Sound and Fury Surrounds Rx Pricing Debate, But What Do They Signify?

Sticker shock is continuing to make prescription drug prices a campaign issue, and with changes in benefit design exposing people to more and more cost-sharing, the issue is unlikely to die any time soon. But whether motion will actually translate into progress is another matter entirely. A quick look at PhRMA’s recently released policy agenda doesn’t give many grounds for optimism. While the industry’s call for careful scrutiny of health plan formulary design will be welcome to many consumer groups who fear that plan formularies are being used as a tool to discourage sicker enrollees, their agenda on “eliminating market distortions” makes no mention at all of the distorting effect on prices of practices such as “ever-greening” – making small changes to a drug in order to extend the life of its patent-exclusivity. And if PhRMA really wanted to support better transparency with respect to clinical evidence, companies could join the international All Trials Campaign, as the AMA did just a few days ago. The campaign calls for more public disclosure of data, both positive and negative, from clinical trials. Often times, data with more negative results are not published, so most doctors never hear about them.

Meanwhile a new Pro Publica analysis shows a correlation between the amount of money that doctors receive from drug companies and their tendency to prescribe brand name drugs. Surprisingly, no mention of this market distortion made it into the PhRMA policy agenda…

Consumers Remain Caught in the Cross-Fire on Surprise Out of Network Costs

Last week Time Magazine ran a big feature on surprise out-of-network bills. You can’t get much more mainstream than that. Why does the inanity of surprise out-of-network bills persist? Acting CMS Administrator Andy Slavitt has an answer: “Everybody in the chain is culpable, but they also – in this wonderful system we have – have the ability to point to each other and say, ‘See? It’s not my fault because it’s the way the system works.’” Insurers and providers are locked in a tug-of-war over payment rates, but consumers are the collateral damage. Policy makers need to step in to prevent consumers from becoming roadkill in a game of chicken, as indeed some are doing (see for example this proposal from the Insurance Commissioner in PA.) But, so far, progress has been slow on the legislative front.

Affordability—a Multifaceted Problem

The issue of surprise out-of-network bills is really just one aspect of the affordability problem. As a recent Harvard School of Public Health survey makes clear, the problem extends far beyond high deductibles and narrow networks in Marketplace plans. More than a quarter of U.S. households report that health care costs have created a serious financial problem for them within the past two years.

Tip of the Iceberg – Lead Poisoning in Flint and Beyond

Even as pressure ratchets up on Governor Rick Snyder and EPA officials for their failure in Flint, a new report released last week shows that hundreds of schools and day care centers across the country have lead levels that are unsafe for children and most are not tested regularly. Since lead poisoning causes permanent damage with serious health and economic consequences into adulthood, ensuring safe water for children would seem like a patently obvious case for applying an “ounce of prevention.” However, the scope of the problem demands federal action and infrastructure investments have been difficult to move through an austerity-minded Congress.