The Department of Health and Human Services (“HHS”) perhaps offered its last regulatory hurrah for the Affordable Care Act today when it released the (very?) final notice of benefit and payment parameters rule for 2018. Here’s a link to a summary of the massive rulemaking. The fact sheet disclose the one aspect of the rule that impacts the FEHBP and other group health plans:
Annual Limitation on Cost Sharing: The maximum annual limitation on cost sharing is the product of the dollar limit for calendar year 2014 ($6,350 for self-only coverage) and the premium adjustment percentage for 2018, rounded down to the next lower $50. We are finalizing a maximum annual limitation on cost sharing for 2018 of $7,350 for individual coverage and $14,700 for family coverage.
The cost sharing limit applies only to essential health benefits.
In a piece of good news for the health sector, HHS also announced last night, according to Modern Healthcare, that
it was killing a five-year Medicare initiative that would test new ways of paying for outpatient drugs in an effort to bring those prices down.
Providers, drug makers and pharmaceutical companies immediately slammed the proposal when it was first unveiled in March..
Ted Okon, executive director of the Community Cancer Alliance, which represented one of the specialities that would be most negatively affected, immediately tweeted that the pilot was “the most contrived, absurd experiment on cancer care I have seen.”
Unquestionably there are structural problems with the prescription drug market. It would be encouraging if the sector could work out the problems without government intervention but time is growing short.
The FEHBlog was critical of Gilead Sciences for price gouging on its Hepatitis C drugs. Of course, once another manufacturer created competition for that class of drugs the price dropped. But that’s not the end of the story. The Wall Street Journal reports today that
A federal jury in Delaware on Thursday ordered Gilead Sciences Inc. to pay $2.5 billion in damages to Merck & Co. for infringing its patents in developing hepatitis C drugs.
The patent-infringement decision, issued by a jury in a U.S. District Court in Delaware, involved two Gilead drugs that have rung up billions of dollars in sales, Sovaldi and Harvoni.
The jury decided that Gilead’s two drugs violated the patents held by Idenix Pharmaceuticals, a company bought by Merck for $3.9 billion in 2014.
Gilead plans an appeal.