Mid-week update

David Ermer–Uncategorized–

The Hill reports that the President is urging the Senate to follow the House of Representative’s lead by passing an opioid crisis bill.  The Hill further reports that a group of eight health benefit organization lobbying groups, including AHIP and the Blue Cross Blue Shield Association, is pleading with the Senate leadership not to adopt the House opioid bill provision that would extend private sector primary coverage liability over Medicare from 30 to 33 months effective January 1, 2020.

Also on the opioid crisis front —

  • Opioid Watch offers this interesting perspective on tackling the opioid crisis. 
  • The Centers for Disease Control’s cheerfully named Morbidity and Mortality Weekly Report offers statistics on the extent to which the opioid crisis is affecting pregnant women, which is an OPM priority. 
A couple weeks ago, the FEHBlog mentioned that the U.S. District Court for the Northern District of Texas set September 10 as the date for hearing the preliminary injunction motion submitted by a group of States lead by Texas that challenges the ACA’s constitutionality in the wake of the Congress’s decision to zero out the ACA’s individual mandate penalty effective January 1, 2019. The FEHBlog has read that the Court moved up the hearing date to September 5 as September 10 is the Jewish New Year. Meanwhile, according to the Washington Examiner, CMS Administrator Seema Verma testified before Congress that she would work with Congress to protect people with pre-existing conditions if the ACA is declared unconstitutional. 
The Wall Street Journal reports on a Wisconsin hospital, Gunderson Lutheran, efforts to evaluate its list price for common procedures by assessing the underlying costs. “Armed with the new information, Gundersen was able to pinpoint waste, and it set out to cut inefficiencies and lower costs. Changes to the process mean the knee surgery now costs the hospital an average $8,700 at most to perform, an 18% savings.” Bravo. 
Health Data Management reports that 

Hospitals have been closing at a rate of about 30 a year, according to the American Hospital Association, and patients living far from major cities may be left with even fewer hospital choices as insurers push them toward online providers like Teladoc and clinics. * * * 

There are already a lot of hospitals with high negative margins, consultancy Veda Partners healthcare policy analyst Spencer Perlman says, and that’s going to become unsustainable. Rural hospitals with a smaller footprint may have less room to negotiate rates with managed care companies and are often hobbled by more older and poorer patients.

Finally, the FEHBlog’s pharmacist friend from Connecticut pointed out  this Reuters report dated August 14  —

[Prescription benefits manager] Express Scripts has built a specialty pharmaceutical business in which it gets paid to help drug companies dispense a new generation of high-priced drugs. The company is now holding discussions with biotechnology companies Biomarin Pharmaceutical, Spark Therapeutics, and Bluebird Bio to exclusively distribute their new hemophilia therapies when they are expected to become available in 2019 and 2020. Analysts project those drugs could top $1 million to $1.5 million in price. Express Scripts Chief Medical Officer Steve Miller says the potentially curative therapies will likely be worth the high cost if they supplant the hundreds of thousands of dollars in annual medical costs to treat ailments such as hemophilia. “Even if they charge $1 million, that’s a great deal,” says Miller. “So there are going to be some gene therapies where it is very clear that everyone who has that disease should get it.” To manage any potential conflicts of interest, Miller notes Express Scripts separates its benefits management and specialty pharmacy businesses.