Weekend update

Happy Super Sunday!  Congress is in session again this week as the Hill’s Floor Watch blog details  The Senate Homeland Security and Governmental Affairs Committee continues its markup of the bipartisan postal reform bill (S 1486) on Thursday February 6 at 10 am.

Last Thursday, HHS provided an update on the ACA’s Medicare savings initiative, including Accountable Care Organizations. The lead sentence in the related Kaiser Health News’ report says it all — “Accountable care organizations are saving some money, though what exactly that means is still unclear.” In fairness to HHS, it’s still early in the game.

The Wall Street Journal on Saturday (best paper of the week) published a review of a book on the development of the first Hepatitis C drug that reached the market. This drug recently was overtaken by the Gilead drug mentioned in last Tuesday’s Tidbits. The book review discloses that Gilead owes a lot to the developer of the first drug, Vertex.

Hepatitis C was an “underrated and undervalued disease,” Mr. Werth writes in “The Antidote,” lacking the visibility of AIDS or cancer. The disease also lacked a deep history, its causative virus and responsibility for cirrhosis and liver cancer having been discovered only recently. Worse still for the political visibility of hepatitis C was the disease’s demography: Major vectors of transmission were widely understood to be intravenous drug use and tattooing. There were about three million people infected in America, and 150 million to 200 million world-wide, but U.S. victims were concentrated among the poor and African-Americans. In California, 40% of prisoners were infected with the hepatitis C virus, compared with about 2% of the general population.

So Vertex took a leading role in lobbying to widen hepatitis C screening, to shed any stigma associated with the disease, and to get it thought of not as a drug users’ disease but as an affliction of the influential baby-boomer generation. The company also tried to show that even a hugely expensive drug treatment—Incivek was eventually priced at about $50,000 for a 12-week course—would cost patients and insurers less than the alternatives, such as liver transplantation. For Vertex’s molecule to make serious money, hepatitis C had to be culturally reconsidered and politically repositioned. 

PBMs are pushing back at Gilead’s decision to price its drug $84,000 per course of treatment.

The Government Accountability Office released a report last week on recent trends in federal civil service employment.

From 2004 to 2012, the federal non-postal civilian workforce grew by 258,882 employees, from 1.88 million to 2.13 million (14 percent). Permanent career employees accounted for most of the growth, increasing by 256,718 employees, from 1.7 million in 2004 to 1.96 million in 2012 (15 percent). Three agencies–the Departments of Defense (DOD), Homeland Security (DHS), and Veterans Affairs (VA)–accounted for about 94 percent of this increase. 

For a little FEHBP perspective, OPM’s March 2012 headcount report as found in the FEHBlog’s archives indicates that 1,858,330 annuitants, 1,707,618 civil service employees, and 449,183 Postal Service employees were then enrolled in the FEHBP,  From March 2007 to March 2013, civil service employee enrollment increased by 10% (2/3s of the total permanent career service employee increase of 15%), Postal Service employee enrollment dropped by a jaw-dropping 27% (from 614,044 in March 2007), and annuitant enrollment increase by 3% across the FEHBP. Annuitants compose roughly 46% of the total FEHBP enrollment.

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