Tagged Health Care Costs

Medical Marketing In The U.S. Has Boomed Over Past Two Decades–With Meager Oversight To Keep It In Check

A new analysis of marketing data from the FDA, Medicare, other federal and state agencies, private companies and medical research finds a 69 percent increase, to $29.9 billion, over a recent 20-year period. “Marketing drives more treatments, more testing” that patients don’t always need, said Dr. Steven Woloshin, a Dartmouth College health policy expert.

As Pharma Returns To Status Quo On Drug Prices, Trump Meets With Top Advisers To Discuss Frustrations

“The president’s been really clear — prices of drugs need to be coming down, not going up,” said HHS Secretary Alex Azar, who was reportedly a part of the meeting. Meanwhile, Democrats on Capitol Hill are looking to score some early wins with small drug pricing legislation.

Health Care Industry Spends $30B A Year Pushing Its Wares, From Drugs To Stem Cell Treatment

Hoping to earn its share of the $3.5 trillion health care market, the medical industry is pouring more money than ever into advertising its products — from high-priced prescriptions to do-it-yourself genetic tests and unapproved stem cell treatments.

Spending on health care marketing doubled from 1997 to 2016, soaring to at least $30 billion a year, according to a study published Tuesday in JAMA.

“Marketing drives more testing. It drives more treatments. It’s a big part of why health care is so expensive, because it’s the fancy, high-tech stuff things that get marketed,” said Steven Woloshin, co-director of the Center for Medicine and Media at The Dartmouth Institute for Health Policy and Clinical Practice. His study captured only a portion of the many ways that drug companies, hospitals and labs promote themselves.

Advertising doesn’t just persuade people to pick one brand over another, said Woloshin. Sophisticated campaigns make people worry about diseases they don’t have and ask for drugs or exams they don’t need.

Consumer advocates say that taxpayers pay the real price, as seductive ads persuade doctors and patients alike to order pricey tests and brand-name pills.

“Whenever pharma or a hospital spends money on advertising, we the patients pay for it — through higher prices for drugs and hospital services,” said Shannon Brownlee, senior vice president of the Lown Institute, a Brookline, Mass., nonprofit that advocates for affordable care. “Marketing is built into the cost of care.”

High costs ultimately affect everyone, because they prompt insurance plans to raise premiums, said Diana Zuckerman, president of the National Center for Health Research, a nonprofit that provides medical information to consumers. And taxpayers foot the bill for publicly funded insurance programs, such as Medicare.

“These ads can be amazingly persuasive, and they can exploit desperate patients and family members,” said Zuckerman, who was not involved in the new study.

Drug companies spend the bulk of their money trying to influence doctors, showering them with free food, drinks and speaking fees, as well as paying for them to travel to conferences, according to the study.

Dr. Lisa Schwartz and Dr. Steven Woloshin(Courtesy of the Dartmouth Institute for Health Policy & Clinical Practice)

Yet marketers also increasingly target consumers, said Woloshin, who wrote the study with his wife and longtime research partner, Dartmouth’s Dr. Lisa Schwartz, who died of cancer in November.

The biggest increase in medical marketing over the past 20 years was in “direct-to-consumer” advertising, including the TV commercials that exhort viewers to “ask your doctor” about a particular drug. Spending on such ads jumped from $2.1 billion in 1997 to nearly $10 billion in 2016, according to the study.

A spokeswoman for the pharmaceutical industry group, PhRMA, said that its ads provide “scientifically accurate information to patients.” These ads “increase awareness of the benefits and risks of new medicines and encourage appropriate use of medicines,” said Holly Campbell, of PhRMA.

The makers of genetic tests — including those that allow people to learn their ancestry or disease risk —also bombard the public with advertising. The number of ads for genetic testing grew from 14,100 in 1997 to 255,300 in 2016, at a cost that year of $82.6 million, according to the study. AncestryDNA spends more than any other company of its kind, devoting $38 million to marketing in 2016 alone.

Some companies are touting stem cell treatments that haven’t been approved by federal regulators. The Food and Drug Administration has approved stem cell therapy for only a few specific uses — such as bone marrow transplants for people with leukemia. But hundreds of clinics claim to use these cells taken from umbilical cord blood to treat disease. Many patients have no idea that these stem cell therapies are unapproved, said Angie Botto-van Bemden, director of osteoarthritis programs at the Arthritis Foundation.

Stem cell clinics have boosted their marketing from $900,000 in 2012 to $11.3 million in 2016, according to the study.

In recent months, the FDA has issued warnings to clinics marketing unapproved stem cell therapies. Twelve patients have been hospitalized for serious infections after receiving stem cell injections, according to the Centers for Disease Control and Prevention.

Medical advertising today goes beyond TV and radio commercials. Some online campaigns encourage patients to diagnose themselves, Woloshin said.

The website for Restasis, which treats dry eyes, prompts patients to take a quiz to learn if they need the prescription eye drops, said Woloshin, who co-wrote a February study with Schwartz on the drug’s marketing strategy. The Restasis website also allows patients to “find an eye doctor near you.”

Many of the doctors included in the Restasis directory have taken gifts from its manufacturer, Allergan, Woloshin said. The doctor directory includes seven of the top 10 physicians paid by the company, his study says.

In a statement, Allergan spokeswoman Amy Rose said the company uses direct-to-consumer advertising “to support responsible disease awareness efforts.” The ads “do not displace the patient-physician relationship, but enhance them, helping to create well-informed and empowered consumer and patient communities.”

Drug sites don’t just lead patients to doctors. They also provide scripts for suggested conversations. For example, the website for Viagra, which treats erectile dysfunction, provides specific questions for patients to ask.

The website for Addyi, often called the “female Viagra,” goes even further. Patients who answer a number of medical questions online are offered a 10- to 15-minute phone consultation about the drug for $49. Patients who don’t immediately book an appointment receive an email reminder a few minutes later.

“This is more evidence,” Brownlee said, “that drug companies are not run by dummies.”

In Montana, Neither Republicans Nor Democrats Want To End Medicaid Expansion But They Differ On Path Forward

Republicans are arguing for new restrictions, such as work requirements, as lawmakers begin to work toward a compromise to keep Medicaid expansion alive in the state. “If I was a betting man, I’d think Medicaid will pass in some form,” said state Senate President Scott Sales (R-Bozeman). Medicaid news comes out of Louisiana, Idaho and Virginia, as well.

Wis. Republican Lawmakers See Bumpy Road Ahead For Legislation Protecting Preexisting Conditions Coverage

The state’s Senate and the Assembly have struggled in the past to find common ground. “I don’t want to overpromise on that right out of the gate,” Senate Majority Leader Scott Fitzgerald of Juneau said, even as Assembly Speaker Robin Vos of Rochester announced his chamber would be taking up a bill protecting the coverage. Other health law news comes out of Connecticut and California, as well.

Some Hospitals Frustrated With CMS Rule Requiring Them To Post Prices As Experts Say It Won’t Help Cut Consumers’ Costs

“The unfortunate thing is that for most consumers, because it’s standard charges not related to their coverage, it’s not that helpful,” Rick Gundling, senior vice president of the Healthcare Financial Management Association, told Modern Healthcare. “It was an exercise that doesn’t add a lot of value to the consumer.”

Hospitals Now Have To List Prices For Medical Procedures, But Experts Question The Usefulness For Consumers

“The only people for whom these list prices are remotely relevant are those among us who don’t have any health insurance at all,” said Martin Gaynor, professor of economics and health policy at Carnegie Mellon University. Even just knowing the difference between what one hospital charges versus another won’t mean much in practice for consumers.

Hospitals Now Have To List Prices For Medical Procedures, But Experts Question The Usefulness For Consumers

“The only people for whom these list prices are remotely relevant are those among us who don’t have any health insurance at all,” said Martin Gaynor, professor of economics and health policy at Carnegie Mellon University. Even just knowing the difference between what one hospital charges versus another won’t mean much in practice for consumers.

Drugmakers ‘Not Being Fair To The Consumer,’ Trump Accuses As Pharma Goes Back To Status Quo On Raising Prices

President Donald Trump’s tweet came in contrast to a statement from HHS Secretary Alex Azar that praised Trump’s leadership as the reason the pharma industry had announced “smaller and fewer drug price increases.” Meanwhile, the movers and shakers in the industry are headed to the J.P. Morgan Healthcare Conference this week.

Drugmakers ‘Not Being Fair To The Consumer,’ Trump Accuses As Pharma Goes Back To Status Quo On Raising Prices

President Donald Trump’s tweet came in contrast to a statement from HHS Secretary Alex Azar that praised Trump’s leadership as the reason the pharma industry had announced “smaller and fewer drug price increases.” Meanwhile, the movers and shakers in the industry are headed to the J.P. Morgan Healthcare Conference this week.

Medicaid Plans Cover Doctors’ Visits, Hospital Care — And Now Your GED

Emilia Ford became pregnant at 15 and, after her daughter was born, dropped out of high school.

As she held down different jobs during the past decade — including housekeeping and working in a relative’s retail store — she always thought about going for her GED to show she met high school academic skills.

But the Brookhaven, Pa., woman needed assistance finding tutors and paying for the set of four tests, which cost $20 each.

She found help from an unexpected source: her Medicaid health plan.

AmeriHealth Caritas, a Philadelphia-based insurer with 2 million Medicaid members in Pennsylvania and five other states, helps connect members with nonprofit groups providing GED test preparation classes, offers telephone coaching to keep members on track and pays the testing fees.

Ford is one of 62 plan members who have earned a GED certificate since the benefit began in 2013.

“I could not believe this was something a health insurance company would do,” said Ford, 25. “I thought health insurers only paid for medical costs.”

Not anymore.

Medicaid health plans are starting to pay for non-traditional services such as meals, transportation, housing and other forms of assistance to improve members’ health and reduce medical costs.

That change follows efforts by state Medicaid programs to give health plans financial incentives to control spending, said Jill Rosenthal, senior program director for the National Academy for State Health Policy.

Rather than continue to pay a set fee each month to cover members’ health costs, many states are implementing policies that let health plans share in any savings they can demonstrate. That provides motivation for insurers to address factors such as literacy and poor housing, which can drive up health costs.

“Health plans now have incentives for them to find the root causes of problems that will reduce costs that will benefit the plan, its beneficiaries and the states,” Rosenthal said.

AmeriHealth Caritas CEO Paul Tufano said studies show people with lower educational levels tend to be in poorer health. “Helping members attain their GED can be incredibly consequential for them to live the kind of life they want to live,” he said.

But Tufano acknowledged that only a small fraction of people who need the assistance reach out for it. About 1,000 members have started GED training through the insurer in Pennsylvania, Louisiana, South Carolina and Delaware.

“Many of our members are just surviving to keep their heads over water, holding on to jobs and dealing with issues like safe housing, access to food and transportation to get to work or doctor,” he said.

AmeriHealth Caritas is one of just a handful of Medicaid health plans that offer a GED benefit.

WellCare, which covers 2.2 million Medicaid recipients in Missouri, Nebraska, Georgia, Kentucky, Hawaii and Illinois, had 226 members sit for their GED exams since the plan began paying for it in 2012, said spokeswoman Alissa Lawver. The Tampa-based plan does not know how many passed.

A Wellcare survey of its Medicaid adult members in Georgia in 2012 found that about 20 percent did not have a high school diploma or a GED.

“There is a significant relationship between education and health,” Wendy Morriarty, president of WellCare’s ‘Ohana Health Plan in Hawaii, said when launching the benefit in 2016. “A GED is a tool that can lead to increased opportunities for our members to attend college, seek higher-paying jobs and find stable housing. This benefit has the ability to improve the health and well-being of local families and communities.”

Advocates for Medicaid praise the health plans’ efforts.

“I think this sets the standard for the unique role of Medicaid managed care in bridging health care and social services,” said Sara Rosenbaum, health law and policy professor at George Washington University.

Ford said having a coach at AmeriHealth walk her through the sign-up process for GED classes, help her register for tests and call her twice a week to keep her motivated was vital to her success. The program also offered child care and transportation to the prep classes and exam sites. She started in May 2017, taking two classes a week, and passed her exams last summer.

When she finished, AmeriHealth hired Ford as an intern in its member services department. In December 2017, the insurer hired Ford to a full-time position — with health benefits — to work as a GED coach for other Medicaid members.

The job meant Ford became the first of nine siblings to get off Medicaid and find employer-based coverage.

“I feel like I was saved from the struggle I was going through,” Ford said. “This is something big that my family was proud of.” While she was growing up, she said, her father drove a school bus and her mom took care of the kids.

In the past year, Ford has helped 12 plan members earn their GEDs and she’s coaching 30 more.

“I can tell them I have been where you are on the other side of the phone and can share my experience and it helps give them more trust in me,” Ford said.

“The hardest thing is not giving up even after failing a test and being able to get back up and push yourself and get over the discouragement,” she said. “There is always something good that you can take from a bad situation.”

Must-Reads Of The Week From Brianna Labuskes

Happy New Year! Welcome to 2019 and the 116th Congress! I hope everyone had a wonderful and restful break, because now the fun (or something in that neighborhood) starts again.

Democrats are raring to go now that the new class has been sworn in and Nancy Pelosi has retaken the House gavel. They’re setting the stage to put Republicans in the political hot seat with a vote to formally intervene in the Affordable Care Act lawsuit currently moving through the courts.

I’m pretty sure everyone at this point realizes that vowing to protect preexisting conditions was (and will be) a winning issue on the campaign trail. The Democrats’ move will (and, let’s be honest, is designed to) put the GOP in the awkward position of voting against those popular provisions.

The Washington Post: The New Congress: Pelosi Retakes House Gavel As Shutdown Continues

The Washington Post: House Democrats Vote to Defend ACA in Court — and Jam Republicans

Then on the states’ side of things, the attorneys general leading the defense of the health law have filed an appeal against the federal judge’s ruling (from December, I know it feels ages ago) that the ACA can’t stand without the individual mandate penalty. The filing was, obviously, completely expected, but it does continue to move the case down a long legal path likely to end at the Supreme Court.

The Wall Street Journal: Democratic-Led States Appeal Ruling Invalidating Affordable Care Act


Stories about excessive human waste piling up in national parks are grabbing headlines, but when it comes to the shutdown the issues go much deeper than that for Native Americans. Because of treaties, tribes receive a significant amount of the funding they need to provide basic services (like running health clinics) from the federal government. So, the shutdown cuts deeper for them than in other places in the country.

“The federal government owes us this: We prepaid with millions of acres of land. We don’t have the right to take back that land, so we expect the federal government to fulfill its treaty and trust responsibility,” said Aaron Payment, the chairman of the Sault Ste. Marie Tribe, in The New York Times’ coverage.

The New York Times: Shutdown Leaves Food, Medicine and Pay in Doubt in Indian Country

P.S. If you’re confused about the shutdown and what health programs are affected, 1) you’re not alone, and 2) read KHN’s roundup, which, without bias, is the most comprehensive health-related breakdown I’ve seen. Cliff notes, though: Most big-ticket items (like Medicaid and Medicare) were already funded by Congress earlier in the year and are insulated from the standoff’s dramatics.

Kaiser Health News: How The Government Shutdown Affects Health Programs


Bristol-Myers Squibb kicked off the year with a huge $74 billion deal with Celgene. The experts at Stat break down exactly what the acquisition means for the industry. A big takeaway is that one of the sector’s largest companies will essentially cease to exist. The deal could also spark more megamergers and further consolidation of the biotech landscape — which, as you can imagine, will not be good for drug prices.

Stat: 9 Big Takeaways From the $74 Billion Bristol-Celgene Deal

Next week, movers and shakers in the biotech industry will be flocking to San Francisco for the annual J.P. Morgan Healthcare Conference. It’s the place to see and be seen, but some attendees want to be anywhere but there. Why? The location.

Stat: Will San Francisco’s Issues Push People Away From J.P. Morgan?


Adding work requirements to Medicaid has proven to be the honey it takes to make expanding coverage more palatable to Republican states. But, in Arkansas — the testing ground for what exactly those rules look like in practice — thousands of residents are getting kicked off the Medicaid rolls. A picture of confusion, flawed technology and basic human error is emerging as advocates try to figure out what is going wrong.

Politico: Conservative Health Care Experiment Leads to Thousands Losing Coverage


If you managed to tune out a bit from the news over the holidays, here are some developments you should know about:

A second migrant child died in U.S. custody, prompting President Donald Trump to attempt to shift blame to the Democrats. The administration has been under ever-increasing scrutiny for the quality of care the young migrant children are receiving.

The New York Times: Trump Blames Democrats Over Deaths of Migrant Children in U.S. Custody

Hospitals were handed a major victory when a judge blocked cuts to the 340B drug program, which requires pharmaceutical manufacturers to sell drugs at discounts to hospitals serving large proportions of low-income and vulnerable people, such as children or cancer patients. The judge said the administration overstepped its authority in its push to try to lower drug prices.

Stat: Judge Blocks Trump Administration Cuts to 340B Hospital Payments

A damning investigation into the nation’s major hospital watchdog found that more than 100 psychiatric hospitals have remained fully accredited by the commission despite serious safety lapses, some of which were connected to the death, abuse or sexual assault of patients.

The Wall Street Journal: Psychiatric Hospitals With Safety Violations Still Get Accreditation


And in my miscellaneous file: 

• The old and powerful veteran advocacy groups — aka the “Big Six” — have been major players on Capitol Hill for years. But their power is diminishing as leaner, more efficient and more tailored groups chip away at the establishment and reflect the priorities of a new generation of veterans.

The New York Times: Their Influence Diminishing, Veterans Groups Compete With Each Other and Struggle With the V.A.

• The prominent Memorial Sloan Kettering Cancer Center has not been having a good fall. That’s in part due to the fabulous reporting done by The New York Times and ProPublica, which revealed conflicts of interest among the organization’s leaders. If you haven’t kept up with the story, this offers a great overview on how this ethical morass is playing out not only there but across the country as well.

The New York Times: Memorial Sloan Kettering’s Season of Turmoil

• Does medication-assisted treatment for opioid addiction simply replace one drug with another? Or is it necessary to stop a relentless and sweeping epidemic that has claimed far too many victims? That’s the raging debate as experts try to get their arms around the crisis.

The New York Times: In Rehab, ‘Two Warring Factions’: Abstinence Vs. Medication

• An outbreak of cancer in children is pitting families deep in Trump Country against the president’s agenda to roll back health and environmental restrictions.

The New York Times: A Trump County Confronts the Administration Amid a Rash of Child Cancers

• Between salmonella in turkeys and E. coli in romaine lettuce, the country was beset with foodborne illness outbreaks last year. But one of the biggest recalls is one you probably haven’t even heard about.

New Food Economy: The Listeria Scare That Hit Whole Foods, Trader Joe’s, and Walmart Led to 100 Million Pounds of Recalled Product — And No One Noticed


Apparently, New Year’s resolutions won’t bring you joy (whether you achieve them or not), but if one of yours is to switch up your diet, check out the newly released rankings from U.S. News & World Report.