Thursday Update

The budget resolution bill remains on track for passage. According to California Healthline, the bill in addition to adding a self plus option to the FEHBP as discussed in yesterday’s post also would give Congress three more months to replace the defective statutory sustainable rate of growth formula used to set Medicare Part B reimbursement rates for doctors. That’s a relief for FEHBP carriers who have to coordinate benefits with Medicare Part B for thousands of enrollees and also use the Medicare Part B reimbursement schedule to pay doctors for annuitants without Medicare Part B (5 USC § 8904(b)).  LifeHealth Pro reports that both the Senate Finance Committee and the House Ways and Means Committee met today about the SRG replacement bill now under discussion (HR 2810).

Last Sunday, the FEHBlog noted a Washington Post article about Genentech manipulation of FDA labelling rules to boost profits. It is illegal for drug manufacturers to promote the off label uses of their drugs. (According to the Post, Genentech refuses to seek a labelling change for a cheaper drug that serves the same purpose as a much more expensive drug in its portfolio.)  On Monday, according to a Reuters report, the Supreme Court refused to hear a drug manufacturer’s appeals against a health plan which had obtained a federal racketeeting verdict against that manufacturer Pfizer. The health plan used Pfizer’s offlabel marketing of one of its prescription drugs to form the predicate acts for the RICO claim which carries treble damages. Other health insurers are lining up to file similar suits. Good for them.

PwC’s Health Research Institute has released its list of top 10 health industry issues for 2014.  The headline is encouraging –“Consumers tell HRI they do not believe expensive medical treatment means better quality.” To that end, the FEHBlog noticed this interesting Uwe Reihardt column in today’s New York Times on the topic of health care transparency.  The column notes that

a three-day conference [recently was held] in Washington, funded by the Robert Wood Johnson Foundation and a large number of other sponsors, under the theme “Health Care Price, Cost and Quality Transparency.” Slides of most of the many illuminating presentations featured at the conference are available to the public (click on “faculty materials”).

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