which it regulates, and advertisements intended to create disease awareness, which it does not. Other nations, including the United Kingdom and the Netherlands, that ban direct-to-consumer marketing permit disease awareness efforts. Challenges arise when disease awareness efforts are made for conditions for which only 1 approved drug product is available; in this case, awareness will boost the sales of a specific drug, and several nations, include the United States, selectively regulate this type of advertising. Recently, a novel form of disease awareness promotion, through a daytime soap opera, raised questions about the role and regulation of this form of marketing. (Sham Mailankody and Vinay Prasad, 5/18)

CityBeat Cincinnati: November Ballot Issue Leaves Lower Drug Prices Up To Ohioans
This November, Ohio voters will decide on a referendum that sounds like a sure thing for passage: lower drug prices. No, this isn’t a follow-up to last year’s marijuana measure, which failed anyway. The discount would only apply to drugs purchased by state employees and retirees and through state programs like Medicaid. An estimated 3.7 million Ohioans, close to a third of the state’s population, would directly benefit. (James McNair, 5/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Amazon Mulls Entering PBM Field, Even As These Middlemen Bear Brunt Of Blame Over High Drug Costs

News outlets report on stories related to pharmaceutical pricing.

Stat: Can Amazon Win As A Pharmacy Benefits Manager?
What kind of impact could Amazon have if the ubiquitous company enters the mysterious and complicated world of pharmacy benefit managers? The online retailer is reportedly exploring the pharmacy business and, as part of the plan, may build an internal PBM for its own employees, but later roll this out to the world at large. The possibility is intriguing because it comes at a time when these middlemen — which negotiate with drug makers for favorable insurance coverage — are under varying degrees of financial and political pressure. (Silverman, 5/18)

Stat: US Drug Prices Are So High That Canada Wants Other Countries As Reference Points
How high are drug prices in the US? So high that the Canadian government may remove the US from its long-standing list of countries that are used as a guide for determining whether prices are excessive. In a proposal issued last week, Health Canada said it wants to overhaul the framework used by the Patented Medicine Prices Review Board, which assesses therapeutic benefits and sets ceiling prices. Right now, this is accomplished, in part, by benchmarking prices against what drug makers currently charge in seven other countries — the US, France, Germany, Italy, Sweden, Switzerland, and the UK. (Silverman, 5/22)

The Wall Street Journal: How The FDA Approved A $300,000-A-Year Drug Its Own Experts Didn’t Believe Worked
Jennifer McNary, a stay-at-home mother, was desperate to find a medicine that might spare her two sons an early death from a rare form of muscular dystrophy. Chris Garabedian, the chief executive of a pharmaceutical firm, was desperate to find a profitable drug that would reverse his company’s slow fall. They met in June 2012 at a conference on Duchenne muscular dystrophy and joined forces, often behind the scenes and with little public disclosure, in a yearslong mission to push the government to approve a drug to treat DMD, as it is known. (Pulliam and Mullins, 5/19)

Stat: Generic Hepatitis C Meds Really Are Cost Effective: Study
For the past three years, various governments and patient advocacy groups have clamored for lower-cost hepatitis C medicines, given the high cure rate for these pricey new drugs. Now, a new study finds that upfront treatment with cheaper generic versions can offer a substantial payback. Using a mathematical model for patients in India, researchers found that copycat versions costing around $300 would increase life expectancy by more than eight years and reduce lifetime health care costs by more than $1,300 per person. (Silverman, 5/18)

The Wall Street Journal: FDA Approves Merck’s Keytruda To Treat Cancers With Genetic Defects
The U.S. Food and Drug Administration on Tuesday approved Merck & Co.’s Keytruda drug to treat tumors with a certain genetic defect—the first time the agency has cleared a cancer drug for a use not tied to the site of a tumor. The FDA approved Keytruda to treat tumors with genetic defects known as “microsatellite instability” or “mismatch repair” deficiencies, which are present in an estimated 4% of cancers. Studies showed the drug shrank tumors in a significant number of patients with colorectal and 14 other cancer types that had the genetic defect. (Loftus, 5/23)

CQ Roll Call: House GOP Tries Last-Minute Push For FDA Marketing Change
Republicans are attempting to address a major priority of the drug and medical device industries as part of a bill to fund the Food and Drug Administration, but in so doing risk injecting a controversial issue into what was supposed to be a smooth bipartisan negotiation. The makers of drugs and devices want the FDA to loosen the regulations governing how they can discuss and promote uses of their products that haven’t been explicitly approved. Approved uses are typically identified on a product’s label, but the practice of using drugs or devices in a so-called “off-label” way is common in some areas of medicine where treatment options may be limited, such as for cancer patients or pediatric populations. (Siddons, 5/24)

Stat: FDA Leaps Into Precision Medicine — With Caveats
The many proponents of precision medicine have long promised a world where terms like “lung cancer” and “melanoma” are rendered quaint by the awesome power of genomics. And the FDA, with its latest approval, just endorsed that vision of the future. The agency cleared Merck’s blockbuster cancer drug Keytruda to treat any solid tumor with one of two genetic abnormalities, marking the first time the FDA has granted such an agnostic approval. There are, of course, caveats — the mutations are rare, and Keytruda can be used only after a prior treatment has failed — but it’s a milestone approval nonetheless, and one that will be heartening to some forward-thinking biotech companies. (Garde, 5/23)

Stat: UK Regulator Says Merck Broke Competition Laws Over Biosimilars
The UK antitrust regulator accused Merck of illegally offering discounts for the Remicade biologic medicine in order to block lower-cost biosimilar versions. In a brief statement, the Competition and Markets Authority said it found that the drug maker “provisionally” broke the competition law and was “abusing its dominant position” in the market with its discount scheme. Remicade is used to treat chronic inflammatory diseases such as rheumatoid arthritis. (Silverman, 5/23)

Reuters: India’s Drug Pricing Regulator Clamps Down On Drug Cocktails
India’s drug pricing regulator has demanded explanations from 65 domestic and global drugmakers for selling new forms of essential diabetes and antibiotic drugs without its approval. The move could bring penalties for the drugmakers, among them Abbott Laboratories, Sanofi, Novartis and Indian firms such as Sun Pharmaceutical Industries and Lupin, the National Pharmaceutical Pricing Authority (NPPA) said on its website. (Siddiqui, 5/18)

Reuters: UK Competition Watchdog Accuses Merck Of Obstructing Biosimilars
Britain’s competition watchdog has accused Merck & Co of operating an unfair discount scheme for its medicine Remicade that it said was designed to restrict competition from so-called biosimilar copies. The Competition and Markets Authority (CMA) said on Tuesday it had provisionally found the U.S. company’s European unit, Merck Sharp & Dohme, had abused its dominant position through the scheme, opening it up to potential financial penalties. (Hirschler, 5/23)

Stat: Former Lilly Employee Wins An Ironic Lawsuit Over Disability Benefits
A federal appeals court ruled last week that Eli Lilly should not have ended disability benefits to a former human resources director who claimed she was unable to continue working because she suffered from fibromyalgia, a chronic neurologic condition. Yet at the same time the former employee was fighting in court to have those benefits restored, the drug maker was marketing a medicine in the US to treat the condition, which one of its own consultants had described as “very disabling,” according to court documents. (Silverman, 5/22)

Stat: How A Drug Ad Made Its Way Into ‘General Hospital’
[Anna] Devane is a soap opera character, as you might have guessed, appearing for the last 32 years on “General Hospital.” And her dramatic diagnosis is brought to you by Incyte Corp., a biotech company that happens to market a drug for her on-screen disease, the rare blood disorder polycythemia vera. The scene, which aired in February, is a novel twist on what’s called unbranded advertising, in which drug companies detail the symptoms of a disease but refrain from mentioning the names of any drugs. (Garde, 5/18)

FiercePharma: Drama And Diagnosis On Soap Opera Set Troubles Cancer Doctors, Puts Incyte In Hot Seat
Soap operas often include medical mysteries and miracles, but a couple of real-life doctors are concerned about Incyte’s connection to the latest drama on General Hospital. Writing in JAMA, oncologists Sham Mailankody and Vinay Prasad question the ABC soap opera’s rare-disease plot enabled by a partnership with the biopharma company Incyte. In the General Hospital storyline begun in February, leading character Anna Devane is diagnosed with a rare blood cancer called polycythemia vera (PV). The show doctors explain to the character, who is played by Incyte spokesperson Finola Hughes, that PV is part of a group of rare blood cancers called myeloproliferative neoplasms, and that there are treatments, but no cure. (Bulik, 5/22)

Stat: This Company Admitted Failure — And The Stock Market Rewarded It
Rather than shunning the company, investors embraced it. Only a small number of them cashed out their shares. (The coauthor of the paper who took responsibility for the error returned the stock, but made the shares a donation.) The IPO, delayed by a few weeks, went forward. And within a few years WntResearch stock went on a surge that to date has left it up nearly 500 percent over 6 1/2 years. In other words: Openness was a risk in the short run but a long-term boon for the company. (Oransky and Marcus, 5/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Viewpoints: ‘Taxpayer-First Budget’ Inflicting Pain; Slow Rollout Of Menu Calorie Counts

A selection of opinions on health care from around the country.

The New York Times: A Budget That Promises Little But Pain
If President Trump’s 2018 budget, to be unveiled on Tuesday, was worthy of praise, you can bet Mr. Trump would be in Washington to bask in it. But his overseas trip keeps him at a distance physically, if not politically. As detailed in a preview on Monday by Mick Mulvaney, the White House budget director, the budget is a naked appeal to far-right Republicans aiming for a partisan rallying cry, even as a legislative victory most likely remains out of reach. Of 13 major initiatives in the budget, nine are drastic spending cuts, mostly aimed at low-income Americans. The biggest of those, by far, is an $866 billion reduction over 10 years in health care spending, mostly from Medicaid. (5/23)

The Washington Post: Another Bad Budget From Trump Targets The Poor
President Trump released a proposal for fiscal year 2018 discretionary spending — the “skinny budget” — two months ago, and the $1.1 trillion plan garnered deservedly poor reviews. In a nutshell, Mr. Trump would have gutted the Environmental Protection Agency, the National Institutes of Health and similarly crucial domestic agencies to fund a big boost in defense spending and border security. On Tuesday the White House releases its ideas for the remaining $3 trillion or so in federal spending, including large-scale entitlements such as Medicaid, and the early indications are that the priorities embodied in this sequel will be no more humane or rational. (5/22)

Miami Herald: The Federal Budget Released Today Puts Taxpayers First
This Tuesday, the president will release his Fiscal Year 2018 budget request. The title on the cover reads “A New Foundation for American Greatness.” But it’s what’s inside that’s more important. What people will see there is something that has been missing from Washington for a long time: “A Taxpayer First Budget.” … For years, we’ve focused on how we can help Americans receive taxpayer-funded assistance. Under President Trump’s leadership, we’re now looking at how we can respect both those who require assistance and the taxpayers who fund that support. For the first time in a long time, we’re putting taxpayers first. (Budget director Mick Mulvaney, 5/22)

The Washington Post: Trump’s First Budget: Why Attention Must Be Paid To It
So, with two partial exceptions, the President’s budget cannot be viewed as anything other than the standard issue, highly partisan, thoroughly uncompromising budgets we’ve seen from Republicans since the rise of Paul D. Ryan. The purpose of these budgets, which even Ryan himself has characterized as more “visionary” than realistic, is to shrink government outside of defense and give the savings to their wealthy donors in the form of regressive tax cuts. Their ultimate targets are Social Security, Medicare, and Medicaid, and with this budget, we can see that strategy evolving. (Jared Bernstein, 5/22)

Los Angeles Times: Trump’s Budget Plan Continues His Deceitful Attack On The Disabled — And Violates A Campaign Pledge
We pointed out back in March that Trump budget direct Mick Mulvaney displayed an alarming ignorance about Social Security disability benefits during an appearance on the CBS program “Face the Nation.” Now it turns out that there was method to his muttering. In effect, Mulvaney was telegraphing that the Trump White House was planning to cut disability benefits sharply. Axios reported Sunday that the Trump budget due out Tuesday will include $1.7 trillion in cuts to major social insurance and assistance programs, including food stamps, the Children’s Health Insurance Program, and Social Security disability. (Michael Hiltzik, 5/22)

Forbes: This Week’s Rollout Of Trump 2018 Budget Could Be His Biggest Failure Yet
On top of everything else, the Trump 2018 budget and OMB Director Mulvaney’s first testimony about it, which is currently scheduled for Wednesday before the House Budget Committee, is virtually certain to get much less attention because the Congressional Budget Office is now expected to release its estimates of the impact of the House-passed American Health Care Act that same day … and those numbers are very likely to be devastating. … CBO’s new AHCA numbers took on dramatically increased importance last week when the Republican leadership let it be known that the House might have to vote on the bill a second time because, as reported, it might not satisfy all of the Senate’s Byrd rule requirements. (Stan Collender, 5/21)

Philly.com: Slash Medicaid And You Jeopardize Care For Everyone
Just before launching his presidential campaign, Donald Trump promised that if elected, he would not cut funding for Medicaid. Chalk that up to yet another campaign promise reneged on. Trump’s budget proposal calls for more than $800 billion in cuts. … But even more is at stake than the lives of poor and disabled Americans, something the architects of these plans don’t seem to care much about. The cuts would jeopardize the entire health care system. (Robert I. Field, 5/23)

The Washington Post: Trump’s Budget Is So Cruel A Russian Propaganda Outfit Set The White House Straight
Trump, who once vowed “no cuts” to Medicaid, would now cut Medicaid by more than $800 billion, denying support to 10 million people. He lops a total of $1.7 trillion off that and similar programs, including food stamps, school lunches and Habitat for Humanity. Mulvaney, defending the budget Monday, made a frank admission: “This is, I think, the first time in a long time an administration has written a budget through the eyes of people who actually are paying the taxes. Too often in Washington I think we often think only on the recipient side.” (Dana Milbank, 5/22)

USA Today: Calorie Labeling Isn’t Rocket Science
Watching your weight while grabbing a bite at your favorite chain restaurant, supermarket food bar or convenience store was supposed to get easier under a 2010 federal law requiring that certain businesses post calorie counts. This isn’t rocket science. But after seven years, the final posting rules are still on hold, and this month the Trump administration delayed compliance again. If the newest date — May 7, 2018 — holds, it will have taken nearly as long to post calorie counts as it did to put a man on the moon after President Kennedy announced this ambitious goal in 1961. (5/22)

USA Today: Pizza Makers Weigh In On Calories
America’s pizza delivery companies want a reasonable 21st century solution to the nutrition labeling challenge: We simply want approval to put the information where our customers look for it. At Domino’s, we’ve been posting nutritional information on our website for nearly 14 years because it’s the easiest way to provide the information to our customers where they will most likely see it. Unfortunately, the menu labeling rule as written does not make accommodations for brands whose majority of orders come from people who order online. The rule seems better suited to sit-down chains and fast-food joints. (Tim McIntyre, 5/22)

Forbes: North Carolina Poised To Reform Welfare Programs To Protect Truly Needy
A provision in the [North Carolina] Senate’s budget proposal, spearheaded by Sen. Ralph Hise, would rein in frequently-exploited loopholes in the state’s food stamps and Medicaid systems, bringing overdue protection to valuable resources for families who need them most and protecting the system from abuse. North Carolina’s current broad-based eligibility expansion in food stamps has been ripe for reform since 2010 when former Gov. Bev Perdue took advantage of a loophole that expanded welfare eligibility beyond the federal limits. (Josh Archambault, 5/22)

The New York Times: Hey Parents, Surprise, Fruit Juice Is Not Fruit
Many American children consume more than half of their fruit as juice, and the American Academy of Pediatrics has issued new guidelines clarifying its stance on that substitution: For most kids, it’s a bad thing. The new guidelines aren’t just intended to persuade pediatricians to talk to parents about the disadvantages of the ubiquitous juice box. They also take aim at the federal government’s Dietary Guidelines for Americans, which are the basis for the nutritional guidelines in the Department of Agriculture’s School Lunch Program — guidelines that allow for the replacement of half of the recommended daily servings of fruits with 100 percent fruit juice. (KJ Dell’Antonia, 5/22)

Louisville Courier-Journal: Fighting The Opioid Epidemic
As many as two million Americans are struggling with prescription drug addiction across the nation. Tragically, heroin and opioid overdoses claim an average of 91 lives every day. This startling trend continues to get worse, especially here in Kentucky. … I made securing crucial new resources to help combat heroin and prescription opioid abuse a top priority in the government funding bill that was recently signed into law. These new resources, which dedicates substantial funding through the appropriations process to address this crisis, will allow us to take another step towards ending it. (Senate Majority Leader Mitch McConnell (R-Ky.), 5/23)

Stat: Training Medical Students How To Teach Helps Them Embrace Ambiguity
In volunteering to help teach the course, neither of us anticipated that questions asked by first-year medical students would heighten our curiosity and passion for medicine. But they did. We looked for answers and followed up with the students who asked them. In the process, we also reflected on how to be better self-directed learners and more effective teachers. (Jasmine Rana and Taylor Freret, 5/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

New Hampshire Governor Supports Moving State To High-Risk Pool Model

Meanwhile, the state’s conservatives speak out against reported rate increases for next year. “The latest premium increases under Obamacare will break many families’ budgets,” says New Hampshire Republican State Committee Chairman Jeanie Forrester.

New Hampshire Union Leader: Sununu Proposes Return Of High-Risk Pool
Gov. Chris Sununu and the state’s top insurance official on Monday backed a revision in state law that would allow officials to waive some of the provisions of Obamacare — including provisions addressing pre-existing conditions. In a joint statement, Sununu and New Hampshire Insurance Commissioner Roger Sevigny endorsed an amendment to House Bill 469, which they said would authorize Sevigny to seek federal waivers if they would keep insurance affordable and available in the state. On Sunday, the New Hampshire Sunday News reported about a document that details a potential premium increase of 44 percent next year on the Obamacare Exchange. (Hayward, 5/23)

New Hampshire Union Leader: NH Conservative Groups Critical Of Possible Obamacare Rate Increases 
Granite State conservative groups weighed in Monday on a report in the New Hampshire Sunday News that health insurance policies through the Affordable Care Act could see high rate increases in the coming year. “The latest premium increases under Obamacare will break many families’ budgets. The law is obviously failing working people and is doing far more harm than good. Republicans in Congress are actively working to reform our nation’s healthcare system with a plan that lowers premiums while ensuring folks have access to quality coverage,” said New Hampshire Republican State Committee Chairman Jeanie Forrester. (5/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Disagreement Over Preexisting Conditions Reveals Deep Intra-Party Divide Over Health Law

The push-and-pull between moderate and conservative Republicans is not limited to the House debates. Cracks in the Senate are showing as well.

The Hill: Divisions Emerge In The Senate On Pre-Existing Conditions 
Senate Republicans are showing early divisions over what to do about ObamaCare’s protections for people with pre-existing conditions. Some conservatives, including Sen. Mike Lee (R-Utah), want to simply repeal those provisions and other ObamaCare regulations and leave them up to the states. But advocates of a more centrist approach, like Sen. Bill Cassidy (R-La.), are speaking out in favor of pre-existing condition protections and endorsing a “Jimmy Kimmel test” for the bill, where no one can be denied coverage.  (Sullivan, 5/23)

Nashville Tennessean: Senate Republicans Consider ‘Two-Step’ Process For Obamacare Replacement
Republican senators working to craft their own bill to replace the Affordable Care Act are looking at possibly phasing out the requirement that Americans buy health insurance instead of ending it abruptly. Sen. Lamar Alexander, who chairs the committee that oversees health care issues, said Monday a “two-step” process for ending the insurance mandate and other provisions is something that senators have been discussing. (Collins and Whetstone, 5/22)

The Hill: Conservative Groups Press Senate On ObamaCare Repeal 
Two conservative groups are seeking to influence the Senate’s healthcare bill with a list of recommendations aimed at keeping the bill to the right. Americans for Prosperity and Freedom Partners detailed their requests in a letter sent Monday to Senate Majority Leader Mitch McConnell (R-Ky.), who has convened a working group of senators to examine what ObamaCare repeal-and-replace bill can pass the chamber. (Roubein, 5/22)

Kaiser Health News: GOP’s Health Bill Could Undercut Some Coverage In Job-Based Insurance
The American Health Care Act that recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too. The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, drugs and maternity care. (Andrews, 5/23)

Meanwhile, back in the House —

Politico Pro: House Panel To Start Work On ‘Third Bucket’ Obamacare Bills 
House Republicans on Wednesday plan to start work on three Obamacare replacement bills they’re hoping to pass with bipartisan support, sources familiar with the matter said. These bills are part of the so-called third bucket of the GOP repeal and replace strategy — legislation that doesn’t fit the fast-track budget reconciliation procedure being used to get Obamacare repeal through the Senate, but which further advances the Republican vision of reshaping health care. (Haberkorn and Everett, 5/22)

And, a look at how many people have gained coverage under the Affordable Care Act —

The New York Times: Nearly 20 Million Have Gained Health Insurance Since 2010
The number of Americans without health insurance has fallen drastically in recent years, according to new data from the National Center for Health Statistics. In 2016, there were 28.6 million Americans without health insurance, down from more than 48 million in 2010. Some 12.4 percent of adults aged 18 to 24 were uninsured, 69.2 percent were covered by private plans and 20 percent had public coverage. (Bakalar, 5/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

GOP’s Health Bill Could Undercut Some Coverage In Job-Based Insurance

This week, I answer questions about how the Republican proposal to overhaul the health law could affect job-based insurance and what the penalties for not having continuous coverage mean. Perhaps anticipating a spell of uninsurance, another reader wondered if people can rely on the emergency department for routine care.

Q: Will employer-based health care be affected by the new Republican plan?

The American Health Care Act that recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too.

Michelle AndrewsInsuring Your Health

The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, drugs and maternity care.

Small businesses (generally companies with 50 or fewer employees) in those states would also be affected by the change.

Plans offered by large employers have never been required to cover the essential health benefits, so the bill wouldn’t change their obligations. Many of them, however, provide comprehensive coverage that includes many of these benefits.  

But here’s where it gets tricky. The ACA placed caps on how much consumers can be required to pay out-of-pocket in deductibles, copays and coinsurance every year, and they apply to most plans, including large employer plans. In 2017, the spending limit is $7,150 for an individual plan and $14,300 for family coverage. Yet there’s a catch: The spending limits apply only to services covered by the essential health benefits. Insurers could charge people any amount for services deemed nonessential by the states.

Similarly, the law prohibits insurers from imposing lifetime or annual dollar limits on services — but only if those services are related to the essential health benefits.

In addition, if any single state weakened its essential health benefits requirements, it could affect large employer plans in every state, analysts say. That’s because these employers, who often operate in multiple states, are allowed to pick which state’s definition of essential health benefits they want to use in determining what counts toward consumer spending caps and annual and lifetime coverage limits.

“If you eliminate [the federal essential health benefits] requirement you could see a lot of state variation, and there could be an incentive for companies that are looking to save money to pick a state” with skimpier requirements, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.

Q: I keep hearing that nobody in the United States is ever refused medical care — that whether they can afford it or not a hospital can’t refuse them treatment. If this is the case, why couldn’t an uninsured person simply go to the front desk at the hospital and ask for treatment, which by law can’t be denied, such as, “I’m here for my annual physical, or for a screening colonoscopy”?

If you are having chest pains or you just sliced your hand open while carving a chicken, you can go to nearly any hospital with an emergency department, and — under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) — the staff is obligated to conduct a medical exam to see if you need emergency care. If so, they must try to stabilize your condition, whether or not you have insurance.

The key word here is “emergency.” If you’re due for a colonoscopy to screen for cancer, unless you have symptoms such as severe pain or rectal bleeding, emergency department personnel wouldn’t likely order the exam, said Dr. Jesse Pines, a professor of emergency medicine and health policy at George Washington University, in Washington, D.C.

“It’s not the standard of care to do screening tests in the emergency department,” Pines said, noting in that situation the appropriate next step would be to refer you to a local gastroenterologist who could perform the exam.

Even though the law requires hospitals to evaluate anyone who comes in the door, being uninsured doesn’t let people off the hook financially. You’ll still likely get bills from the hospital and physicians for any care you receive, Pines said.

Q: The Republican proposal says people who don’t maintain “continuous coverage” would have to pay extra for their insurance. What does that mean? 

Under the bill passed by the House, people who have a break in their health insurance coverage of more than 63 days in a year would be hit with a 30 percent premium surcharge for a year after buying a new plan on the individual market.

In contrast, under the ACA’s “individual mandate,” people are required to have health insurance or pay a fine equal to the greater of 2.5 percent of their income or $695 per adult. They’re allowed a break of no more than two continuous months every year before the penalty kicks in for the months they were without coverage.

The continuous coverage requirement is the Republicans’ preferred strategy to encourage people to get health insurance. But some analysts have questioned how effective it would be. They point out that, whereas the ACA penalizes people for not having insurance on an ongoing basis, the AHCA penalty kicks in only when people try to buy coverage after a break. It could actually discourage healthy people from getting back into the market unless they’re sick.

In addition, the AHCA penalty, which is based on a plan’s premium, would likely have a greater impact on older people, whose premiums are relatively higher, and those with lower incomes, said Sara Collins, a vice president at the Commonwealth Fund, who authored an analysis of the impact of the penalties.

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Categories: Health Care Costs, Health Industry, Insurance, Insuring Your Health, Repeal And Replace Watch, The Health Law

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Viewpoints: Opening For Medicare Long-Term Care?; Texas Seeks Planned Parenthood Money

A selection of opinions on health care from around the country.

Forbes: Congress May Open The Door To Some Medicare Long-Term Care
Congress is taking a small, but important, step towards expanding Medicare to include some long-term supports and services. … the biggest changes would apply to the care provided by managed care programs. One would expand the use of those special needs plans, which are explicitly aimed at people with chronic conditions and high medical needs. Some of these programs already provide supports and services as part of their benefit packages but they remain relatively small. The other would give Medicare Advantage plans important new flexibility to offer social supports and other non-medical services to their members. (Howard Gleckman, 5/17)

Los Angeles Times: Texas Wants To Use Federal Money To Attack Planned Parenthood — And Might Get It
Five years ago, Texas voluntarily gave up $30 million a year in federal funding for women’s health programs, just so it could exclude Planned Parenthood from the roster of approved providers. Instead, the state established its own so-called Healthy Texas Women program in which it could set its own rules. Now, staggering under the cost of the program and hopeful that the Trump administration will see things its way, Texas is applying for a restoration of the federal subsidy under the same terms. Signals from the White House and the Department of Health and Human Services suggest the state might succeed. If so, some other states may follow, and the cause of women’s reproductive health will suffer a major blow. (Michael Hiltzik, 5/18)

Des Moines Register: Health Has No Religion; Health Care Shouldn’t Have One Either
A policy with wide-ranging consequences for patients of Mercy Medical Center was made public recently through a Facebook post on a page for mothers. It came from a woman who was denied a tubal ligation after having a cesarean section because Mercy is a Catholic hospital. In verifying that prohibition, I discovered other religious-based restrictions at Mercy and 547 other Catholic hospitals across the U.S. How are these institutions fulfilling their legal and professional obligations to their patients and the taxpayers who subsidize them with billions of dollars? (Rekha Basu, 5/18)

Next Avenue: Aging at Home Will Be Harder With Medicaid Cuts
Proposed cuts to Medicaid under the American Health Care Act passed by the House recently could change life for (Ti) Randall and many others. Medicaid is not only an insurance program for low-income people. It’s a lifeline for older adults like Randall who need supportive services to stay at home. At-home services are a lifeline for Medicaid as well, which would otherwise be paying for more expensive care in an institutional setting. (Beth Baker, 5/17)

Stat: Doctors Must Be Honest About Their Own Biases When Treating People In Pain
Many doctors enter medicine to prevent and treat suffering. Yet it seems that as we advance in our training, the more bothersome and frustrating evaluations of pain become. We want to make people feel better, but we don’t always know why or how much someone is hurting. And there are consequences of both prescribing too much or too little pain relief. So we turn to this language to minimize the pain we don’t understand or can’t fix. Unfortunately, this tends to occur more often with patients of color. (Katherine Brooks, 5/17)

Stat: Why Taking Drugs To Treat Addiction Doesn’t Mean You’re ‘Still Addicted’
My patient was lucky: He didn’t die because of a widely held, and completely inaccurate, definition of addiction — one that was recently supported by remarks from Health and Human Services Secretary Tom Price, who disparaged medication use as merely “substituting one opioid for another.” But until politicians, the media, and the public catch up with addiction science, we will not be able to stop the epidemic of overdose deaths. (Sarah E. Wakeman and Maia Szalavitz, 5/18)

JAMA: Primary Care Of Patients With Chronic Pain
Primary care physicians have the responsibility for the care of patients with chronic pain, often in follow-up to an episode of acute pain treated in an urgent care center, emergency department, or specialty clinic setting. The lack of a full understanding of how chronic pain differs from acute pain can lead to all pain being treated as acute pain, often with opioids. The current widespread use of opioids is essentially a case-finding system that identifies the roughly one-sixth of the adult population particularly susceptible to opioid misuse, sometimes leading to escalating doses, a shift to illegal nonprescription opioids, addiction, and unintentional overdose. (Jill Schneiderhan, Daniel Clauw and Thomas L. Schwenk, 5/18)

Des Moines Register: Iowa Should Allow Needle Exchange Programs
The Iowa Department of Public Health in February released its first report on hepatitis C infections in this state. The number of Iowans diagnosed with the liver-damaging virus that can lead to death has increased nearly three-fold, from 754 cases in 2000 to 2,235 cases in 2015. The number of infected Iowans aged 18 to 30 has quadrupled in recent years. … preventing the spread of the virus is so important, and Iowa is not doing all it can. Unlike several other states, we do not have a needle exchange program, which is an important part of infection prevention. (5/18)

The (Eugene, Ore.) Register-Guard: Oregon’s Medicaid Mess
“Troubling” doesn’t begin to describe the current situation at the Oregon Health Authority, which, state auditors have discovered, has been doling out hundreds of millions of dollars to tens of thousands of Medicaid recipients who may or may not be eligible for the benefits. … About three years ago, Oregon got permission from federal regulators to temporarily quit verifying that each OHP patient still qualified for Medicaid. At the time, the state was in the throes of extricating itself from Cover Oregon, which failed spectacularly in setting up an online program to enroll people in health care. Somehow, the state never got around to resuming these routine eligibility checks. (5/19)

Morning Consult: Turning Up The Volume On Over-The-Counter Hearing Aids
Hearing aids currently cost around $5,000 per pair. Fitting and tuning are not covered by Medicare or most private insurance plans. Unable to afford these out-of-pocket costs, nearly 80 percent of Americans with hearing loss choose to suffer on their own. … It shouldn’t be this way. The technology exists to deliver relief to these patients and the families that love them. But government has to act to ensure that those who stand to gain the most from that innovation are able to access it. The Over-the-Counter Hearing Aid Act of 2017 would be a needed update to federal policy. (Rep. Joe Kennedy III (R-Mass.) and Rep. Marsha Blackburn (R-Tenn.), 5/18)

The Kansas City Star: Vital Diabetes Device Denied By Medicare
I’m angry because people like me are being denied an essential medical treatment by Medicare, the federal program that’s supposed to be supporting seniors, not forcing them to abandon an essential medical device. The device I use is called Omnipod. It’s a wireless insulin delivery pump. … A few months before turning 65, I was told that unlike almost all private insurers in this country, Medicare wouldn’t pay for Omnipod. And I was even more confused to learn that this was the only FDA-approved insulin pump not covered by Medicare. (Susan Vietti, 5/18)

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Perspectives: Doctors Are Still Prescribing Brand Name Drugs Over Generics, And You Can Blame Pharma For It

Read recent commentaries about drug-cost issues.

RealClear Health: Why Are Physicians Still Prescribing High Cost Brand Name Drugs? Ask Pharma.
Generic drugs are a boon in health care. Typically lower in cost and as effective as their branded counterparts, they help control pharmacy spending and increase access to important therapies for patients who could be deterred by the high cost of some branded drugs. In fact, research shows that the use of generic drugs produces annual savings in excess of $200 billion. (Troyen Brennan, 5/14)

The Washington Post: Trump’s New FDA Commissioner Has A Huge Decision To Make
Last week, the Senate confirmed Scott Gottlieb to lead the Food and Drug Administration. That puts the new commissioner in the hot seat to tackle several high-profile issues that are critically important to patients and consumers. Among the most important decisions he’ll have to make early on is whether to accept industry proposals to reduce standards under which drugs can be advertised — regulations that have protected patients for more than 50 years. (William B. Schultz, 5/16)

Cincinnati Enquirer: Lowering Prescription Drug Costs Will Improve Care For All Americans
I agree with Gov. John Kasich, we cannot allow Washington politicians with taxpayer-funded health insurance to rip coverage away from Ohioans who are battling cancer, getting regular checkups for the first time, or finally getting treatment for their opioid addiction. Of course we need to do more to lower costs for Ohioans, and I’m ready to work with anyone on commonsense ideas to make our health care system work better. (Sherrod Brown, 5/25)

Cincinnati Enquirer: Who Represents Us?
Negotiated pricing is the common-sense solution to reining in the costs of prescription drugs. It has been in use for many decades, for drugs bought by the Veterans Administration, General Services Administration, all military branches, and the Defense Supply Center Philadelphia; why not Medicare? There is no acceptable reason for these laws. (James Baker, 5/10)

CNN: Health Care Costs Are Bankrupting Us
The financial insecurity experienced by many Americans certainly figures into any root-cause analysis for why President Trump was elected. But for most Americans, the “biggest tax cut ever” will do little to reduce that insecurity. Driving down health care costs — and making them more predictable — is far more important. (H. Gilbert Welch and Elliott Fisher, 5/11)

The Wall Street Journal: The Drug Lobby’s In-House Hygiene
This week’s non-Comey news file contains an encouraging development for U.S. medical innovation amid the running political debate over pharmaceutical prices. The main drug lobby ousted 22 members and adopted corporate governance reforms. (5/10)

Bloomberg: Merck Can’t Say How Good Its Good News Is
Merck & Co.’s 2017 just got a whole lot brighter. The company announced Wednesday evening that its immune-boosting cancer drug Keytruda can now be prescribed in combination with chemotherapy, vaulting it ahead of its rivals in the space. It’s huge news. But exactly how huge it is going forward is largely out of Merck’s control. (Max Nisen, 5/11)

The Fiscal Times: How Trump Can Score A Big, Bipartisan Win On Health Care 
Prescription drugs may not be the costliest part of our health system, but they’re the fastest-rising charge that hits individual pocketbooks directly. The demand for legislative reform is palpable; every politician in Washington has an interest in defusing the drug price explosion. But as close as victory sits, it’s also just out of our grasp. (David Dayen, 5/16)

Montana Standard: Three Easy Steps To Drug Price Control
I find it is despicable the House of Representatives is blaming the high cost of health care on the poor, elderly and chronically ill. They need to address the real reasons for increasing costs of health care, the increasing costs of health care. Take drug costs, for starters. The total drug expenditures for 2015 in America rose 12.2 percent during the previous year. (Michael Bernhardt, 5/11)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Drugmakers Deploy Lobbyists As Battle Over High Prices Moves To State Level

May 17 2017

News outlets report on stories related to pharmaceutical pricing.

The Wall Street Journal: As States Wage Battles On High Drug Prices, Drugmakers Fight Back
Amid increasing calls for curbs on U.S. drug pricing, some of the most aggressive legislative action is happening at the state level—and industry lobbyists are fanning out to fight back. Lawmakers have introduced bills in about 30 state legislatures this year, seeking to regulate drug prices; require manufacturers to justify price increases; or to form purchasing groups with other states to negotiate lower prices, according to the National Academy for State Health Policy, a nonprofit policy group that has drafted model drug-pricing bills for state use. (Loftus, 5/17)

Stat: Can Importing Drugs Bring Down Drug Prices For Americans?
Poll after poll shows Americans are increasingly concerned about the price of prescription drugs. With each new survey, the debate about importing drugs from Canada seems to gain steam. At least four different bills have been introduced this year in Congress, and while the fate of legislation to replace the Affordable Care Act dominates the agenda on Capitol Hill, buying drugs across the border is an idea that won’t go away. (Sheridan, 5/11)

Stat: The 5 Most Overpaid Pharma CEOs In The World
There’s no shortage of ways to rank pharma CEOs: Drug sales. Corporate profits. Even haircuts. Here at STAT, we chose to look at it from a shareholder’s perspective. We calculated shareholder returns over the past three years at the 25 biggest drug companies in the world. Then we compared that with CEO compensation. Five outliers popped out: chief executives who got raises well out of step with what they delivered to investors. (Garde, 5/16)

FiercePharma: The Top 15 Generic Drugmakers By 2016 Revenue
Branded drugmakers weren’t the only ones working through a tumultuous 2016. Generics companies faced pricing pressure, too. And while branded companies suffer pricing pain on costly cutting-edge therapies, generics outfits feel the pinch with already-thin margins, making pressure all the more agonizing.How is the industry responding? By consolidating and hoping to save money, for one. Take a look at FiercePharma’s 2014 ranking, and it’s clear that some companies have made leaps too big to depend on organic growth alone. (Sagonowsky, 5/16)

Stat: Researchers Urge FDA To Lower The Bar On Alzheimer’S Drug Approvals
Could changing up regulatory requirements for Alzheimer’s drugs help give desperate patients new options for treatment? A group of researchers and patient advocates think so. They authored a paper that argues that the Food and Drug Administration should evaluate Alzheimer’s drugs for efficacy in either cognition or function — but not both. Efficacy and cognition are the main endpoints measured in Alzheimer’s disease. The hallmark of cognitive impairment is memory loss, while functional impairment involves losing the ability to perform tasks of daily living — from reading to going to the bathroom to getting dressed in the morning. Currently, FDA expects drugs to improve both cognition and function. (Keshavan, 5/15)

NBC News: Patients Beg For Pricey Drugs On Facebook Black Market
Desperate patients are swapping pricey pharmaceutical drugs on Facebook. Doctors say it’s dangerous. But when you need a drug every day to survive, you’re going to find a way to get it. It shouldn’t be that surprising. You can buy, sell or trade almost anything on Facebook, from designer sneakers to unwanted fishing boats to antique medical cots. Now, even life-saving insulin. (Popken, 5/11)

Kansas City Star: 60,000 Older Missourians To Lose Prescription Drug Aid 
Roughly 60,000 older Missourians will lose state aid to help them pay for prescription drugs starting in July. But lawmakers hope the cut won’t be permanent. Seniors who earn less than 85 percent of the federal poverty level, or roughly $10,000 a year for an individual, qualify for both Medicaid and Medicare. (Hancock, 5/11)

Stat: Lower FDA Standards Could Have Cost Billions For Failed Alzheimer’S Drug
Priced at $10,000 per person, the cost totaled roughly $10 billion during that time. To some, this would appear to be a bargain for a drug that combats a pernicious disease, yes? But what if it turns out the drug later failed yet another trial and patients with a mild form of Alzheimer’s weren’t helped, after all? The money —much of it spent by Medicare — would have been wasted and patients’ hopes dashed. (Silverman, 5/12)

FiercePharma: EU Officials Question ‘Unjustified’ Cancer Drug Pricing From Aspen
Upon receiving information that Aspen Pharmacare has taken steep price increases on lifesaving cancer meds in Europe and threatened to pull its products in order to get the hikes through, EU antitrust regulators have pledged to take a close look at the South African drugmaker’s business practices. Europe’s competition authority opened an investigation into Aspen on Monday, seeking to learn whether the company “abused a dominant market position in breach of EU antitrust rules,” according to a release. It noted this is the first time it has looked into excessive pricing in pharmaceuticals. (Sagonowsky, 5/15)

Stat: What Strike? FDA Sees Through Delaying Tactic
That is the lesson that the management at Vikshara Trading & Investments learned the hard way when the company tried to forestall an agency inspection last year by insisting that its workers were on strike and its plant in Gujarat, India, was inaccessible. But were they really on strike?…A year ago, the FDA scheduled an inspection, but last June, Vikshara said employees went on strike and blocked the entrance to the facility. As a result, the agency canceled a planned June 27 inspection. Last July, Vikshara said the strike was ongoing and, in August, provided purported evidence, such as employee resignation letters and a photograph of striking employees blocking the entrance. (Silverman, 5/9)

Stat: Biosimilar Company Uses Citizen’s Petition In A New Way
An aspiring biosimilar manufacturer is employing a citizen’s petition in a novel way in hopes of setting regulatory approval standards. In a May 3 letter, Apotex asked the Food and Drug Administration to set a specific requirement for other biosimilar companies that, depending upon what the agency decides, may serve as a barrier to regulatory approval of their treatments. (Silverman, 5/11)

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Drugmakers Would Be Required To Notify HHS, Justify Price Hikes Under New Bill

The companies would have to provide manufacturing, R&D, marketing costs, as well as net profits associated with the drugs. In other pharmaceutical news, consolidation and how it’s led to higher drug prices; direct-to-consumer ads and their role in pushing drugs; and what happens when a patient’s body turns against the drugs trying to save them.

Stat: Bipartisan Bill Will Be Reintroduced To Make Pharma Justify Price Hikes
A bipartisan group of lawmakers will re-introduce a bill on Tuesday that would require drug makers to justify their pricing and provide a breakdown of their expenses before raising prices on some medicines. Under the Fair Drug Pricing Act, companies will have to notify the US Department of Health and Human Services and submit a report 30 days before they increase the price of certain drugs that cost at least $100 by more than 10 percent in one year, or 25 percent over three years. The bill is being co-sponsored by Senator Tammy Baldwin (D-Wis.), Senator John McCain (R-Ariz.), and US Representative Jan Schakowsky (D-Ill.) (Silverman, 5/15)

Modern Healthcare: Consolidation Spurs Drug Price Spikes 
More consolidation among healthcare distributors and pharmacy benefit managers has led to higher drug prices, according to a new article. The major players in both the distribution market and the PBM sector dominate their markets, the article published Monday in JAMA said. As the firms grew, prices for prescription drugs swelled, the article found. (Kacik, 5/15)

Kaiser Health News: Overwrought Marketing? Ads, Not Research, Create Some Pharma Best-Sellers
An overhead light drawing attention to his face, actor Danny Glover starts to cry, dropping his head into one hand — then, he abruptly switches over to deep belly laughs, before resuming a straight face. “When I act, if I do this it’s totally in my control,” he says, getting to the point: “But for someone with pseudobulbar affect, choosing to cry or laugh may not be your decision. ”The 60-second TV advertisement, which ran widely late last year, concerns a neurological condition known by the acronym PBA, characterized by inappropriate, uncontrolled outbursts of laughing or crying. (Appleby, 5/16)

The New York Times: When The Immune System Thwarts Lifesaving Drugs
The miracle treatment that should have saved Becka Boscarino’s baby boy almost killed him. Doctors diagnosed her newborn son, Magglio, with Pompe disease, a rare and deadly genetic disorder that leads to a buildup of glycogen in the body. Left untreated, the baby would probably die before his first birthday. (Kolata, 5/15)

Meanwhile, Politico investigates lawmakers’ investments in a certain biotech company that was caught up in the controversy surrounding Health and Human Services Secretary Tom Price’s nomination —

Politico: Reckless Stock Trading Leaves Congress Rife With Conflicts
Even a looming scandal wouldn’t deter some of Congress’ most eager stock traders. Rep. Tom Price (R-Ga.), President Donald Trump’s nominee to be Health and Human Services secretary, was under siege, the harsh lights of a Senate hearing upon him. News reports showed he had bought shares in a tiny biotechnology company while sitting on committees that could influence the firm’s prospects. A colleague, Rep. Chris Collins (R-N.Y.), had tipped him off to the investment. (Severns, 5/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.