The Catalyst

ICYMI: New Commonwealth Fund Study Shows Health Insurance Does Not Always Translate to Affordable Care

Posted by Allyson Funk on May 21, 2015 at 5:50 PM

A new survey from the Commonwealth Fund found nearly a quarter of 19-to-64-year-old Americans with health insurance last year—approximately 31 million people—were considered “underinsured.” Meaning patients had health insurance, but their coverage did not always protect them from high medical bills and major financial issues. The culprit? Increasing deductibles and high out-of-pocket costs.

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.
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Topics: health insurance, coverage, ABCs of Coverage

340B Spotlight: New Charity Care Data Shows Most Hospitals with Contract Pharmacies Provide Little Charity Care

Posted by Karyn Schwartz on May 21, 2015 at 12:13 PM

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.[1]

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.

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Topics: 340B, HRSA, hospitals, 340B Spotlight

New Study Illustrates Biopharmaceutical Industry’s Commitment to Personalized Medicine

Posted by Gretta Stone on May 20, 2015 at 3:13 PM

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.

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Topics: Personalized Medicine, cancer, Tufts, Healthy Outlook

Patents: More Important to Biopharmaceutical Sector than Other Industries

Posted by Setareh Samii on May 18, 2015 at 3:23 PM

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.

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Topics: R&D, Patents, IP, Congress

Medicare Monday: How Successful Negotiation Takes Place in Medicare

Posted by Allyson Funk on May 18, 2015 at 2:21 PM

#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.

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Topics: Part D, CBO, Medicare, #MedicareMonday

WSJ Editorial: SCOTUS Needs to Hear Alameda Case

Posted by Robert Zirkelbach on May 18, 2015 at 12:12 PM

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.”

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Topics: SCOTUS, take-back programs, Wall Street Journal

Week in Review: The Latest from PhRMA

Posted by Christian Clymer on May 15, 2015 at 4:49 PM

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.

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Topics: Innovation, IP, drug cost, cost of medicines

Focusing Payment and Delivery on Patients

Posted by Allyson Funk on May 15, 2015 at 11:39 AM

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.

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Topics: cancer, Alternative Payment Models, Payment and Delivery Reform

ICYMI: Next Generation Cures

Posted by Tina Stow on May 15, 2015 at 11:30 AM

On Tuesday, May 12th, PhRMA and The Hill convened a symposium with legislators and leading health care experts on “Next Generation Cures.” Speakers and panelists focused on how all health care stakeholders can work together to create a policy and regulatory environment conductive to encouraging innovation and investment in the research and development needed for new therapies and cures for patients.

Senator Richard Burr kicked off the event by discussing the state of health care in America and what Congress can do to improve quality of care and access to medicines for patients. “We have to make sure there’s a pathway that’s understandable, not only through approval but reimbursement,” said Sen. Burr. Addressing 21st century breakthroughs, Sen. Burr stated that focusing on innovation is imperative to encourage research for new medicines, enabling us to reach the next level of treatments and cures. Giving President Obama credit for launching a new precision medicine initiative, Sen. Burr reiterated that this is a significant opportunity to get legislation right and help increase access to clinical trials and new treatments for patients.

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Topics: FDA, PhRMA, The Hill, Cures, National Health Council, #Hope2Cures

Ask About Adherence – Q&A with National Consumers League

Posted by Samantha Dougherty on May 14, 2015 at 1:12 PM

Ask About Adherence is a blog series featuring Q&A’s with experts in medication adherence. In this post, we speak with Sally Greenberg, National Consumers League (NCL) executive director, on medication synchronization.

Stay tuned for the next Q&A and be sure to share your thoughts in the comments section below. We’d love to hear from you on ways to improve medication adherence!

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Topics: adherence, #Adherence123s, Ask About Adherence

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