Can Individual States Effectively Cap Prescription Drug Costs?

By Sophie Putka - The median price of a newly launched drug in 2023 was $300,000 a year, up from $2,115 in 2018. A tangle of manufacturers, insurers, pharmacy benefit managers, wholesalers, and pharmacies wrestle over their share of the cost in negotiations that remain nearly invisible to the average patient, who pays more out-of-pocket for prescription drugs every year. Read Full Article…

HVBA Article Summary

1. Medicare Payment Cuts: The Centers for Medicare & Medicaid Services (CMS) has proposed a nearly 3.4% cut to the Medicare Physician Fee Schedule for 2024, which has raised significant concerns among medical groups. This reduction is seen as exacerbating the gap between physician practice expenses and Medicare reimbursement rates, potentially impacting the quality of care for Medicare patients​​.

2. MedPAC Recommendations: The Medicare Payment Advisory Commission (MedPAC) has recommended several changes to Medicare payment policies, including a 1.5% increase in Medicare payments for hospital inpatient and outpatient services in 2025. However, they also suggest a 3% decrease for skilled nursing facilities and a 7% reduction for home health agencies​.

3. Healthcare Funding: The fiscal year 2024 appropriations bill for the Department of Health and Human Services (HHS), signed by President Biden, keeps most funding levels flat compared to the previous year. Notable allocations include $49 billion for the National Institutes of Health (NIH) and $1 billion for domestic HIV/AIDS prevention and research​.

Why Are Primary Care Physicians Optimistic About AI?

By Katie Adams - Primary care physicians are generally pretty optimistic about AI’s potential to make care delivery more efficient, according to new survey results released by Elation Health. Read Full Article…

HVBA Article Summary

1. 1. AI's Potential to Enhance Efficiency

   Nearly 70% of primary care physicians recognize AI's potential to enhance care delivery efficiency. They believe AI can streamline various processes, reducing the time spent on repetitive tasks and improving overall productivity within the healthcare environment.

   2. Reducing Administrative Burden

   Automated dictation and scribing tools have significantly reduced administrative tasks for clinicians. These tools help in documenting patient interactions more accurately and quickly, freeing up valuable time for doctors to focus more on patient care rather than paperwork.

   3. AI as a Valuable Assistant

   AI is viewed as an aid to primary care providers, improving efficiency and allowing more patient interaction time. Rather than replacing doctors, AI enhances their ability to provide personalized care, ensuring that physicians can spend more quality time addressing patient needs.

3 Recent Supreme Court Decisions that Affect Healthcare

By Marissa Plescia - The Supreme Court has made a series of decisions that have implications for healthcare. Below is an overview of these decisions. Read Full Article…

HVBA Article Summary

1. Supreme Court Overturns Chevron Deference: In a landmark 6-3 ruling, the Supreme Court overturned the Chevron deference established in 1984, which required courts to defer to administrative agencies when dealing with ambiguous statutes. This decision arose from the combined cases of Loper Bright Enterprises v. Raimondo and Relentless, Inc. v. Department of Commerce, with significant implications across various sectors, including healthcare. The majority opinion was written by Justice John Roberts, while Justice Elena Kagan dissented, joined by Justices Sonia Sotomayor and Ketanji Brown Jackson.

2. Impact on Agency Rule Implementation: The ruling is expected to impede executive agencies' ability to implement laws passed by Congress, leading to more frequent legal challenges against agency rules. This shift will particularly affect the healthcare industry, potentially hindering the enforcement of regulations related to prescription drug affordability, Medicaid eligibility, infectious disease control, public safety standards, and consumer protections in private employer-sponsored plans.

3. Healthcare Implications of Related Supreme Court Decisions: Alongside the Chevron ruling, the Supreme Court made significant decisions affecting healthcare. In a unanimous ruling, the Court maintained access to the abortion pill mifepristone, allowing its continued availability via telehealth and pharmacies. Additionally, the Court upheld a lower-court decision requiring Idaho hospitals receiving federal funds to provide emergency abortions despite the state's strict abortion ban, citing the Emergency Medical Treatment and Labor Act (EMTALA).

President Biden: Novo Nordisk, Eli Lilly must stop ripping off Americans with high drug prices

By USA Today - As president of the United States and the chairman of the Health, Education, Labor, and Pensions Committee in the Senate, we have long been concerned about the outrageous prices that the pharmaceutical industry charges the American people for prescription drugs. Read Full Article…

HVBA Article Summary

1. Unjustifiably High Drug Prices in America: For decades, Americans have been forced to pay exorbitantly high prices for prescription drugs, far exceeding the costs in other countries. This has resulted in 1 out of 4 Americans being unable to afford the medications prescribed by their doctors, a situation that is neither rational nor justifiable.

2. Legislative Progress and Price Reductions: Significant strides have been made to address these high costs. The Inflation Reduction Act, despite passing without any Republican support, has led to considerable savings for seniors, including a cap on insulin costs and a $2,000 annual limit on prescription drug expenses starting next January. Additionally, Medicare is now negotiating drug prices, a practice common in other major countries, which is widely supported by the American public.

3. Continued Efforts and Corporate Accountability: While progress has been made, much more needs to be done. Legislative efforts aim to expand drug price negotiations and ensure affordability for all Americans, not just seniors. The pharmaceutical industry, exemplified by companies like Novo Nordisk and Eli Lilly, must cease their price-gouging practices. These companies make immense profits while charging Americans substantially more for drugs that can be manufactured at a fraction of the retail cost. The push for fair pricing continues to be a moral and fiscal imperative for the nation.

Fact Check: Manufacturers Set High Drug Prices and Prevent Competition

By AHIP - Recent media coverage on high drug prices continues to obscure the primary role drug manufacturers play in the high cost of prescription medications. Read Full Article…

HVBA Article Summary

1. Significant Price Increases: Drug manufacturers have been increasing the prices of brand-name drugs, with a median price hike of 4.5% in early 2024, often surpassing the rate of inflation.

2. Anti-Competitive Practices: Pharmaceutical companies engage in anti-competitive patent practices, leading to an estimated additional cost of $40.7 billion for U.S. consumers in one year.

3. Patent Manipulation: The top 10 brand-name drugs in terms of U.S. net sales revenue in 2021 had over 1,400 patents, which manufacturers use to extend exclusivity and maintain high prices.

The GLP-1 coverage dilemma for employers

By Paige Tweeter - Big costs require big decisions, as illustrated by how GLP-1s are causing leaders of hospital employee health plans to rethink their coverage plans. Read Full Article…

HVBA Article Summary

1. Insurance Coverage Challenges: While GLP-1 medications such as Ozempic, Trulicity, and Wegovy are popular for treating Type 2 diabetes and weight loss, insurance coverage remains complicated. Health plans often cover diabetes treatments but are more restrictive regarding weight loss and off-label uses, causing financial burdens for patients and insurers.

2. Escalating Costs and Demand: The high list prices of GLP-1s for weight loss, ranging from $1,050 to $1,350 for a four-week supply, have led to significant expenditures. In 2023, the U.S. healthcare industry spent $38.6 billion on semaglutide and $13.2 billion on tirzepatide, with spending increasing dramatically from 2022. This surge in demand has strained health plan budgets and led some insurers to reduce coverage.

3. Divergent Coverage Trends: Health systems are split in their approach to covering GLP-1s. While some, like RWJBarnabas Health and Hennepin Healthcare, have stopped covering weight loss prescriptions due to cost and adherence issues, others, including Elevance Health and Kaiser Permanente, have expanded coverage following new FDA approvals. This divergence highlights the complexities health plans face in managing drug benefits amid evolving indications and rising costs.

New hospital price transparency rule goes into effect

By Laura Dyrda - The new CMS price transparency rule went into effect July 1, requiring hospitals to report price information in a standard machine-readable format, according to the American Hospital Association. Read Full Article…

HVBA Article Summary

1. Standardized Machine-Readable Format: The 2024 Hospital Outpatient Prospective Payment System and ASC rule requires hospitals to provide price transparency information in a single, machine-readable file. Hospitals must adhere to a standard CMS template layout with specific data specifications and a data dictionary to facilitate easier public access to hospital charges.

2. Homepage Footer and .txt File Requirement: The final rule mandates that hospitals include a footer on their homepage linking to the webpage with the machine-readable file (MRF). Additionally, a .txt file must be placed in the root folder of the hospital's website, identifying the URLs for both the MRF and the relevant webpage. This aims to improve the automated accessibility of hospital charge information and streamline CMS enforcement.

3. Compliance and Enforcement Measures: CMS will issue warning notices to hospitals not in compliance with the new requirements and will require acknowledgements of receipt for these notices. The agency can communicate directly with health system leadership regarding issues and will publish enforcement activities, including civil monetary penalties, as part of the final rule.
   

Samsung Bioepis Gets FDA Approval for Biosimilar of J&J’s Stelara

By Tyler Patchen - Samsung Bioepis announced Monday that the FDA has approved Pyzchiva (ustekinumab—ttwe), a biosimilar of Johnson & Johnson’s blockbuster immunotherapy Stelara. Pyzchiva is approved to treat severe plaque psoriasis patients who are candidates for systemic therapy or phototherapy. The biosimilar is also indicated for active psoriatic arthritis, moderately to severely active Crohn’s disease, as well as moderately to severely active ulcerative colitis. Pyzchiva has also been granted a provisional determination for interchangeability and will be commercialized by Sandoz in the U.S. Read Full Article…

HVBA Article Summary

1. FDA Approval for Biosimilar: The FDA has approved Samsung Bioepis' biosimilar Pyzchiva (ustekinumab-ttwe) for treating severe plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. It will be commercialized by Sandoz in the U.S.

2. Cost Reduction and Treatment Options: Pyzchiva has a provisional determination for interchangeability and is expected to reduce healthcare costs by offering more treatment options.

3. Market Entry and Competition: The approval follows a patent settlement with J&J, with market entry set for February 2025. Pyzchiva will compete with similar biosimilars from Alvotech, Teva Pharmaceuticals, and Amgen.HVBA Article Summary

Diets Heavy in Ultra-processed Foods Linked to Earlier Death: Study

By Dennis Thompson - People who eat more ultra-processed foods are more likely to suffer an early death, particularly from heart disease or diabetes, a new study warns. Older adults who consume higher amounts of ultra-processed foods are about 10% more likely to die than those who eat less processed foods, over an average 23-year follow-up. Read Full Article…

HVBA Article Summary

1. Increased Mortality Risk with Ultra-Processed Foods: Older adults who consume higher amounts of ultra-processed foods have a 10% increased likelihood of dying earlier compared to those who eat less processed foods, as revealed by a study with an average 23-year follow-up. This association is particularly strong with soft drinks and highly processed meats like hot dogs, sausages, and deli cold cuts, according to researcher Erikka Loftfield from the National Cancer Institute (NCI).

2. Health Recommendations and Additive Concerns: Erikka Loftfield highlights that a diet low in ultra-processed foods is already recommended for disease prevention and health promotion. Ultra-processed foods, made from substances extracted from whole foods and containing various additives like colors, emulsifiers, flavors, and stabilizers, are designed to be tasty and shelf-stable but pose significant health risks. Examples include packaged baked goods, sugary cereals, ready-to-eat or ready-to-heat products, and deli meats.

3. Study Findings and Ongoing Research: The study analyzed data from over 540,000 individuals aged 50 to 71, gathered in the mid-1990s, revealing that high consumption of ultra-processed foods is linked to increased mortality, particularly from heart disease and diabetes. Despite these findings, Loftfield emphasizes that further research is needed to understand which specific aspects of ultra-processed foods contribute to health risks. The findings were presented at the American Society for Nutrition's annual meeting and await publication in a peer-reviewed journal.