Tagged Health Industry

How Reselling Unused Test Strips For Blood Glucose Is Driving An Unusual Trade Online And On The Streets

Often the sellers of the strips are insured and paid little out of pocket for them, while the buyers may be underinsured or uninsured, and unable to pay retail prices, which can run well over $100 for a box of 100 strips. Unlike the resale of prescription drugs, which is prohibited by law, it is generally legal to resell unused test strips.

House Dems Open Investigation Into Pharma’s Drug Pricing Strategies, Calling The Probe One Of The Broadest In Decades

House Oversight and Reform Committee Chairman Elijah Cummings sent letters to drugmakers requesting detailed information about their pricing practices, focusing on drugs that are the costliest to Medicare Part D as well as drugs that have had the largest increases over a five-year period. The move is just the latest in a flurry of legislation and congressional action taken on the topic of high drug prices this year.

Record On Big Pharma Hangs Over Cory Booker As He Readies For A 2020 Run

Sen. Cory Booker (D-N.J.) drew criticism when he voted against a budget amendment allowing for the importation of drugs. As he preps to enter the 2020 fray, he’s been taking steps to counter that line of attack by joining forces with Sen. Bernie Sanders (I-Vt.) on his legislation aimed at high drug prices.

Record On Big Pharma Hangs Over Cory Booker As He Readies For A 2020 Presidential Run

Sen. Cory Booker (D-N.J.) drew criticism when he voted against a budget amendment allowing for the importation of drugs. As he preps to enter the 2020 fray, he’s been taking steps to counter that line of attack by joining forces with Sen. Bernie Sanders (I-Vt.) on his legislation aimed at high drug prices.

‘Fanciful, Inflated, Difficult To Decode And Inconsistent’: Experts Blast Rules Requiring Hospitals To Post Prices

The Trump administration now requires hospitals to post their chargemasters online in an effort to increase pricing transparency in the industry. But many experts criticize the rules, saying the information is unusable to consumers. In other hospital news: children’s hospitals brace for changes from the administration’s tax reform law, and hospitals push physicians to go in-network.

Massive Tent City At Center Of Protests Over Migrant Youth Care Closes

“It was chilling to see thousands of children locked up in a tent prison in the desert. It’s great news that those children have finally been moved out of Tornillo,” said Oregon Sen. Jeff Merkley. However, critics of the administration’s care of young migrants note that there are still thousands of children in U.S. custody in shelters throughout the country.

Listen: Do Consumers Benefit When Hospitals Post Sticker Prices Online?

Julie Appleby, a Kaiser Health News senior correspondent, appeared last week on WBUR’s “Here & Now” with Jeremy Hobson and on Science Friday to discuss the new requirement from the Centers for Medicare & Medicaid Services that hospitals post their list prices online. But, according to KHN’s coverage, the information popping up on hospital websites “may initially serve to confuse more than illuminate.”

You can listen to the “Here & Now” segment and the Science Friday discussion.

And check out KHN’s story, “As Hospitals Post Sticker Prices Online, Most Patients Will Remain Befuddled” (Jan. 4), co-written by Appleby and Barbara Feder Ostrov, for more insight.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday, where we’re 20 days and so-and-so hours (depending on when you read this) into the partial federal shutdown. As of today, it’s tied as the second-longest one in U.S. history, matching the funding gap that stretched from December ’95-January ’96 under President Bill Clinton. (Side note: The history of U.S. shutdowns is a good read for us policy nerds.)

Although health care has been somewhat insulated from the standoff (because funding for the Department of Health and Human Services had already been approved), the battle is really a lesson in the power of a ripple effect. Among the health-related things that have been touched by the impasse in some way: the CVS-Aetna merger, domestic violence victims, food stampswildfire and storm disaster funding, pollution inspections, drug approvals and the Affordable Care Act lawsuit.

But a lot of focus this week was on how the shutdown is curtailing food safety inspections by the Food and Drug Administration, especially following a year that was marked by several high-profile foodborne illness outbreaks.

Politico: FDA Looks to Restart Safety Inspections for Risky Foods Amid Shutdown


This week, my pharma files in Morning Briefing were bursting at the seams, and to be honest, I don’t see that changing anytime soon. This is definitely going to be a year of drug-pricing news, especially because it’s one of the few bipartisan topics that Capitol Hill watchers say might gain traction in a divided Congress.

In recent days, that — along with the fact that drug prices are most certainly a winning election issue — was on stark display. Democratic hopefuls for 2020 are jostling at the starting line to be the one to get THE big, flashy pharma bill out, with Vermont Sen. Bernie Sanders (joined by fellow hopeful New Jersey Sen. Cory Booker and others) as the latest to announce a proposal.

Sanders’ bundle of bills includes allowing the importation of cheaper drugs from Canada, letting Medicare negotiate prices and stripping monopolies from drug companies if their prices exceed the average price in other wealthy countries.

One interesting thing to note (from Stat’s coverage) is that even potential candidates from states that have a heavy biopharma presence (like Massachusetts Sen. Elizabeth Warren and New Jersey’s Booker) are coming out swinging against the industry — a sure sign that being firmly against Big Pharma is seen as crucial to securing the Democratic nomination.

Stat: Democrats Eyeing 2020 Put an Early Spotlight on Drug Prices

The Hill: Sanders, Dems Unveil Sweeping Bills to Lower Drug Prices

The pharma action this week wasn’t limited to the Hill, because the movers and shakers in the industry were all thinking big thoughts at the annual J.P. Morgan Healthcare Conference. There, Johnson & Johnson CEO Alex Gorsky argued that drugmakers were going to have to step up their own self-policing when it comes to pricing or face “onerous” alternatives. Looking at the stories above, I’m thinking he’s not wrong.

The Wall Street Journal: Health-Care CEOs Outline Strategies at J.P. Morgan Conference

Meanwhile, health systems tired of shortages and high prices are flocking by the dozens to the fledgling nonprofit that was created by a group of hospitals to manufacture its own generic drugs.

Stat: Generic Drug Maker Formed by Hospitals Attracts a Dozen More Members

It was hard to pick just a few pharma stories this week, considering the abundance of choices, but one that you should absolutely make time to read is this insulin-rationing piece. Insulin has become the new face of public outrage against outrageous price increases, and this piece presents a good overview of how that came to be, as well as the human toll the hikes have taken. The gut-punch sentence: “Within a month of going off [his mother’s] policy, [Alec Raeshawn Smith] would be dead.”

The Washington Post: Insulin Is a Lifesaving Drug, But It Has Become Intolerably Expensive. and the Consequences Can Be Tragic.


In a largely symbolic move, House Democrats voted to intervene in the health care lawsuit — a strategy geared more toward putting Republicans on record voting against the law (and thus against popular provisions they promised in the midterms to protect) than anything else.

The Hill: Dems Hit GOP on Health Care With Additional ObamaCare Lawsuit Vote

The vote highlighted a problem the GOP faces as it eyes 2020: For the longest time, Republicans have fallen back on “repeal and replace” as their main health care message. Now, the party is going to have to come up with a “positive vision” if they want to regain ground with voters, experts say.

The Hill: GOP Seeks Health Care Reboot After 2018 Losses


States, states, states! Everyone says that’s where the health care movement will be in the next two years, which certainly held true this week.

In California, new Gov. Gavin Newsom revealed his big health care dreams that include reshaping how prescription drugs are paid for, taking steps toward a single-payer system, reinstating the individual mandate, expanding Medi-Cal coverage for immigrants in the country illegally, and creating a surgeon general position for the state.

Reuters: New California Governor Tackles Drug Prices in First Act

Sacramento Bee: Gavin Newsom CA Health Plan Includes Individual Mandate

Meanwhile, up in Washington state, Gov. Jay Inslee proposed a “public option” health care plan for residents, a move that would set the stage for a universal coverage system. (It should be noted that Inslee is a 2020 contender.)

Seattle Times: Inslee Proposes ‘Public Option’ Health-Insurance Plan for Washington

In New York, several big health care developments emerged this week. NYC Mayor Bill de Blasio plans on investing $100 million into making sure that everyone in the city — including residents in the United States illegally — is guaranteed health coverage.

The New York Times: De Blasio Unveils Health Care Plan for Undocumented and Low-Income New Yorkers

And in Albany, Gov. Andrew Cuomo, citing the looming threat to Roe v. Wade, promised to cement a woman’s right to abortion in the state’s constitution.

The Wall Street Journal: Cuomo Vows to Codify Roe V. Wade Decision Into New York Constitution


It seems these days, you can’t swing a cat without hitting someone talking about “Medicare-for-all,” but what about a Medicaid “buy-in”? Some states are considering the option as a politically palatable alternative to help people who are struggling to buy coverage on the exchanges. The plans might not offer the full range of benefits available to traditional beneficiaries, but it could be something.

Stateline: Medicaid ‘Buy-In’ Could Be a New Health Care Option for the Uninsured

Speaking of MFA: A new Politico/Harvard poll shows that 4 in 5 Democrats favor Congress enacting a taxpayer-funded national health plan. Also to note, a fair amount of Republicans (60 percent) supported the idea of letting Americans under 65 buy into Medicare.

Politico: POLITICO/Harvard Poll: Many Democrats Back a Taxpayer-Funded Health Care Plan Like Medicare For All


As of Jan. 1, hospitals have had to post their prices online — which has resulted in much grumbling from industry and experts alike who say the numbers are meaningless to consumers. Centers for Medicare & Medicaid Administrator Seema Verma acknowledged the flaws with the rules this week, but still called them an important first step toward transparency.

Modern Healthcare: Verma: Chargemaster Rule Is ‘First Step’ to Price Transparency


In the miscellaneous file for the week:

• The Chinese scientist who used CRISPR to edit the genes of human embryos had scientists up in arms over the ethical dilemma late last year. But the path of medical breakthroughs is often littered with lapses such as his. Do the ends ever justify the means in these cases? And if so, where should the line be drawn?

CNN: Unethical Experiments’ Painful Contributions to Today’s Medicine

• Juul: Public health crusader? That’s the image the e-cigarette company (under ever-increasing government scrutiny for its marketing practices directed toward youths) is going with these days. But experts are calling its new ad campaign — which touts Juul products as a way to tackle adults’ smoking habits — revisionist history.

The New York Times: Juul’s Convenient Smoke Screen

• A woman who was in a vegetative state for more than 10 years reportedly gave birth last month. The workers at the nursing facility she was in didn’t realize she was even pregnant until she went into labor, raising all kinds of questions about quality of care, abuse and the medical complications of the process.

CNN: How Does Someone in a Vegetative State Have a Baby?

• HIV prevention medication has been shown to be highly effective and, quite literally, a lifesaver to vulnerable populations. But taking it was costing some people their chance at qualifying for life insurance. Now, though, one insurer has settled a lawsuit over the denials, possibly leading the way to changes in the industry.

The New York Times: Facing Legal Action, Insurer Now Will Cover People Taking Truvada, an H.I.V.-Prevention Drug


And good news! The E. coli outbreak is officially over, so you can go back to your romaine (yay?). Have a great weekend!

Powerful Chamber Of Commerce Pledges To Fight Any Efforts By Congress To Move Toward Single-Payer

“We’ll use all our resources to make sure that we’re careful there,” said Thomas Donohue, the president and CEO of the Chamber of Commerce. In other coverage and access news: insurer settles discrimination allegations over consumers who take HIV-prevention medication; a look at what happens when an insurer’s pricing tool gets it wrong; and trends for the coming year.

Powerful Chamber Of Commerce Pledges To Fight Any Efforts By Congress To Move Toward Single-Payer

“We’ll use all our resources to make sure that we’re careful there,” said Thomas Donohue, the president and CEO of the Chamber of Commerce. In other coverage and access news: insurer settles discrimination allegations over consumers who take HIV-prevention medication; a look at what happens when an insurer’s pricing tool gets it wrong; and trends for the coming year.

Federal Shutdown Mostly Spares Health Coverage, But Other Issues Loom

As the partial government shutdown drags on, about 800,000 federal employees who work for the shuttered agencies — and their families — are facing the reality of life without a paycheck.

And those workers need to consider a host of other related issues as they attempt to make ends meet.

For starters, what will happen to their health insurance?

For the most part, federal employees needn’t worry about that, according to the Office of Personnel Management (OPM) in an FAQ blog post.

Both the online FAQ and the health insurance industry’s trade association confirm that coverage through the Federal Employees Health Benefits (FEHB) program will continue even if some federal agencies affected by the shutdown aren’t issuing those paychecks or paying premiums.

“The shutdown should not impact their coverage,” said Kristine Grow, spokeswoman for America’s Health Insurance plans, the trade group that represents insurers, including those that offer coverage through the federal program. “It’s business as usual.”

Once the shutdown ends and those payments resume, workers should expect that their usual share of premiums plus some of the accumulated amount that wasn’t deducted during the missed pay periods will be taken out.

“Procedures may vary somewhat by payroll office, but the maximum additional deduction allowed under regulations is one pay period’s worth of premiums (in addition to the current pay period’s premium),” said an OPM spokeswoman.

What about government contract workers?

Less clear is what happens to workers under contract with the affected federal agencies — including some people working as analysts, administration assistants and janitorial staff — who are mostly excluded from the FEHB program.

Many companies that contract with the federal government offer workers insurance. The federal Office of Personnel Management recommends these contracted employees consult the human resources office at their company for answers regarding the shutdown.

“In 95 percent of cases, even if it’s not required by law, I would think most everyone would continue that coverage,” said Rachel Greszler, a senior policy analyst and research fellow at the Heritage Foundation who studies economics, budget and labor issues.

For contract workers who buy their own coverage and are struggling to pay bills without their paychecks, it’s a different story. One strategy may be to ask their insurers for a grace period in paying their premiums, similar to how the government has suggested workers seek accommodation from mortgage lenders and other creditors. But there is no requirement that insurers grant such a request.

“We are concerned about the disruption that this shutdown has caused our members and their families,” noted a corporate statement from CareFirst BlueCross BlueShield. “We are currently exploring how to best address this issue should the shut-down continue.”

What else could be affected?

Depending on how long the shutdown lasts, dental, vision and life insurance programs may start sending bills directly to workers.

Federal workers pay the premiums for these benefits themselves, according to Dan Blair, who served as both acting director and deputy director of the OPM during the early 2000s. He is now a senior counselor and fellow the Bipartisan Policy Center.

Because workers’ checks are not being processed, the amounts usually sent to these carriers each pay period also aren’t being paid. If the shutdown lasts longer than two or three pay periods, workers will get premium bills directly from these firms and should pay them “on a timely basis to ensure continuation of coverage,” the OPM says in its FAQ. Blair agrees.

There also may be a delay in processing claims for flexible spending accounts. These are special accounts in which workers use pretax money deducted from their paychecks to cover certain eligible medical expenses, such as eyeglasses, braces, copayments for doctor visits or medications, including some over-the-counter products. With no paychecks going out, these deductions are not being made and transferred into FSAs. Once paychecks start up again, the amount deducted will be adjusted so the worker will get the annual total they had requested.

During the shutdown, though, reimbursement claims to these accounts also won’t be processed, the OPM says. Blair suggests holding off on big-ticket purchases during the shutdown, if possible, and always keeping paperwork on the purchases.

Another consideration: Those who changed plans before the furlough may find their paperwork wasn’t processed in time.

In those cases, the OPM says to stick with the old health plan until the shutdown ends and the new plan is processed. The new plan will pick up any claims incurred.

How will workers know if their change was processed? The OPM’s FAQ says workers who receive an ID card in the mail are enrolled.

“The new policy will be what applies and pays benefits, but there could be some administrative burdens and hassles on the part of workers if the shutdown continues much longer, if the initial bills are not going to the right insurance company,” Greszler said.

Overall, Blair says workers should continue to monitor news media sites, particularly those that focus on federal workers and issues, looking for any updates.

“We’re getting into uncharted territory and there are always things that pop up that no one has planned for,” said Blair, who did not face any shutdowns during his tenure at OPM.