Happy Columbus Day Weekend. Senate leaders are continuing discussions aimed at a compromise to end the partial shutdown and avoid a possible default according to the Wall Street Journal and the Washington Post. The FEHBP has been rolling along without interruption during the partial shutdown because the FEHBP is funded through the Employee Health Benefits Fund in the U.S. Treasury. There was precedent for the status quo holding during a government shutdown because the FEHBlog remembers the partial shutdowns in 1995 and 1996. The default, however, would be unprecedented, and the FEHBlog does not expect it to occur.
It is important to understand that the default will not occur on October 17. The federal government actually reached the debt limit back in May 2013. October 17 is the date that that Treasury expects to exhaust its extraordinary measures, but it is not the default or X date according to MSNBC and the Wall Street Journal’s Numbers Guy. The FEHBlog appreciates that it’s helpful to give Congress a a deadline, like October 17, but as we get closer to the deadline without a clear resolution at hand, it’s fortunate that the default will not occur according to Bipartisan Policy Center estimates until sometime between October 22 and November 1. Stay tuned.
The NY Times has a lengthy front page article today on the high price of asthma drugs. The article appears to the FEHBlog to advocate for wholesale price controls like Britain, Canada, Germany, etc. (Bloomberg wrote about the fact that last week Maine started to permit consumers to order mail order prescription drugs from Canada which violates the federal Food and Drug Act in the FEHBlog’s understanding.) The article points out that the drug spiral is attributable to a failure of regulators to coordinate their activities. The article explains that the cost of generic inhaled drugs skyrocketed in recent years because the EPA banned the traditional inhaler propellant. So the drug companies patented new approaches to propelling the drugs and the market contracted and prices shot up. This is not a market problem; it’s a regulatory problem.
The NY Times article also stresses the importance of the cost of drugs to consumers in the determining whether the consumer will take prescription or over the counter drugs. For example
Juan Carlos Molina, the director of external communication for GlaxoSmithKline, which makes Advair, said in an e-mail that the price of medicines was “closely linked to this country’s model for delivery of care,” which assumes that health insurance will pick up a significant part of the cost. An average co-payment for Advair for commercially insured patients is $30 to $45 a month, he added.
Modern Healthcare reports about the trend among major insurer to reduce or waive consumer cost sharing from preventive drugs like Lipitor (or its generic equivalent) or lipids.
Aetna ha[s] gone further and reduced or waived cost-sharing for drugs used for secondary prevention, such as statins for patients who already have had a heart attack to reduce the chance of a reoccurrence.
Other medications for which some insurers have reduced or waived cost-sharing include drugs for preventing or treating high blood pressure, asthma, stroke, diabetes, osteoporosis, pediatric conditions, and maternal and fetal problems.
There are no data on how many insurers have made these policy changes. But the moves are consistent with the U.S. healthcare system’s gradual shift toward a more primary-care and prevention-oriented approach and a greater focus on management of chronic disease.