High Out-of-Pocket Costs Hurt Patients: Even with health coverage, approximately 31 million Americans were considered “underinsured” last year due to high deductibles and increasing out-of-pocket costs, according to a new survey from the Commonwealth Fund. The study found that those with low incomes and/or health problems were at the greatest risk of being underinsured. Read more in a Catalyst post about the survey and check out AccessBetterCoverage.org for information on choosing a plan to meet your needs.
Loretta was diagnosed with Stage 4 lung cancer 12 years ago - but thanks to medical breakthroughs and innovative medicines, she is living a happy, active life today.
Matt was given a five percent chance of living five more years when diagnosed with advanced non-small cell lung cancer - but advances in cancer research changed his prognosis and now he trains for half-marathons.
Key findings from the survey include:
- Adults with low incomes or health problems are at greatest risk of underinsurance and have high rates of medical bill issues: 42 percent of those with incomes below the federal poverty level were underinsured.
- Medical bill and debt problems have long-term financial consequences: Nearly half of survey respondents said they exhausted their savings to pay medical bills, nearly one quarter were dealing with collection agencies and 7 percent had to declare bankruptcy.
New data raises even more questions about how hospitals are using for-profit pharmacies to expand a little known program called 340B. This program was designed to allow qualifying hospitals and clinics receiving certain federal grants to access deeply discounted pharmaceuticals so they can more easily provide medicines for their uninsured or vulnerable patients.
Unfortunately, there are not sufficient safeguards in place to ensure that hospitals qualifying for the program are true safety net hospitals providing a disproportionate share of charity care to low-income, uninsured patients.
Now, new data shows the majority of hospitals that are aggressively expanding use of this program through for-profit pharmacies are actually providing below average levels of charity care.
Potential personalized medicines represent 42 percent of drugs in the pipeline. This new finding, from a survey by the Tufts Center for the Study for Drug Development (CSDD), is remarkably high, particularly given that about 15 years ago the science of genomic medicine was just developing and that number was virtually zero.
Until recently many believed that biopharmaceutical companies were resistant to personalized (or precision) medicine and were not performing research to advance the field. Critics often speculated that the science was too hard and companies would not consider developing medicines for such small patient populations.
According to Abraham Lincoln, the patent system “secured to the inventor for a limited time exclusive use of his inventions, and thereby added the fuel of interest to the fire of genius in the discovery and productions of new and useful things.”
While this quote is from the mid-1800s, it is especially true today for the biopharmaceutical sector. It’s also timely as Congress is considering new legislation that would erode patent rights and potentially undermine industry’s ability to bring new treatments and cures to patients and grow the US economy.
#MedicareMonday is continuing to take a closer look at proposals that could hurt the success of Medicare Part D. This week we’re talking about proposals to repeal the non-interference clause in Medicare Part D.
What is non-interference?
From the beginning, the law creating Medicare Part D includes a provision called the non-interference clause; it prohibits the Secretary of Health and Human Services from interfering in the private price negotiations between Medicare Part D plans and drug manufacturers and pharmacies in the program, and prevents the Secretary from establishing a single formulary for the program.
A new editorial in the Wall Street Journal, “Bad Drug Trip in Alameda,” highlights a case currently before the Supreme Court (SCOTUS), PhRMA v. Alameda, that challenges a drug take-back program that was enacted in Alameda, CA, in 2012.
As the editorial notes, “the Alameda program requires all drug makers to fund and operate a county-wide disposal program, wherever they are headquartered in the world, as long as their products find their way into Alameda through interstate commerce.”
The editorial urges the Justices to hear the case “to prevent long-term harm to commerce and the constitutional order.” It points out that “the Constitution gives Congress the exclusive Article I power to regulate shared state markets” and says “that ought to preclude states from interfering in interstate commerce, especially by imposing protectionist policies against out-of-state businesses.”
Continued Misconceptions on Cost: This week, another misleading account of spending on medicines was released. The report, issued by Express Scripts, ignored the fact that for the past 50 years, spending on retail prescription drugs has consistently accounted for just 10 percent of overall health care spending. Instead, it focused on the cost of treating the sickest patients with the most health conditions, and failed to address the tremendous benefit innovative medicines provide to patients, the health care system and society.
As the way we pay for and deliver health care in the United States evolves, we’ve talked about the importance of patient engagement in the process and ensuring that our system doesn’t treat patients like an average, but as individuals.
Not surprisingly, patient advocacy groups are in agreement. A story in Inside Health Policy last week highlights the efforts of 60 groups, including the Alliance for Aging Research, Association of Community Cancer Centers, Partnership to Improve Patient Care and others, to ensure the Department of Health and Human Services (HHS) puts patients at the forefront of the development of payment reforms and models. (More on HHS’ initiative here and here.) The groups stress that doing so will open doors for more individualized treatment that will lead to improved health outcomes.