Health Brief: CVS Health Sued for Alleged Drug Co-Pay ‘Clawbacks’

Government Brief

  • President Donald Trump promised to tackle the nation’s opioid crisis in an address, but he stopped short of declaring a national state of emergency, as his presidential commission on the epidemic recommended. Trump blamed former President Barack Obama for not doing more to curb opioid abuse, but he offered few specific details for how he would confront the crisis. (The New York Times)
  • The Puerto Rico government, some hospitals and nonprofits are offering incentives to attract and keep doctors to the island, as a mass exodus of medical personnel set off by the commonwealth’s debt crisis worsens. (NBC News)
  • Pro-Obamacare group Save My Care launched a digital ad campaign tying some vulnerable Republican senators and House members to the GOP effort to repeal Obamacare. (Washington Examiner) 

Business Brief

  • A California woman filed a lawsuit accusing CVS Health Corp. of overbilling customers who used insurance to buy certain generic medicines and hiding that the medicines’ cash price was cheaper because of agreements with pharmacy benefit managers who get the extra co-pay money. (Bloomberg)
  • The cost of large employer health plans is expected to increase by 5 percent next year to an average cost of more than $14,000 per employee, according to a new survey of 148 large companies. The price hikes, which are modest compared to those on the Obamacare exchanges, were attributed to pricey specialty drugs and individuals with expensive medical conditions. (The Washington Post)
  • Nearly 41 percent of the 6.3 million consumers purchased off-market health plans in 2015 despite being eligible for Obamacare subsidies to help them afford coverage on the exchanges, according to a new study. (Modern Healthcare)

Chart Review

Events Calendar (All Times Local)

National Association of Insurance Commissioners summer national meeting 9 a.m.
Center for Global Development event on implementing clinical trials during epidemics 12:30 p.m.
No events scheduled.

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Vowing Again to Tackle Opioid Crisis, Trump Faults His Predecessor
Peter Baker and Michael D. Shear, The New York Times

President Trump promised again on Tuesday to tackle the growing epidemic of opioid abuse in the United States after blaming his predecessor for not doing more to stem the surge of drug overdoses. But he offered no specific ideas for how he would do so. Meeting with top advisers during his working vacation in New Jersey, Mr. Trump cited statistics saying that deaths stemming from opioid overdoses had skyrocketed in recent years and had become the leading cause of accidental death in the United States.

Pro-Obamacare group targets repeal voters
Robert King, Washington Examiner

The pro-Obamacare group Save My Care launched a digital ad campaign that targets key House and Senate Republicans who voted in favor of repealing the healthcare law. The ads target three senators and seven House members in an attempt to tie them to votes for unpopular repeal efforts.

How U.S. states have used emergency declarations to fight the opioid epidemic
Erin Mershon and Andrew Joseph, Stat News

In Arizona, it allowed state officials to get daily reports on overdoses. In Alaska, it allowed officials to expand naloxone use. In Massachusetts, it led to new prescription monitoring guidelines and even a controversial ban on a specific painkiller.

Colon cancer deaths rise among younger adults, and no one knows why
Jacqueline Howard, CNN

Adults in the United States are dying from colon and rectal cancers at an increasing rate about age 50, when they should just be beginning screenings, according to a new study from the American Cancer Society. Since routine screening is generally not recommended for most adults under 50, the cancers found in younger adults are often in advanced stages and more deadly, said Dr. James Church, a colorectal surgeon at the Cleveland Clinic in Ohio.

Ibuprofen linked to slight risk of kidney damage in ultramarathoners
Lisa Rapaport, Reuters

Ultramarathoners who manage race day pain with ibuprofen are a bit more likely to develop kidney injuries than their competitors who don’t use the drug, a small experiment suggests. The difference in the odds of kidney damage wasn’t big enough to be statistically meaningful, and at least some of the added risk may be associated with dehydration, researchers report in the Emergency Medicine Journal.

Havens Jump on North Korea Tension; Stocks Slide: Markets Wrap
Samuel Potter, Bloomberg

A risk-off tone gripped markets on Wednesday, with gold, the Japanese yen and bonds rising as tension grew between the U.S. and North Korea. European stocks slumped following declines across most of Asia.


Large employers say health plans will cost more than $14,000 for an employee in 2018
Carolyn Y. Johnson, The Washington Post

Large employers say the cost of health-care plans will grow 5 percent next year, to an average cost of more than $14,000 per employee. The increases, reported in a new survey of 148 large companies, were attributed largely to expensive specialty drugs and individuals with high medical costs.

Many consumers pass up premium subsidies by buying off-exchange health plans
Harris Meyer, Modern Healthcare

For unknown reasons, a sizable number of Americans who qualify for premium subsidies are passing them up by buying health insurance outside the Affordable Care Act’s insurance exchanges. That could be affecting the health of the individual insurance market, particularly to the extent people are buying plans that do not comply with ACA insurance rules.

Democratic rep calls on Wisconsin governor to expand Medicaid
Nathaniel Weixel, The Hill

A Democratic congressman from Wisconsin is calling on Gov. Scott Walker (R) to expand the state’s Medicaid program, known as BadgerCare. Rep. Ron Kind told Walker in a letter sent Tuesday that the failure by congressional Republicans to repeal ObamaCare should be a message that “the time for partisan attacks on the law has passed.”


Puerto Rico’s Exodus of Doctors Adds Health Care Strain to Dire Financial Crisis
Mariela Patron, NBC News

Puerto Rico’s struggling financial crisis has set off an exodus of medical personnel, leaving physicians with unmanageable patient loads and triggering a cascade of problems for patients and hospitals. The government, some hospitals and non-profits are offering incentives to try to keep or attract doctors to Puerto Rico as the situation worsens.

CVS Moves Deeper Into Doctors’ Turf
Sharon Terlep, The Wall Street Journal

CVS Health Corp. CVS -0.70% , hit by slower store sales and the defection of some big insurance providers, is moving ever more onto doctors’ turf in a bid to win back business. The company said Tuesday that it intends to expand a program in which it marshals pharmacists, hundreds of on-site medical clinics and its vast data network to help people manage chronic diseases including asthma and high blood pressure.

St. Louis-based Abbott EMS to get a new owner in $2.4 billion deal

Envision Healthcare Corp. said on Tuesday it would sell its ambulance business to buyout firm KKR & Co. in an all-cash deal valued at $2.4 billion as it sharpens its focus on its core businesses. The merger with Envision’s American Medical Response (AMR), the largest U.S. provider of ambulance services, would allow KKR’s Air Medical Group to easily substitute costly helicopter flights with ambulances for shorter trips.

D.C. shuts down obstetrics ward at United Medical Center for 90 days
Fenit Nirappil, The Washington Post

District regulators have ordered the only full-service hospital in Southeast Washington to stop delivering babies and operating its nursery for the next 90 days. The D.C. Health Department is restricting United Medical Center’s license that allowed it to perform obstetrics and nursery care while the hospital implements a plan to improve those services, a spokeswoman for the agency said Tuesday.

Push for value-based care fuels burnout at community health centers
Maria Castellucci, Modern Healthcare

Community health centers, which offer primary care to approximately 24.3 million low-income individuals, are known for their high rates of employee turnover because of the stress associated with caring for complex patients on a fee-for-service pay model. But efforts to transform care delivery at these centers to value-based approaches also contribute to workplace dissatisfaction and burnout, according to a new study published in Health Affairs.

Pharma, Biotech and Devices

CVS Health Is Sued Over ‘Clawbacks’ of Prescription Drug Co-Pays
Jef Feeley and Jared S Hopkins, Bloomberg

CVS Health Corp. was sued by a California woman who accused the drugstore operator of charging customers co-payments for certain prescription drugs that exceed the cost of medicines. CVS, the largest U.S. pharmacy chain, overbilled consumers who used insurance to pay for some generic drugs and wrongfully hid the fact that the medicines’ cash price was cheaper, Megan Schultz said in her Aug. 7 lawsuit. Schultz said in one case she paid $166 for a generic drug that would have cost only $92 if she’d known to pay cash.

Generic Drug Prices Are Falling, but Are Consumers Benefiting?
Charles Ornstein and Katie Thomas, The New York Times

Not all drug prices are going up. Amid the public fury over the escalating costs of brand-name medications, the prices of generic drugs have been falling, raising fears about the profitability of major generic manufacturers.

New Hampshire sues Purdue Pharma over opioid marketing practices
Nate Raymond, Reuters

New Hampshire sued OxyContin maker Purdue Pharma LP on Tuesday, becoming the latest state or local government to accuse the drugmaker of engaging in deceptive marketing practices that have helped fuel a national opioid addiction epidemic. The lawsuit filed in Merrimack County Superior Court claimed that Purdue Pharma significantly downplayed the risk of addiction posed by OxyContin and engaged in marketing practices that “opened the floodgates” to opioid use and abuse.

Health IT

We still haven’t solved the health care cybersecurity problem
David Nather, Axios

It’s been a few months since the worldwide WannaCry ransomware attacks, and a month and a half since the NotPetya attacks that hit U.S. hospitals and the drug company Merck. The cyberattacks were bad enough to get the attention of the health care industry — and the rest of us — but not bad enough to force the industry to solve the underlying problems.

Opinions, Editorials and Perspectives

Health insurance exchanges are on shaky ground. Here’s how to stabilize them
David M. Anderson, Stat News

At least for now, the Affordable Care Act is here to stay. This means that the health insurance exchanges — which make it possible for people who do not get health insurance through work or government programs to buy it — will continue to function.

Opinion: Why HELP Could Be on the Way for Obamacare Recipients
Patricia Murphy, Roll Call

Sen. Lamar Alexander had barely announced his plans to hold hearings next month on the Health, Education, Labor and Pensions Committee on stabilizing the insurance markets for Obamacare when the idea started getting panned. Keep in mind there are no specific hearings scheduled yet, no witnesses, no bill written, and few parameters of what is on or off the table.

Research Reports

Medicare Competitive Bidding Program Realized Price Savings For Durable Medical Equipment Purchases
David Newman, et al., Health Affairs

From the inception of the Medicare program there have been questions regarding whether and how to pay for durable medical equipment, prosthetics, orthotics, and supplies. In 2011 the Centers for Medicare and Medicaid Services (CMS) implemented a competitive bidding program to reduce spending on durable medical equipment and similar items.