Jingle Bells

The FEHBlog thought that he could take a week off, but noooo, the ACA regulators kept up the drumbeat of new rules with an proposed rule updating the summary of benefits and coverage (“SBC”).  The SBC is a four double side page explanation of health plan coverage to be accompanied by a uniform glossary of health insurance terminology. Of course, is the brainchild of the ACA, and it sits on top of the lengthier and definitive summary plan description for ERISA plans and plan brochure for FEHB plans.  The FEHBlog is not sure how many people actually use the SBC, which was introduced a couple years ago, but the ACA regulators have decided in their infinite wisdom to update it with, e.g., a new “coverage example” for a simple leg fracture to accompany the existing examples of diabetes 2 treatment and the delivery of a baby. Timothy Jost in Health Affairs already has taken the time to review the proposed changes here. The rule is now in its comment period. The ACA regulators anticipate that the new SBC will be used beginning on September 15, 2014   Congress should require health care providers to give their patients a list of the networks in which they participate and sample prices. That would really improve transparency.

The other big news is that last Friday December 19, the Food and Drug Administration approved for marketing Abbvie’s “Viekira Pak (ombitasvir, paritaprevir and ritonavir tablets co-packaged with dasabuvir tablets) to treat patients with chronic hepatitis C virus (HCV) genotype 1 infection, including those with a type of advanced liver disease called cirrhosis.”  Genotype 1 is the most common form of Hepatitis C.  Gilead Sciences no longer has a monopoly with its Sovaldi and Harvoni drugs for that disease. On Monday, the Chicago Tribune reported that the large prescription drug manager Express Scripts announced  that on January 1, 2015, it will only offer Abbvie’s drug for Hepatitis C genotype 1 infections.   “Express Scripts did not say how much AbbVie would cut the $83,319 wholesale cost of the drug, but said it will be comparable to the price Gilead Sciences charges in Western Europe for its blockbuster drug Sovaldi, which costs $51,373 in France and $66,000 in Germany, for example ”  The Wall Street Journal’s Phamalot blog added more perspective in its report which explains why Abbvie’s drug will not entirely supplant Gilead’s drugs and that Express Script’s deal is not exclusive.  “Sanford Bernstein’s Porges writes that he also expects Gilead ‘will need to make a significant concession to CVS/Caremark in order to retaliate against AbbVie and possibly secure an exclusive arrangement with CVS/Caremark.’”

Merry Christmas to all!