Tagged Prescription Drugs

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Apologies for unexpectedly going MIA last week, but your girl here decided she needed some firsthand experience with the health care system via a trip to the emergency room. (Hot tip: Stay hydrated during stomach bug season, folks!) Many thanks to the wonderful Damon Darlin (also known as KHN’s executive editor) for filling in last week. Make sure to check it out if you missed it.

Onward to this week, though, where we’re finally starting to slow down as we drift toward the holidays.

“I hate to panic, but …” was a quote from NPR’s coverage of the health law enrollment numbers that pretty much summed up the atmosphere the day before the sign-up deadline. The big number to focus on here is that there are nearly 20 percent fewer new enrollees than at about this same time last year. The lag has advocates pointing nervous fingers at the Trump administration’s efforts to chip away at the health law.

But some experts eschew Chicken Little predictions (at least quite yet), saying that fewer sign-ups don’t necessarily mean more people will be uninsured. For one, the unemployment level is the lowest in decades (although that has nuances that are too complex to get into right here) so people who used to get health law plans might be covered by their employers. Secondly, the sign-up numbers don’t reflect anyone who is sticking with the plan they currently have.

Either way, we won’t have long to wait to see how it shakes out.

NPR: Enrollment in HealthCare.Gov Plans May Be Down for 2019

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming

Amid all that talk of sabotage and low numbers came a study that found 4.2 million Americans are actually eligible to get what amounts to free health care through the exchanges, as an unintended consequence of President Donald Trump nixing key health law payments last year.

The Hill: Study: 4.2 Million Uninsured People Eligible for Free ObamaCare Coverage


A quietly simmering debate over fetal tissue research brewing the past few months has started to come to a boil this week. (Although, if you’ve been reading your Morning Briefing regularly, this won’t come as a surprise.) Back in September, the administration launched an audit of all federally funded research that uses fetal tissue. The far-reaching ramifications were felt recently when a lab that has played an integral role in testing for HIV cures was put on notice that its funding could be canceled.

The sides are firmly drawn here and have deep roots in abortion politics (as witnessed in this quote from CQ’s coverage of Thursday’s heated House hearing on the topic: “Obviously the 800-pound gorilla in the room is that we know aborted tissue is being used,” said Georgia Republican Rep. Jody Hice).

With the National Institutes of Health signaling interest in pumping $20 million into finding an alternative to fetal tissue for research purposes, I don’t think this topic is going away anytime soon.

The New York Times: Fetal Tissue Research Is Curtailed by Trump Administration

The Hill: NIH to Fund Research Into Fetal Tissue Alternatives


The death of a 7-year-old Guatemalan girl who had been taken into Border Patrol custody is likely to intensify scrutiny of the care immigrants detained by the U.S. government are receiving. U.S. Customs and Border Protection said the girl had not eaten or consumed water in several days, and it’s unclear whether the agents had tried to rectify that situation. Advocates are saying the death is reflective of a “culture of cruelty” within the agency.

Meanwhile, there are nearly 15,000 migrant children in detention facilities in the country, where issues with background checks, abuse and neglect continue to make headlines.

The Washington Post: 7-Year-Old Migrant Girl Taken Into Border Patrol Custody Dies of Dehydration, Exhaustion

NPR: Almost 15,000 Migrant Children Now Held at Nearly Full Shelters

More voices are starting join the growing chorus of advocates, doctors and city leaders who oppose the administration’s proposed policy to penalize immigrants who are accepting government aid (such as Medicaid). It’s not just about public health, they say. The policy would also take a heavy financial toll.

Dallas Morning News: Dallas Mayor Says Trump Administration’s Proposed ‘Public Charge’ Rules Would Harm City’s Immigrants, Economy


There was some shade being thrown at the Supreme Court this week, when the justices declined to take up a case on state Medicaid funding and Planned Parenthood. Justice Clarence Thomas called out his conservative colleagues Chief Justice John Roberts and Justice Brett Kavanaugh for dodging the case. “So what explains the court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood,’” he wrote. The case itself was somewhat complex, but essentially the decision leaves in place Medicaid patients’ right to sue over provider issues.

The Associated Press: Justices Won’t Hear States’ Appeal Over Planned Parenthood


The maker of a device that reverses overdoses recently drew fire for jacking up the list price of its injector from $575 to $4,100 during a span of time that opioid-related deaths were also accelerating rapidly. As you can imagine, this did not go over well with either lawmakers or the public when it came to light. Now Kaleo, in damage-control mode, is releasing a generic version that comes with a $178 price tag. The whole journey is quite the snapshot of what’s going wrong with high health care costs.

Stat: Kaleo, Maker of $4,100 Overdose Antidote, to Offer Generic For $178

Speaking of, you have to check out the salacious details emerging in this case that started as an antitrust lawsuit against just two drugs and has ballooned into this sweeping investigation into price-fixing allegations in the generics marketplace.

The Washington Post: Generic Drug Price-Fixing Investigation Expands to 300 Drugs and 16 Companies

Pharma, meanwhile, is sweating over the Democrats taking power in the House. Once a political powerhouse of nearly mythological proportions, the industry has lost clout in recent years, and companies don’t think the new power structure will work in their favor.

Stat: Will Democrats in Congress Keep the Door Open for Pharma — or Slam It?


Whew! That was not as short as expected. Just in case you want some more great reads for your weekend, check out the miscellaneous file:

• What happens to your life when millions of people have witnessed you hit rock bottom? As the opioid epidemic dug deep roots into the country, there was this trend where videos and photos of people overdosing would go absolutely viral. Public health officials and cops at the time justified putting them up because the videos could act as a deterrent for drug use. For the people used as the face of the crisis, however, it was deeply life-altering.

The New York Times: How Do You Recover After Millions Have Watched You Overdose?

• Baby boomers are now aging alone more than any other generation in U.S. history. That isn’t just a sad statistic — it’s also a looming public health crisis. Loneliness has been as closely linked to early mortality as smoking up to 15 cigarettes or consuming more than six alcoholic drinks a day.

The Wall Street Journal: The Loneliest Generation: Americans, More Than Ever, Are Aging Alone

• A rash of recent headlines explores whether trauma is passed down through genes. It’s a very buzzy idea, but the evidence that trauma can leave a signature that lasts generations is circumstantial at best.

The New York Times: Can We Really Inherit Trauma?

 

I’ll leave you with some bah-humbug! warnings about not eating that raw cookie dough this holiday season (even though it’s clearly the best part of making cookies). Have a great weekend!

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Apologies for unexpectedly going MIA last week, but your girl here decided she needed some firsthand experience with the health care system via a trip to the emergency room. (Hot tip: Stay hydrated during stomach bug season, folks!) Many thanks to the wonderful Damon Darlin (also known as KHN’s executive editor) for filling in last week. Make sure to check it out if you missed it.

Onward to this week, though, where we’re finally starting to slow down as we drift toward the holidays.

“I hate to panic, but …” was a quote from NPR’s coverage of the health law enrollment numbers that pretty much summed up the atmosphere the day before the sign-up deadline. The big number to focus on here is that there are nearly 20 percent fewer new enrollees than at about this same time last year. The lag has advocates pointing nervous fingers at the Trump administration’s efforts to chip away at the health law.

But some experts eschew Chicken Little predictions (at least quite yet), saying that fewer sign-ups don’t necessarily mean more people will be uninsured. For one, the unemployment level is the lowest in decades (although that has nuances that are too complex to get into right here) so people who used to get health law plans might be covered by their employers. Secondly, the sign-up numbers don’t reflect anyone who is sticking with the plan they currently have.

Either way, we won’t have long to wait to see how it shakes out.

NPR: Enrollment in HealthCare.Gov Plans May Be Down for 2019

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming

Amid all that talk of sabotage and low numbers came a study that found 4.2 million Americans are actually eligible to get what amounts to free health care through the exchanges, as an unintended consequence of President Donald Trump nixing key health law payments last year.

The Hill: Study: 4.2 Million Uninsured People Eligible for Free ObamaCare Coverage


A quietly simmering debate over fetal tissue research brewing the past few months has started to come to a boil this week. (Although, if you’ve been reading your Morning Briefing regularly, this won’t come as a surprise.) Back in September, the administration launched an audit of all federally funded research that uses fetal tissue. The far-reaching ramifications were felt recently when a lab that has played an integral role in testing for HIV cures was put on notice that its funding could be canceled.

The sides are firmly drawn here and have deep roots in abortion politics (as witnessed in this quote from CQ’s coverage of Thursday’s heated House hearing on the topic: “Obviously the 800-pound gorilla in the room is that we know aborted tissue is being used,” said Georgia Republican Rep. Jody Hice).

With the National Institutes of Health signaling interest in pumping $20 million into finding an alternative to fetal tissue for research purposes, I don’t think this topic is going away anytime soon.

The New York Times: Fetal Tissue Research Is Curtailed by Trump Administration

The Hill: NIH to Fund Research Into Fetal Tissue Alternatives


The death of a 7-year-old Guatemalan girl who had been taken into Border Patrol custody is likely to intensify scrutiny of the care immigrants detained by the U.S. government are receiving. U.S. Customs and Border Protection said the girl had not eaten or consumed water in several days, and it’s unclear whether the agents had tried to rectify that situation. Advocates are saying the death is reflective of a “culture of cruelty” within the agency.

Meanwhile, there are nearly 15,000 migrant children in detention facilities in the country, where issues with background checks, abuse and neglect continue to make headlines.

The Washington Post: 7-Year-Old Migrant Girl Taken Into Border Patrol Custody Dies of Dehydration, Exhaustion

NPR: Almost 15,000 Migrant Children Now Held at Nearly Full Shelters

More voices are starting join the growing chorus of advocates, doctors and city leaders who oppose the administration’s proposed policy to penalize immigrants who are accepting government aid (such as Medicaid). It’s not just about public health, they say. The policy would also take a heavy financial toll.

Dallas Morning News: Dallas Mayor Says Trump Administration’s Proposed ‘Public Charge’ Rules Would Harm City’s Immigrants, Economy


There was some shade being thrown at the Supreme Court this week, when the justices declined to take up a case on state Medicaid funding and Planned Parenthood. Justice Clarence Thomas called out his conservative colleagues Chief Justice John Roberts and Justice Brett Kavanaugh for dodging the case. “So what explains the court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood,’” he wrote. The case itself was somewhat complex, but essentially the decision leaves in place Medicaid patients’ right to sue over provider issues.

The Associated Press: Justices Won’t Hear States’ Appeal Over Planned Parenthood


The maker of a device that reverses overdoses recently drew fire for jacking up the list price of its injector from $575 to $4,100 during a span of time that opioid-related deaths were also accelerating rapidly. As you can imagine, this did not go over well with either lawmakers or the public when it came to light. Now Kaleo, in damage-control mode, is releasing a generic version that comes with a $178 price tag. The whole journey is quite the snapshot of what’s going wrong with high health care costs.

Stat: Kaleo, Maker of $4,100 Overdose Antidote, to Offer Generic For $178

Speaking of, you have to check out the salacious details emerging in this case that started as an antitrust lawsuit against just two drugs and has ballooned into this sweeping investigation into price-fixing allegations in the generics marketplace.

The Washington Post: Generic Drug Price-Fixing Investigation Expands to 300 Drugs and 16 Companies

Pharma, meanwhile, is sweating over the Democrats taking power in the House. Once a political powerhouse of nearly mythological proportions, the industry has lost clout in recent years, and companies don’t think the new power structure will work in their favor.

Stat: Will Democrats in Congress Keep the Door Open for Pharma — or Slam It?


Whew! That was not as short as expected. Just in case you want some more great reads for your weekend, check out the miscellaneous file:

• What happens to your life when millions of people have witnessed you hit rock bottom? As the opioid epidemic dug deep roots into the country, there was this trend where videos and photos of people overdosing would go absolutely viral. Public health officials and cops at the time justified putting them up because the videos could act as a deterrent for drug use. For the people used as the face of the crisis, however, it was deeply life-altering.

The New York Times: How Do You Recover After Millions Have Watched You Overdose?

• Baby boomers are now aging alone more than any other generation in U.S. history. That isn’t just a sad statistic — it’s also a looming public health crisis. Loneliness has been as closely linked to early mortality as smoking up to 15 cigarettes or consuming more than six alcoholic drinks a day.

The Wall Street Journal: The Loneliest Generation: Americans, More Than Ever, Are Aging Alone

• A rash of recent headlines explores whether trauma is passed down through genes. It’s a very buzzy idea, but the evidence that trauma can leave a signature that lasts generations is circumstantial at best.

The New York Times: Can We Really Inherit Trauma?

 

I’ll leave you with some bah-humbug! warnings about not eating that raw cookie dough this holiday season (even though it’s clearly the best part of making cookies). Have a great weekend!

For The Asking, A Check Is In The Mail To Help Pay For Costly Drugs

Kip Burgess was relieved last year when pharmaceutical giant Amgen overnighted him a $2,976 check to help pay for his go-to arthritis drug, Enbrel.

The 36-year-old psychologist had run into an increasingly common problem: The copay coupon sent by Amgen couldn’t cover the drug’s more than $4,000 monthly price.

“Nothing in the world gives me more anxiety than just getting my medication,” Burgess said. “There’s nothing you can do but beg.”

Panicked, Burgess had called Amgen and pleaded for help. The drugmaker sent him the check after he provided a credit card statement and an explanation of benefits to prove he bought its drug.

It’s one of the little-known secrets in health care: When financial incentives like copay coupons and debit cards won’t work, pharmaceutical companies sometimes will write a check — what they call direct reimbursement — to make sure a loyal patient will stay on a high-cost, brand-name drug.

Drugmakers began using now-popular copay coupons and other forms of assistance more than a decade ago to help patients pay out-of-pocket costs for medicines, particularly high-cost specialty drugs such as those that treat autoimmune disorders. The coupons have a dual purpose: They mask the true costs of a drug for patients and give patients a financial incentive to stay on an expensive drug until their insurance deductible is met.

Ellen Albritton, a senior policy analyst with Families USA, said the multiple calls Burgess made to his insurer, pharmacy manager and the drugmaker to pay for his drug is “a lot to put on a patient.”

“This highlights just how dysfunctional the system is, and it just isn’t working for patients,” Albritton said.

“Nothing in the world gives me more anxiety than just getting my medication,” says Kip Burgess, a psychologist who depends on Enbrel to treat his arthritis, a drug that costs more than $4,000 a month. “There’s nothing you can do but beg.”(Kristen Norman for KHN)

The practice of sending checks is legal as long as the patients are not enrolled in government-funded insurance such as Medicare and Medicaid, said William Schiffbauer, a Washington, D.C.-based health insurance attorney.

“You can accept cash from anybody as long as it’s not a government program,” Schiffbauer said, noting there may be income tax obligations for the patient. The federal anti-kickback and Stark laws were meant to prevent bribery of patients and doctors and do not apply to private commercial insurance plans.

AbbVie, which makes the blockbuster arthritis drug Humira, will send a check if patients can prove their copay card doesn’t work for a variety of reasons, said Adelle Infante, director of external communications for the company. 

Amgen, the maker of Burgess’ arthritis medicine, provides up to $12,000 of copay assistance each year to commercially insured Enbrel patients who need help meeting out-of-pocket expenses, often regardless of the patient’s financial status. When the cards fail to work, for whatever reason, Amgen can send direct reimbursement.

While Amgen’s primary assistance is through copay cards, “in some instances, based on patient preference, Amgen will provide direct reimbursement” after a patient has already paid for the medicine, Amgen’s Kristen Neese, director of corporate affairs, said in an emailed statement.

Harry Totonis, chief executive of ConnectiveRx, a pharmaceutical services company, said sending checks to patients is “not a commonly used practice” and happens “a fraction of 1 percent” of the time. He declined to confirm the average value of the checks or name the drugmakers that issue checks via ConnectiveRx.

“All of these programs try to help patients afford the medications,” said Totonis, whose company bought PSKW, which issued the check Burgess received from Amgen in 2017.

Daniel Nam, executive director of federal programs for AHIP, the America’s Health Insurance Plans, said direct reimbursement using checks is just another way for manufacturers to make insurance companies pay for expensive drugs, which helps jack up monthly premiums.

This approach will “create a new black hole of patient-directed payments and avoid any scrutiny,” he said.

Insurers and lawmakers have begun to push back against the popular copay programs, saying they raise the cost of medications in the long run. California passed a law last year limiting their use and federal litigators have increased scrutiny.

Insurers and pharmacy benefit managers like CVS Caremark and ExpressScripts have begun refusing to use copay cards as the drugmakers intended.

CVS Caremark introduced “copay accumulator” programs two years ago. Patients can use a copay card or coupon to help cover the cost of the drug, but the payment does not count toward their insurance plan’s deductible or out-of-pocket maximum. That often means that when the assistance from the drugmaker — which is generally limited to a fixed dollar amount — runs out, the patient is on the hook for a much larger share of the cost of the drug.

“It is important to remember that while manufacturer-sponsored programs, such as copay cards, can help reduce out-of-pocket costs for patients in the short-term, they can also lead to increased health care costs in the system by encouraging the use of higher cost, often branded drugs,” Christine Cramer, senior director of CVS Health’s corporate communications, emailed this month.

A copay accumulator likely triggered Burgess’ panicked call in 2017. Amgen had issued Burgess a copay card preloaded with $12,000 to help cover his out-of-pocket expenses. But his pharmacy began charging the full monthly cost for Enbrel, not merely his out-of-pocket share, against his copay card. And that big charge didn’t count against his annual deductible.

So, after a couple of months, Burgess suddenly needed to pay thousands of dollars to meet his deductible and get the medication that helped him get out of bed in the morning.

But Amgen is reformulating the remedy Burgess sought, and he and other patients may be out of luck. As of 2018, Amgen said, it will send checks only to financially needy patients whose insurers and pharmacy benefit managers use accumulator programs. The patients must show incomes at 500 percent or below the federal poverty level, or $60,700 for an individual and $125,500 for a family of four. An Amgen email stated that only “an extremely small number of patients” have received money that way.

Burgess doesn’t qualify. He had to raid his savings this year for the money to cover his deductible.

“It really feels like they are throwing me under the bus to get back at the insurance company,” Burgess said. “These two giant corporations are fighting it out, and they don’t really care about me in any shape or form.”


KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.