Health Brief: Express Scripts to Lower Drug Costs for Uninsured Customers

Washington Brief

  • Majority Leader Mitch McConnell’s decision to create a 13-man working group on health care that includes the Senate’s most conservative members and ardent foes of Obamacare, while excluding the chamber’s more moderate GOP lawmakers, is being viewed as an attempt to placate the right as congressional Republicans move to overhaul the 2010 Affordable Care Act. (The New York Times)
  • Republican leaders and senior Trump administration officials are trying to downplay criticism from Democrats and some Republicans that the House GOP’s health care bill would put coverage of millions of Americans at risk. The public messaging battle could play a key role in shaping the policies of the Senate bill and any final compromise. (The Wall Street Journal)
  • The GOP effort to repeal Obamacare could complicate efforts to reauthorize the Children’s Health Insurance Program, with funding for the program set to expire on Sept. 30. The Senate Finance Committee postponed a CHIP hearing scheduled for this week at the request of two Democrats who didn’t want the House GOP’s vote to repeal Obamacare to overshadow efforts to reauthorize the program. (Modern Healthcare)

Business Brief

  • Express Scripts, the nation’s largest pharmacy benefit manager, launched a program with GoodRX Inc. to offer discounts on 40 brand name drugs to millions of people who don’t have health insurance through government programs like Medicare and Medicaid. (BioPharma Dive)
  • Some insurers are planning to file steep 2018 rate increases for plans sold on the Obamacare marketplaces, in part to account for the uncertainty surrounding the future of the ACA amid congressional efforts to replace it. (Vox) Anthem and ConnectiCare, the only two insurers selling plans on  Connecticut’s individual market, have already requested double digit rate hikes. (Axios)
  • The Pharmaceutical Research and Manufacturers of America is mulling new membership rules that would require drug makers to spend $200 million a year on research and development. The proposed changes, which the drug lobby’s board may vote on as soon as today, could cause the ouster of some of the group’s smaller members. (Bloomberg News)

Chart Review

Events Calendar (All Times Local)

Tuesday
American Hospital Association annual meeting 7 a.m.
Wednesday
Senate HELP Committee marks up FDA Reauthorization Act 10 a.m.
Thursday
Consumer Healthcare Products Association Regulatory Science and Quality Conference 8 a.m.
AEI discussion on practice regulation and health care reform 12 p.m.
Friday
Consumer Healthcare Products Association Regulatory Science and Quality Conference 8 a.m.
National Economists Club luncheon on the ACA and AHCA 12 p.m.

 

General

Divided Senate Republicans Turn to Health Care With a Rough Road Ahead
Robert Pear, The New York Times

The top Republican in the Senate, Mitch McConnell of Kentucky, has a reputation as a shrewd tactician and a wily strategist — far more than his younger counterpart in the House, Speaker Paul D. Ryan. So the Senate majority leader’s decision to create a 13-man working group on health care, including staunch conservatives and ardent foes of the Affordable Care Act — but no women — has been widely seen on Capitol Hill as a move to placate the right as Congress decides the fate of President Barack Obama’s signature domestic achievement.

Republicans Confront Health-Bill Backlash
Stephanie Armour and Kristina Peterson, The Wall Street Journal

House Republicans may have won the battle to pass a health-care overhaul, but the fight over public messaging that is now ramping up could be critical to the shape of the bill that emerges from the Senate and to any final compromise. GOP leaders and the Trump administration are urgently trying to tamp down a backlash from Democrats and some Republicans who say the House legislation rolling back and replacing much of the Affordable Care Act would imperil coverage for millions of Americans.

Left adopts shock tactics in Obamacare repeal fight
Kenneth P. Vogel and Kyle Cheney, Politico

One newly formed progressive super PAC is planning to cart caskets to Republican lawmakers’ districts and hold mock funerals for their constituents. Another activist is encouraging protesters to ship their own ashes — should they die without health care —to GOP lawmakers.

GOP lawmakers fear HHS is barring staffers from contacting Congress
Virgil Dickson, Modern Healthcare

Republican lawmakers are concerned that HHS may be trying to prohibit employees from corresponding with members of the legislative branch. In a letter to HHS Secretary Tom Price dated Thursday, Rep. Jason Chaffetz (R-Utah) and Sen. Chuck Grassley (R-Iowa) said they were concerned by a recent HHS memo that told employees they must first talk to the agency’s Office of the Assistant Secretary for Legislation before communicating with lawmakers or their staff.

Senate working group tackles an easy one: Medicaid
Caitlin Owens, Axios

The working group consisting of an ideologically diverse set of senators will discuss Medicaid in its third meeting today. While members will be able to bring up whatever they want to, one senior aide said they expect a “healthy focus on the expansion policy.”

Dollar Advance Saps Commodity Gain; Stocks Rise: Markets Wrap
Samuel Potter, Bloomberg News

The dollar gained a second day as bets increased for a hike in U.S. borrowing costs next month. That took the shine off a bounce in commodities, though mining stocks still spurred European equities to the highest since 2015.

Payers

Express Scripts, GoodRx roll out cost savings program
Jacob Bell, BioPharma Dive

Express Scripts and GoodRx Inc. debuted a new program on Monday that aims to curb out-of-pocket costs for millions of patients in the U.S. The initiative, called Inside Rx, offers discounts on 40 brand name drugs to a select group of consumers — those under 65 and who aren’t on government insurance programs such as Medicaid or Medicare.

The Trump administration is making Obamacare more expensive
Sarah Kliff, Vox

Some health insurance plans selling on the Obamacare marketplaces are planning steep 2018 rate increases, in part to account for the uncertainty over how the Trump administration will administer the law. The administration has been aggressively ambiguous about key policy issues, like whether it will enforce the health care law’s individual mandate or pay out insurance subsidies aimed at the lowest-income Obamacare enrollees.

Connecticut insurers request hefty ACA rate hikes
Bob Herman, Axios

Only two health insurers sell Affordable Care Act plans on Connecticut’s individual exchange, and premium rates could go up by a lot next year for the 86,000 people in the market. Anthem asked regulators for a 33.8% average rate hike to its 2018 individual plans, and ConnectiCare requested a 15.2% average increase.

ACA replacement bill clouds future of Children’s Health Insurance Program
Harris Meyer, Modern Healthcare 

Passage of the House Republicans’ healthcare overhaul bill may have created political and policy complications for the popular Children’s Health Insurance Program, whose funding will end in September unless Congress reauthorizes it. The Senate Finance Committee postponed a planned hearing on CHIP reauthorization scheduled for Tuesday, reportedly at the request of committee Democrats who didn’t want work on the House GOP’s American Health Care Act to overshadow efforts to extend the children’s program.

G.O.P. Bill Could Affect Employer Health Coverage, Too
Margot Sanger-Katz, The New York Times

If it becomes law, the American Health Care Act will have the biggest effects on people who buy their own insurance or get coverage through Medicaid. But it also means changes for the far larger employer health system.

Why Blue States Might Ditch Beloved Obamacare Protections
Chad Terhune and Barbara Feder Ostrov, Kaiser Health News

Under the Republican health bill, it’s up to states whether to dismantle key parts of the Affordable Care Act. Red, or GOP-leaning, states are sure to be interested in rolling back the law’s coverage requirements and freeing insurers to charge people more when they have preexisting conditions.

Providers

Doctors who are mothers face discrimination
Andrew M. Seaman, Reuters

About two thirds of female physicians with children have experienced gender discrimination and one third report discrimination due to pregnancy, maternity leave or breastfeeding, according to a survey conducted last year. The female doctors who reported maternal discrimination were also more likely to report feeling burned out and more likely to value workplace changes that would make life easier for parents.

Free-standing emergency rooms offer costly convenience
Carolyn Y. Johnson, The Washington Post 

Not far from neighborhood streets lined with ­million-dollar homes here lies an open-air mall where people go to eat, shop and — when needed — get emergency medical treatment. People pull up to the front door, park next to a gleaming antique ambulance and enter a waiting room that feels more like a graceful hotel lobby than a holding area for sick people.

Pharma, Biotech and Devices

Drug Lobby Said to Mull Membership Cuts Amid Price Scrutiny
Cristin Flanagan, Bloomberg News

The pharmaceutical industry’s Washington lobbying group will likely adopt new membership rules this week that will oust many smaller companies that don’t spend heavily on research, people familiar with the matter said, amid increasing scrutiny of prescription drug prices. The lobby group, Pharmaceutical Research and Manufacturers of America, or PhRMA, is proposing that to remain a member, companies will have to spend $200 million a year on research and development, based on a three-year average.

PTC Expects Net Price of $35,000 Annually Per Patient for Emflaza
Joseph Walker, The Wall Street Journal

PTC Therapeutics Inc. said Monday that it would receive a net price of $35,000 annually per patient for Emflaza, the muscular dystrophy drug it acquired from Marathon Pharmaceuticals LLC last month. PTC didn’t explain what it meant by “net price,” a term that drugmakers sometimes use to describe the net revenue they receive for a drug after providing discounts, copay assistance and free medicine to patients without insurance.

Drug lobbyist arrested after drunken fracas
Jake Sherman and Anna Palmer, Politico

A Washington lobbyist for a major drug company was arrested at a Republican political event in Florida late Saturday after he got in an altercation with a man, screaming obscenities and making sexual advances on the person’s wife, according to a police report. Jason R. Money, a lobbyist for drug giant AmerisourceBergen Corp., was attending a weekend fundraiser for the Republican Main Street Partnership at the Ritz-Carlton in Amelia Island, Florida

Health IT

FBI Director James ​​​​​​​Comey: Hospitals, bureau must team up to combat healthcare cyberthreats
Paige Minemyer, Fierce Healthcare

FBI Director James Comey, a keynote speaker at this morning’s American Hospital Association annual membership meeting, said one of the key approaches the bureau is taking to improve its cybersecurity threat response is to build stronger relationships with private community entities. Hospital executive teams that don’t know at least one person at the FBI’s local field office are “failing, and we’re failing.”

A Message from PhRMA:

You don’t always pay full price for doctor or hospital visits. So why is a visit to the pharmacy different? Unlike care received at an in-network hospital or physician’s office, patients with high deductibles or coinsurance pay cost sharing based on the list price of a medicine, even if their insurer receives a steep discount. Insurers should share more of the rebates they receive with patients. Get the facts at http://onphr.ma/2pdulvs.

Opinions, Editorials and Perspectives

The Fight Against Rare Diseases Is a Race Against Time
Lisa Yourman, Morning Consult 

President John F. Kennedy once said, “We must use time as a tool, not as a couch.” As a mother of two children (Sarah and Jeffrey) who have been battling cystic fibrosis for more than two decades, I know firsthand the value of time as a tool.

Do high-risk pools work? It depends.
Richard Popper, The Washington Post

If the American Health Care Act ultimately becomes law, states will have the option to once again let insurers on the individual market charge those with preexisting conditions more than healthy people. Among the more contentious pieces of the AHCA, which the House of Representatives passed narrowly on Thursday, is a provision allowing states to request waivers to rules otherwise forbidding higher premiums based on a person’s health status.

Senate Republicans must be pinned down on health care. Here’s how.
Paul Waldman, The Washington Post 

Last week Republicans in the House passed the American Health Care Act and tossed it over to the Senate, which reacted as though someone had deposited a pile of rotting garbage on its doorstep. Republican senators have said that since the House’s bill is so dreadful, they will be starting from scratch to write their own bill.

A Medicare Drug Incentive That Leads to Greater Hospitalizations
Austin Frakt, The New York Times

Many studies have demonstrated what economics theory tells us must be true: When consumers have to pay more for their prescriptions, they take fewer drugs. That can be a big problem.

A Message from PhRMA:

DID YOU KNOW more than 1/3 of the list price for brand medicines is rebated back to payers and the supply chain? Yet, unlike care received at an in-network hospital or physician’s office, patients with high deductibles or coinsurance pay cost sharing based on a medicine’s list price, even if their insurer receives a steep discount. Patients share the costs of medicines, so they should share the savings. Learn more at http://onphr.ma/2pdulvs.

Research Reports

Freestanding Emergency Departments
UnitedHealth Group Center for Health Reform & Modernization

The recent growth in freestanding EDs (FSEDs) is a result of consumer demand for convenient care options, low barriers to entry, and high profit potential. FSEDs are licensed to provide emergency medical care, and are physically separate from hospitals. Like hospital-based EDs, FSEDs encourage the use of emergency departments for non-emergent needs.

Postapproval studies of drugs initially approved by the FDA on the basis of limited evidence: systematic review
Alison M Pease et al., The BMJ

In the US, the Food and Drug Administration determines whether a new drug is sufficiently safe and effective to be made available to doctors for use by patients. To do this, it must find a balance between requiring sufficient high quality clinical evidence from premarket evaluation and allowing promising new drugs to enter the marketplace quickly with continued evaluation after approval.