S. 954, Joe Manchin, to establish procedures regarding the approval of opioid drugs by the Food and Drug Administration.
S. 961, Tom Carper-Roy Blunt, to protect information relating to consumers, to require notice of security breaches, and for other purposes.
S. 968, Kirsten Gillibrand, to require the Commissioner of Social Security to revise the medical and evaluation criteria for determining disability in a person diagnosed with Huntington’s Disease and to waive the 24-month waiting period for Medicare eligibility for individuals disabled by Huntington’s Disease.
S. 971, Ron Wyden, to amend title XVIII of the Social Security Act to provide for an increase in the limit on the length of an agreement under the Medicare independence at home medical practice demonstration program.
S. 984, David Vitter, to amend title XVIII of the Social Security Act to provide Medicare beneficiary access to eye tracking accessories for speech generating devices and to remove the rental cap for durable medical equipment under the Medicare Program with respect to speech generating devices.
S. 991, Patty Murray, to establish the Commission on Evidence-Based Policymaking, and for other purposes.
S. 1005, Ron Wyden, to amend the Internal Revenue Code of 1986 to extend and modify the credit for health insurance costs of certain eligible individuals, and for other purposes.
H.R. 1797, Christopher Smith, to facilitate effective research on and treatment of neglected tropical diseases, including Ebola, through coordinated domestic and international efforts.
H.R. 1800, Sam Johnson, to require the Commissioner of Social Security to update the medical-vocational guidelines used in disability determinations.
H.R. 1807, Danny Davis, to amend the Public Health Service Act to reauthorize a sickle cell disease prevention and treatment demonstration program and to provide for sickle cell disease research, surveillance, prevention, and treatment.
H.R. 1831, Paul Ryan, to establish the Commission on Evidence-Based Policymaking, and for other purposes.
H.R. 1849, Edward Royce, to amend the Public Health Service Act to improve the diagnosis and treatment of hereditary hemorrhagic telangiectasia, and for other purposes.
H.R. 1856, Louise Slaughter, to amend the Employee Retirement Income Security Act of 1974 and the National Labor Relations Act to protect the health benefits of retirees, and for other purposes.
H.R. 1859, Chris Collins, to amend the Public Health Service Act to provide for the participation of pediatric subspecialists in the National Health Service Corps program, and for other purposes.
H.R. 1882, Devin Nunes, to amend the Internal Revenue Code of 1986 to allow a credit against income tax for the purchase of hearing aids.
H.R. 1886, Patrick Tiberi, to amend section 1341 of the Patient Protection and Affordable Care Act to repeal the funding mechanism for the transitional reinsurance program in the individual market, and for other purposes.]]>
Consumers have even greater choice this year with more than 1,000 new networks introduced, a recent McKinsey report concluded. There are now 2,930 exchange networks, and 90 percent of consumers can access both broad and smaller networks – up from 86 percent in 2014. The report also found the overall number of hospitals participating in exchange networks rose in 2015.
As we’ve noted before, the availability of broad and smaller networks gives consumers a wider range of value propositions and prices as they make coverage decisions for themselves and their families. One important value proposition of smaller networks is that premiums are more affordable for consumers. Health plans with smaller provider networks have premiums that are 15 percent to 23 percent lower than broader networks, according to the McKinsey report. Moreover, 70 percent of the lowest-priced plans for 2015 have smaller networks.
Lower costs lead to happy customers, according to a New York Times piece analyzing the new McKinsey data. The article noted consumers with smaller networks are satisfied with their care and that once they choose smaller network plans, they tend to keep them.
Health plans’ high-value network designs go beyond network size and put a strong emphasis on provider quality and effectiveness to ensure cost-effective and high-quality care. These networks enable plans to deliver the right balance of quality, affordability, and choice for consumers.]]>
The HIT will total more than $145 billion over the next 10 years, adding a financial burden on individuals, families, and small businesses at a time when they can least afford it.
“Imposing a tax on health insurance does nothing to make coverage more affordable or accessible. It only increases costs for families, seniors enrolled in Medicare Advantage, small businesses, and state Medicaid programs,” America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni said in a statement in support of bipartisan legislation to repeal the HIT.
More than 200 cosponsors have signed on in support of the House repeal bill spearheaded by Reps. Charles Boustany (LA) and Kyrsten Sinema (AZ). And Sens. John Barrasso (WY) and Orrin Hatch (UT) have introduced the Jobs and Premium Protection Act to repeal this harmful tax.]]>
S. 898, Mark Kirk, to amend the Public Health Service Act to provide for the participation of optometrists in the National Health Service Corps scholarship and loan repayment programs, and for other purposes.
S. 905, Orrin Hatch, to amend the Internal Revenue Code of 1986 to increase the limitation on eligibility for the alternative tax for certain small insurance companies.
S. 910, Orrin Hatch, to amend the Internal Revenue Code of 1986 to clarify the special rules for accident and health plans of certain governmental entities, and for other purposes.
H.R. 1731, Michael McCaul, to amend the Homeland Security Act of 2002 to enhance multi-directional sharing of information related to cybersecurity risks and strengthen privacy and civil liberties protections, and for other purposes.
H.R. 1741, Larry Bucshon, to ensure that patients receive accurate health care information by prohibiting misleading and deceptive advertising or representation in the provision of health care services, and to require the identification of the license of health care professionals, and for other purposes.
H.R. 1752, Mike Kelly, to amend the Internal Revenue Code of 1986 to make members of health care sharing ministries eligible to establish health savings accounts.
H.R. 1753, James Langevin, to establish a National Office for Cyberspace, and for other purposes.
H.R. 1761, Paul Tonko, to amend the Public Health Service Act to provide for the inclusion of occupational therapists in the National Health Service Corps Program, and for other purposes.
H.R. 1770, Marsha Blackburn, to require certain entities who collect and maintain personal information of individuals to secure such information and to provide notice to such individuals in the case of a breach of security involving such information, and for other purposes.
H.R. 1771, Markwayne Mullin, to amend title XIX of the Social Security Act to count portions of income from annuities of a community spouse as income available to institutionalized spouses for purposes of eligibility for medical assistance, and for other purposes.
H.R. 1784, Lynn Jenkins, to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs.]]>
There is wide recognition that the individual coverage requirement is inextricably linked to the Affordable Care Act’s market reforms.
This was the tough lesson learned in eight states in the 1990s that tried implementing insurance market reforms without covering everyone. That approach failed across all eight states, where the individual health insurance markets deteriorated. By encouraging people to wait until they had health problems to buy insurance, premiums increased, which drove more healthy policyholders from the market, driving premiums up even higher.
Let’s use the experiences of those eight states to shift the focus to ensuring insurance market reforms can succeed at maximizing choice and affordability for consumers.
AHIP’s amicus brief in support of the NY AG outlined serious concerns over “anticompetitive product extensions,” which allow pharmaceutical companies to artificially prolong drug patents in order to avoid competition from generics.
Exhibit A: The antitrust lawsuit argues that Actavis intentionally altered its Alzheimer’s drug, Namenda IR, just enough to replace an older version before its patent expiration. Such a move would block any new medications, specifically generic equivalents, from the market. For consumers, the consequences of such coercive conduct results in fewer treatment options and sky-high costs. As AHIP’s Ben Jenkins noted, “forcing a product switch to protect a monopoly punishes consumers in the worst possible way by delaying the entry of more affordable prescription drugs into the market.”
With rising drug prices driving up costs across the board, the Actavis case is a prime example of the serious consequences posed by drugmakers’ monopoly pricing schemes.]]>
During his keynote address, Dr. Peter Bach of Memorial Sloan Kettering demonstrated how cancer drug prices are outpacing the rate of inflation. Moreover, drug prices are rising faster than benefits, which leads to diminishing returns for patients and society, he said.
And what’s worse, the end of rising drug prices is nowhere in sight, Bach said. He pointed to an oncoming avalanche of new drug approvals — largely because it’s easier to design drugs based on genetic information, it’s faster to get them approved, and drugmakers can price them at any level they want.
Executive Director of the National Association of Medicaid Directors Matt Salo discussed the challenge these high drug prices pose for health care safety nets, citing $1,000-a-pill Sovaldi as a prime example. Hepatitis C impacts three million Americans – approximately 750,000 of which are on Medicaid. Therein lies the problem, Salo noted: Sovaldi is a mainstream cure at an orphan drug price. He spoke about how its prohibitive cost has been putting a cure out of reach for many patients while threatening the fiscal integrity of public programs.
Following Salo’s account on how high drug prices impact state Medicaid programs, Leigh Purvis of AARP’s Public Policy Institute explained how excessive price tags hit consumers hard, particularly seniors. About 68 percent of Medicare beneficiaries are being treated for two or more concurrent chronic conditions, often requiring multiple prescriptions. These high drug prices aren’t one-time costs, Purvis noted; they continue on for the rest of the patients’ lives.
The rising prices of drugs mean many Medicare seniors have trouble affording their medications. That has long-term consequences for the health care system, as patients skip their meds, conditions worsen and become more expensive to treat.
Purvis laid it out for the audience: “Medical advances are meaningless if no one can afford them.”]]>
The NIH researchers looked at 51 oncology drugs approved by the FDA from 2009 through 2013 and found that the prices have no significant correlation to novelty or to improvements in overall survival, disease response rate, or progression- or disease-free survival.
It’s also a problem that goes beyond oncology. Specialty drugs designed to treat a range of conditions cost whatever drugmakers think they can get away with.
Testing how much the market will bear, drugmakers are pricing these critically important medications at thousands of dollars for a single prescription, yet patients often require ongoing therapy to live longer, healthier lives. The average cost per prescription to treat inflammatory conditions is $2,913.33, $4,510.06 per prescription for multiple sclerosis treatment, and $4,023.23 per prescription for pulmonary arterial hypertension medications. So patients who must take these medications for months and years at a time will see their prescription costs soar to five- and six-figures.
As these prices show, drugmakers continue to ask for a blank check. But consumers, innovation, and society can no longer afford to write them.]]>
New payment structures and benefit designs give reason to hold out hope for lower costs and better value for oncology patients. UnitedHealthcare and The University of Texas MD Anderson Cancer Center, for instance, are implementing a bundled payment pilot program to promote cost-effective, evidence-based, high-quality care for head and neck cancer, Carmen Nobel of the Harvard Business School wrote recently in Forbes. The payment bundling makes the billing process easier for patients while aiming to drive the best possible outcomes at the lowest possible costs.
UnitedHealth is no stranger to the bundled payment model as a way to slow cancer care costs and promote affordability and quality. UnitedHealth also has bundled payments for breast, colon, and lung cancer in a pilot program with five medical oncology groups across the country. That program focused on identifying best practices, reducing treatment variation, and improving patient outcomes. A study of the program found the bundled payment model saved about $33.36 million in medical costs without affecting the quality of care.
Such payment reforms are part of the health insurance community’s innovation story to deliver better health outcomes for patients, more efficient care delivery, and improved value overall.]]>
According to federal data, it cost Medicare $286 million for New Yorkers taking Sovaldi in 2014. Meanwhile, the entire country spent $286 million on earlier generation hep C drugs in 2013.
Two other new hep C drugs, Harvoni and Olysio also sent Medicare spending sky-high in New York – $76 million for Harvoni and $74 million for Olysio in 2014 alone. The $150 million spent on those two drugs soared above and beyond the $13 million Medicare spent on all other hep C medications in New York that year.
With $1,000- and $1,125-a-pill price tags, Medicare is spending 15 times more to treat hepatitis C than it did in 2013 – an unsustainable path for treating a disease a with an enormous patient population. If all Americans with hepatitis C were treated with $1,000-a pill-Sovaldi, it would cost $227 billion, dangerously close to the roughly $260 billion spent each year in the United States for all drugs.
Until drugmakers price new hep C medications at affordable and sustainable levels, the costs will continue to crush consumers, taxpayers, and government budgets across the country.]]>