Sanders: Weight loss drugs could bankrupt healthcare system

By Jakob Emerson - Weight loss drugs have the potential to bankrupt the U.S. healthcare system, according to a May 15 report from Sen. Bernie Sanders' office. Read Full Article…

HVBA Article Summary

1. Senate Investigation into Drug Pricing: Mr. Sanders, as chair of the Senate Committee on Health, Education, Labor, and Pensions, initiated an investigation into Novo Nordisk's pricing of Ozempic and Wegovy. This scrutiny follows concerns over the steep price disparities between the U.S. and other countries, with Novo Nordisk charging significantly higher prices domestically.

2. Escalating Medicare Spending: Medicare spending on GLP-1s surged to $5.7 billion in 2022 from $57 million in 2018, reflecting a significant escalation. This dramatic increase, highlighted in a report by KFF, underscores the potential financial strain on the healthcare system due to the rising costs of weight loss drugs like Wegovy.

3. Impact on Healthcare Costs: The report findings emphasize the potential fiscal impact of widespread adoption of weight loss drugs. If half of Americans with obesity were to take these medications, it could cost $411 billion annually, posing a significant financial burden on both individuals and government healthcare programs like Medicare and Medicaid. Furthermore, the availability of affordable alternatives, such as selling Wegovy at prices comparable to those in Denmark, could result in substantial savings for the U.S. healthcare system, offering a glimpse into potential solutions for reigning in prescription drug costs.

42 health systems ranked by net income

By Madeline Ashley and Andrew Cass - Net incomes for health systems tanked in 2022 as inflation hit a record high, but many systems saw their net numbers improve in 2023 as nonoperating items, such as investment returns, rebounded. Read Full Article…

HVBA Article Summary

1. Top Earning Nonprofit Health Systems: Stanford Health Care leads the pack with a net income of $6.8 billion, followed by Kaiser Permanente and Advocate Health with $4.1 billion and $2.2 billion respectively.

2. Regional Variability: Results vary across regions and institutions, with notable contributions from organizations like Mass General Brigham in Boston ($1.2 billion) and NYU Langone in New York City ($1.2 billion).

3. Financial Challenges: While many health systems boast significant net incomes, others face financial difficulties, such as Providence in Renton, Washington, which incurred a loss of $595.7 million, and Ascension in St. Louis with a substantial loss of $2.5 billion.

Survey Suggests One in Eight US Adults May Have Used a GLP-1 Drug

By Kerry Dooley Young - About one in eight, or 12%, respondents in a recent survey said they had tried one of the new diabetes or weight loss drugs, with only about half of them (6%) still taking the costly medicines at the time they were polled. Read Full Article…

HVBA Article Summary

1. Affordability Challenges: The KFF poll revealed that a significant portion of respondents (54%) found it difficult to afford medicines like semaglutide and tirzepatide, with 22% expressing that it was very difficult. Despite list prices ranging from $936 to $1349, even with insurance coverage, rebates, or coupons, many patients still faced financial strain.

2. Insurance Coverage Dynamics: While over half (57%) of insured respondents reported partial coverage by their health plans for these medications, a quarter (24%) had full coverage, leaving 19% to cover the entire cost themselves. This highlights the variability in insurance coverage and the financial burden it places on patients, influencing their access to essential treatments.

3. Medicare Restrictions and Policy Shifts: Older Americans and those with disabilities encountered obstacles in accessing these drugs for weight loss due to Medicare Part D's exclusion of obesity drugs from coverage. However, recent policy changes indicate a potential shift, with FDA approval of semaglutide for weight loss and CMS allowing Part D coverage for FDA-approved weight loss drugs with additional indications for reducing cardiovascular risk. This signals a changing landscape that could broaden access to weight loss medications for Medicare beneficiaries.

I asked for hospital prices and got a police visit instead

By Michael Klein - Parents will do anything to help their sick or injured child. Sadly, the American healthcare system often takes advantage of our desperation to overcharge and profiteer. Healthcare price transparency is urgently needed to protect families like mine and restore trust in the medical system. This Congress has the opportunity to deliver it. Read Full Article…

HVBA Article Summary

1. Inadequate Price Transparency Undermines Patient Trust and Decision-making: The experience of a parent seeking medical care for their child reveals the distressing lack of transparency in healthcare pricing. Despite facing a critical decision about their son's treatment, the parent encountered resistance and hostility when attempting to obtain basic price information from hospital staff. This opacity eroded trust in the healthcare system and left the parent feeling unsupported and uncertain about the quality of care provided.

2. The Consequences of Price Opacity Extend Beyond Individual Cases: Beyond the immediate impact on this family, the incident highlights broader systemic issues within the healthcare system. Vulnerable individuals, particularly those with limited English proficiency or lacking confidence, may face even greater challenges navigating opaque pricing structures. The lack of transparency contributes to widespread medical debt, disproportionately affecting marginalized communities and hindering access to timely care.

3. The Urgent Need for Healthcare Price Transparency Legislation: Addressing healthcare price transparency is a bipartisan imperative. Supported by overwhelming public demand, bipartisan legislation such as the Health Care Price Transparency Act 2.0 seeks to mandate the publication of actual, upfront prices by hospitals and insurers. Such legislation aims to empower patients, foster competition, and mitigate financial burdens, thereby enhancing the overall accessibility and affordability of healthcare for all Americans.

Lilly's weekly insulin as effective as daily doses in studies

By Reuters - Eli Lilly (LLY.N), said on Thursday its once-weekly insulin injection, efsitora, showed blood sugar reduction that was consistent with commonly used daily insulins across two studies in patients with type 2 diabetes. Read Full Article…

HVBA Article Summary

1. Weekly Insulin Innovations: Both Lilly and Novo Nordisk are pioneering the development of weekly injections for long-acting insulins. Novo's insulin icodec has received a recommendation for approval in Europe and is undergoing regulatory review in the United States, potentially offering a promising solution to reduce the treatment burden for patients with diabetes.

2. Leadership in Obesity Medicines: Beyond their focus on insulin, both companies are prominent players in the market for obesity medicines, particularly GLP-1 agonists. These drugs not only help control blood sugar levels but also influence gastric emptying. This dual functionality underscores their significance in managing diabetes and related conditions.

3. Clinical Efficacy Studies: Lilly's recent studies comparing efsitora to insulin degludec and insulin glargine have yielded noteworthy results. In a 52-week trial, efsitora demonstrated non-inferiority to insulin degludec in reducing A1C levels, even among patients using GLP-1 therapies. Another 26-week study showed comparable efficacy between efsitora and insulin glargine. These findings suggest potential advancements in diabetes management and underscore the companies' commitment to addressing patient needs.

How this virtual clinic helps employees manage their substance addictions

By Deanna Cuadra - Stigma and cost of treatment dissuade many people with substance use disorders from seeking help. But when this Corning employee realized her drinking had gotten out of control, she had a benefit to turn to: a virtual clinic and addiction management platform called Pelago. Read Full Article…

HVBA Article Summary

1. Access to Employer-Sponsored Virtual Treatment Overcomes Barriers: The anonymity and convenience of employer-provided virtual treatment empowered individuals like the Corning employee to seek help for alcohol addiction, which they might have otherwise been too embarrassed to address in person. Notifications from the company about available programs played a crucial role in encouraging participation.

2. Pelago's Holistic Approach Yields Remarkable Results: Pelago's approach integrates addiction management with personalized care plans, including fitness goals. By incorporating contingency management and offering incentives for positive behaviors, such as sobriety milestones, Pelago achieves a 62% reduction in alcohol use within the first 30 days. This holistic method not only addresses addiction but also fosters overall well-being.

3. Digital Access Enhances Engagement and Long-Term Success: Virtual care for addiction management challenges the skepticism of both employers and employees by providing consistent engagement and support. Through daily check-ins and synchronous support from care team members, users can establish new habits and overcome cravings effectively. The tangible benefits extend beyond individual health, reducing annual medical claims and productivity loss, thereby highlighting the substantial return on investment for employers.

Feds form task force against monopolies and collusion in health care

By Richard Payerchin - Unfair business practices and market domination in health care are the target of a new task force within the U.S. Department of Justice (DOJ). Read Full Article…

HVBA Article Summary

1. Formation of HCMC Task Force: The Department’s Antitrust Division has established the Task Force on Health Care Monopolies and Collusion (HCMC) to spearhead policy formulation, investigations, and enforcement actions related to anticompetitive practices within health care markets. Led by Assistant Attorney General Jonathan Kanter and directed by Katrina Rouse, the Task Force aims to address concerns surrounding payer-provider consolidation, serial acquisitions, labor issues, quality of care, medical billing, information technology, and health care data.

2. Scope of Consideration: The HCMC Task Force will delve into a broad spectrum of issues pertinent to health care markets. These include scrutinizing anticompetitive behaviors, examining the impacts of consolidation on patient health, worker safety, quality of care, and affordability. Additionally, the Task Force will evaluate transactions that contribute to the consolidation within the health sector, potentially posing threats to various stakeholders.

3. Public Engagement Initiatives: In conjunction with its formation, the Department has launched HealthyCompetition.gov, a web portal facilitating the reporting of unfair and anticompetitive practices by physicians, patients, or any concerned individuals. Furthermore, the public comment period for the "Request for Information on Consolidation in Health Care Markets" has been extended until June 5, aiming to gather insights on transactions enhancing health sector consolidation and potential impacts on stakeholders. As of May 10, the initiative has garnered significant public interest, with 3,958 comments received and 1,566 posted online, showcasing a robust engagement from various stakeholders.

Minnesota fines UnitedHealthcare over alleged mental health parity issues

By Rylee Wilson - UnitedHealthcare will pay Minnesota $450,000 to settle allegations it violated mental health parity laws. Read Full Article…

HVBA Article Summary

1. Allegations of Discriminatory Practices: Minnesota's commerce department has accused UnitedHealthcare of applying stricter evaluation criteria to mental health and substance use claims compared to medical claims, potentially indicating discriminatory practices in claims processing.

2. Discrepancies in Reimbursement Rates and Authorization Processes: State officials further alleged that UnitedHealthcare failed to demonstrate equitable reimbursement rates between medical and mental health providers for certain billing codes, inaccurately reported prior authorization data on its website, and imposed more rigorous restrictions on mental health drugs, suggesting disparities in access to care.

3. Regulatory Settlement and Corrective Measures: As part of a consent order, UnitedHealthcare and its subsidiary, PreferredOne Insurance Co., will pay a fine of $450,000. However, the fine could be partially waived if the company implements a corrective action plan addressing the issues raised by the state. Despite the absence of admission of fault, UnitedHealthcare has pledged to collaborate with state officials and enhance access to behavioral health services, citing significant network expansion efforts in Minnesota and nationwide.

Some Rx fills paused as Ascension recovers from cyberattack

By Paige Twenter - Across nine states and Washington, D.C., some Ascension pharmacies cannot fill prescriptions as the St. Louis-based health system works to recover from a May 8 cyberattack. Read Full Article…

HVBA Article Summary

1. Disrupted Access to Healthcare Systems: The ransomware attack has disrupted access to Electronic Health Records (EHRs), patient portals, as well as systems used for ordering tests and medications within Ascension's network. This has resulted in challenges for patients and healthcare providers in accessing crucial medical information and services.

2. Impact on Medication Availability: As of May 16, Ascension is unable to fill some prescriptions at retail pharmacies in multiple states including Alabama, Florida, Texas, and Wisconsin. To mitigate this, the health system is redirecting patients' medication needs to nearby pharmacies, ensuring continued access to essential medications.

3. Varied Regional Impacts: While some regions like Arkansas, Louisiana, and Missouri report no interruption to healthcare services, others like Maryland and Tennessee are experiencing specific challenges. Patients in Maryland and Tennessee are required to bring prescription numbers or bottles, and outpatient pharmacies in Maryland are accepting cash-only transactions due to the cybersecurity event. Despite these challenges, Ascension is committed to minimizing disruptions and is actively working on restoration efforts to return to normal operations.

What to Know Before Incorporating CGM Data into Your Practice

By Avery St. Onge - Continuous glucose monitors (CGMs) have been used for diabetes management for over 20 years, but they're only recently being explored for patients without diabetes. Research has shown that CGMs could lead to better diabetes prevention for high-risk populations such as those with polycystic ovarian syndrome (PCOS), cystic fibrosis, and obesity. Read Full Article…

HVBA Article Summary

1. Expanded Utility Beyond Diabetes Management: CGMs (Continuous Glucose Monitors) are revolutionizing patient care beyond diabetes, offering valuable insights into overall health. Nutrition expert Ashley Koff emphasizes their importance for all patients, not just those with diabetes, citing their ability to provide real-time data on the effects of various lifestyle factors on glucose levels.

2. Comprehensive Approach to Implementation: Implementing CGMs requires a comprehensive system to manage data collection, analysis, patient education, and integration into care plans. Practitioners must invest in user-friendly systems and track additional health factors alongside glucose readings to ensure accurate interpretation and personalized care.

3. Considerations for Accessibility and Integration: While CGMs offer profound benefits, their accessibility and integration into patient care pose challenges. Cost considerations, insurance coverage limitations, and the need for practitioner expertise highlight the importance of thorough education, personalized target setting, and preparation for future AI integration in leveraging CGM technology effectively.