Thursday, March 29, 2018
Push for Healthcare Price Transparency Mobilizes Industry
Push for Healthcare Price Transparency Mobilizes Industry
By Lauren Clason, CQ
A sudden push to shine a light on the shadowy world of medical prices is putting the industry on alert as hospitals, insurers and pharmacy benefit managers work to counter recent questions raised by lawmakers and Trump administration officials.
The pressure has largely targeted drug manufacturers and industry middlemen, like insurers and pharmacy benefit managers, that function as the gatekeepers for medical care. But lawmakers and officials are also taking aim at providers that either can’t or won’t provide patients with the true cost of a medical service.
President Donald Trump and Health and Human Services Secretary Alex Azar plan to unveil a drug pricing proposal in the coming weeks, which could contain a measure aimed at including patients in prescription drug rebates given to insurers and pharmacy benefit managers, or PBMs. Centers for Medicare and Medicaid Services Administrator Seema Verma also told reporters Thursday that upcoming policies will require more information about providers' prices.
"You're going to see us just get started on that with the payment rules but there's a lot more coming around that," Verma said. "When we look at the Medicare system, we all know that if you go to one place it might be cheaper than another place.... What we can do is make it more transparent to the consumer so they understand, hey, if I go here, it might be cheaper. So you’re going to see us do a lot on that.”
And Louisiana Republican Bill Cassidy, along with a bipartisan cohort of senators, is planning on introducing a bill targeting price transparency in the next several weeks.
Cassidy’s bill will focus on prices at the point of sale, according to his office. The senator has been in contact with Azar about the bill, and is shopping the framework to leaders of the relevant committees in both chambers.
The ramped-up pressure has industry groups working to shape the coming proposals. The drug pricing plan from the Trump administration is just now in its “formative stages,” Mark Merritt, president of the Pharmaceutical Care Management Association, the PBM trade group, told CQ.
Merritt offered Azar a number of proposals the industry says would save billions of dollars, including speeding generics to market and eliminating protected classes of drugs where discounts are not allowed. Passing through drug manufacturer rebates in Medicare, he noted, is expected to cost the government $42 billion over 10 years.
“I’m not taking it lightly, but if you’re in health care, this comes with the territory,” he said. “Everybody is in the same place because there’s a lot of pressure to bring costs down, and we welcome that debate.”
Federal Officials' Warnings
Azar delivered stern remarks to multiple industry groups in recent weeks, identifying transparency from both payers and providers as one of his top priorities in what he called the country’s “bizarre third-party payer system.” He recently delegated a point person to handle price transparency, according to Cassidy’s office, but HHS did not return requests for confirmation.
“I believe you ought to have the right to know what a healthcare service will cost — and what it will really cost — before you get that service,” Azar told the Federation of American Hospitals, a trade group of for-profit hospitals. “This is a pretty simple principle. We’ll work with you to make it happen — and lay out more powerful incentives if it doesn’t.”
The hospital industry, for its part, is working to introduce some level of transparency. The American Hospital Association recently assembled a toolkit for its members on how to improve consumer information and has endorsed legislation requiring hospitals to report pricing data.
Azar's warnings were echoed by Food and Drug Administration Commissioner Scott Gottlieb in a speech to America’s Health Insurance Plans, calling out the “Kabuki drug pricing constructs” negotiated between payers and drug manufacturers that he said encourage hefty price increases to “fuel the pricing schemes.”
Industry groups are quick to point the finger at each other over the sensitive nature of their contracts. Daniel Nam, executive director of federal programs for AHIP, told CQ the group is working to clarify the rhetoric around the concept of the “middleman” after Gottlieb’s speech. Passing on the rebates would allow drugmakers to better calculate the rebates of their competitors and elevate prices even further, Nam said. The list prices are the problem, he maintained, because it sets the conversation for discounts.
“One of the other things that I think we have to recognize is there are a lot of fixes in our system that need to be done, but we’re working with a system that has been developed and shaped over the last decades and decades and decades, so any sort of change, first, probably isn’t going to be immediate and probably shouldn’t be immediate,” Nam said. “We need to make sure it’s well understood and we need to make sure that the policies are going to be shaping things in the future the right way for decades to come.”
Nam said the insurance industry needs to be better at engaging with patient and community organizations, even if the groups are backed by the pharmaceutical industry.
“It does become a toxic environment at times,” he said. “But maybe we should just buck up and do it anyway.”
A recent study published in the Journal of the American Medical Association found that health care prices were the main drivers of rising medical spending. The U.S. spent about 18 percent of its gross domestic product on health care in 2016, compared with other wealthy countries that spent from 10 to 12 percent.
While transparency will help, consumer groups contend, further action will be necessary to make a dent in rising costs. Because consumers don’t purchase medical products and services directly, but rather through their employer, insurance company or the government, price transparency in and of itself is often unhelpful.
“Price transparency is an important tool, but it’s only one tool that has to be used in combination with others,” Niall Brennan, president of the Health Care Cost Institute, told CQ. “If we rely solely on price transparency to fix our problems, what we’re doing is placing responsibility of 20 to 30 years of unchecked cost growth on the least powerful people in the system.”
Wednesday, March 28, 2018
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Thursday, March 22, 2018
Boy Scouts, Archdiocese opposing bill to expand rights of sex abuse victims | Georgia Health News
Legislation meant to provide more protection for victims of childhood sexual abuse has met some heavy opposition. Boy Scouts, Archdiocese opposing bill to expand rights of sex abuse victims | Georgia Health News
Latest effort to help cancer hospital fails amid acrimony | Georgia Health News
Latest effort to help cancer hospital fails amid acrimony | Georgia Health News This time, provisions that would allow children’s hospitals to “co-locate’’ pediatric beds in adult hospitals got caught up in the CTCA uproar.
Wednesday, March 21, 2018
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Friday, March 16, 2018
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Wednesday, March 7, 2018
CDC Director Discusses Guns, Flu and High-Security Labs
CQ NEWS
March 2, 2018 – 2:04 p.m.
March 2, 2018 – 2:04 p.m.
CDC Director Discusses Guns, Flu and High-Security Labs
By Andrew Siddons, CQ
Anne Schuchat became the acting director of the Centers for Disease Control and Prevention for the second time when Brenda Fitzgerald resigned as director in January over financial conflicts of interest that had prevented her from testifying before Congress on pressing public health issues.
Schuchat sat down with CQ at the CDC’s Washington office to discuss gun violence research, the severe flu season and the future of the CDC lab that handles dangerous pathogens like Ebola and smallpox.
Schuchat, a physician who holds the rank of rear admiral in the U.S. Public Health Service Corps., has been the CDC’s deputy since 2015 and served as acting director at the beginning of the Trump administration. Earlier in her 30-year career at the CDC, she ran the divisions on immunization, respiratory diseases, global health and infectious diseases.
Investigating Gun Violence
In the wake of the shooting at a Florida high school last month, the CDC’s ability to conduct research on gun violence is “on everybody’s mind,” Schuchat said, adding that she spoke to Health and Human Services Secretary Alex Azar after he was questioned about it during a House Energy and Commerce hearing.
Schuchat said controversial appropriations language that prohibits the CDC from “advocating” for gun control isn’t the problem. The bigger hurdle is that Congress hasn’t provided the money and guidance on how to conduct such research.
“We are not currently funded to do gun violence research,” she told CQ. “We work in some narrow areas when we can, but if funded, we would certainly do more.”
The CDC’s injury prevention division would take the lead on such research, and she noted that it currently conducts surveillance on deaths caused by violence in general. But she suggested that most of the division’s $235 million budget is already spoken for, especially as the CDC is being directed to put more resources toward monitoring opioid addiction and overdose deaths.
If provided funds specifically to study gun violence, Schuchat said that a 2013 Institute of Medicine report lays out a research agenda that she would like the CDC to pursue. She believes that work can all be done without violating a prohibition on “advocacy.”
“I think we need an evidence base to know what works. I can say safely storing your guns is very important,” she said, pointing out that this is established scientific evidence.
“There’s a difference between a policy proposal and the result of a scientific study,” she said. “The question is just whether there’s direction from Congress about more resources, or for a change in our approach.”
Fighting the Flu
Schuchat is a familiar face at congressional hearings, and she will be back on the Hill next week to testify about seasonal influenza. She will join other administration officials at a House Energy and Commerce Oversight Subcommittee to discuss why this season set records for hospitalizations and why the recommended flu vaccine didn’t provide as much protection as in previous years.
Vaccines don’t work as well against this year’s flu strain, H3N2, she explained. While there are questions about whether the virus mutated to thwart the vaccines that are available, she also said that not enough people are getting vaccinated.
“The vaccines aren’t being used as well as they should,” she said. “The majority of children who die from flu haven’t been vaccinated against it.”
She said there is work to do to accelerate the rate of manufacturing vaccines, and more research needs to be done into a “universal” vaccine that can work against all flu strains. Until then, she pointed to the CDC’s work on helping people who come down with the flu gain access to antivirals that can treat flu symptoms.
“CDC worked with manufacturers and insurers and pharmacies to try to pivot during the season to get more quantities of antivirals on the shelves in pharmacies, to get some of the producers to increase their production during the course of it,” she said. “It’s a little easier to do that with antivirals than with vaccines.”
High-Risk Containment Lab
Lawmakers are trying to pass a catch-all spending bill by March 23 that would fund the government for the rest of fiscal 2018, and the administration wants the bill to include $350 million for a new CDC lab that can handle the world’s most dangerous pathogens, such as Ebola and smallpox.
While the $350 million would not cover the whole project, Schuchat said that the CDC needs to start now, since the lab’s automated systems will no longer be able to safely function at some point in the near future. “It takes several years to plan and execute a building of this nature,” she said.
The current lab was built in 2005 — before the iPhone was developed, Schuchat noted — but the CDC wants the next lab to have a longer lifespan.
“The technology is not current, and the approach going forward would be more modular and flexible for upgrades to be possible,” she said. “I think we’ve learned from that era and can really build in a way that would have a longer life.”
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