Today's News and Commentary

About the public’s health

Walgreens and Kroger will stop selling electronic cigarettes: Retail outlets are joining state actions in cutting access to e-cigarettes.

HIV prevention drugs will be available without a prescription in California: This action is a major step in HIV prevention. What are the pros and cons of making prescriptions such as this available over the counter?

Review of Progress on Antimicrobial Resistance: Antimicrobial resistance is an important global public health problem. This study is a nice summary about the lack of progress addressing this issue and the reasons why it has become so prevalent. Of particular concern is the over-the-counter sales of antibiotics in low and middle income countries (LMICs), which substitutes for the availability of professional services. Further, the Review found that (no surprise) a “major reason for the use of antibiotics in LMICs is the prevalence of unhygienic conditions in the community and in healthcare facilities, which contribute to infection and limit the impact of messages about awareness and infection prevention and control.”

The Cannabis Effect on Crime: Time-Series Analysis of Crime in Colorado and Washington State: The authors conclude that: “results suggest that marijuana legalization and sales have had minimal to no effect on major crimes in Colorado or Washington. We observed no statistically significant long-term effects of recreational cannabis laws or the initiation of retail sales on violent or property crime rates in these states.”

U.S. firearm health rate rose sharply in recent years across most states & demographic groups: “In all, the United States saw a 14% rise in the rate of firearm deaths from 2015 through 2017, compared with the rate seen in the years 1999 through 2014.
During the entire 19-year period, 612,310 Americans died from firearm injuries that were self-inflicted, caused by others, accidental or of undetermined cause. Nearly one-fifth of the deaths happened in just the last three years of that time.” However, as the map in the article shows, there is wide variation is those rates- some (like California, NY and RI) even decreasing by about 12.5%. What makes some states successful and others very dangerous?

About pharma

FDA: US Heparin Supply Not Impacted by African Swine Fever in China: This article highlights the fragile value chain for US pharmaceuticals.

Does Zantac Break Down Into a Carcinogen?: A new development in the recall of ranitidine (Zantac):
“The generic Zantac that's being shelved across the country isn't necessarily ‘contaminated’ with N-nitrosodimethylamine (NDMA); rather, the carcinogen may stem from breakdown of the ranitidine molecule…The carcinogenic breakdown doesn't appear to be a class effect for H2 antagonists, and it doesn't seem to extend to proton pump inhibitors (PPIs), the other major heartburn drug class.” The question is why it has taken so long for this problem to surface when Zantac’s commercial launch was in 1981.

California bans pharma's infamous 'pay-for-delay' deals: “When generic challengers come for a branded med’s patent, drugmakers have in the past chosen to pony up and stall their rivals with an anticompetitive pact better known as “pay for delay.” In an effort to keep drug prices down, California is looking to end the practice.
California Gov. Gavin Newsom signed a new bill Tuesday that will make California the first state to ban pay-for-delay deals in pharma.”

Drug Super Spenders: 2016 to 2018 Growth in Number of Members and Total Pharmacy Plus Medical Benefit Drug Cost for Members with Extremely High Annual Drug Cost in a 17 Million Member Commercially Insured Population: This detailed summary highlights how few patients account for a large portion of pharma costs. For example: “In 2018, there were 4,869 members (0.0275% of all members) accounting for $2.119B drug spend, which was 8.6% of all drug spend.”

About health insurance

As Medicare enrollment nears, popular price comparison tool is missing: The enrollment site for Medicare plans was recently redesigned. In August, CMS Administrator Seema Verma said: “The new tool will provide more enhanced price and quality information.” However, “the plan finder can no longer add up and sort through the prescription costs plus monthly premiums and any deductibles for all those plans…Medicare officials say the total cost calculator will be fixed in time for the annual enrollment season, which starts nationwide Oct. 15 and runs through Dec. 7.” If not fixed, Medicare beneficiaries could spend thousands of dollars more per year by not closing the best plan. NOTE: Beneficiaries should check prices every year, since annual out-of-pocket costs can vary significantly.

MA [Medicare Advantage] insurer startup Devoted Health first to subsidize Apple Watch: The headline is self-explanatory. Apple is working to get approval from other plans as well.

Survey: Site of care, biosimilars key for employers to lower drug prices: Employers are trying to shift payment for these high cost pharmaceuticals to the drug benefit portion of insurance coverage and away from inpatient settings. The supposition is that they are more expensive in the latter setting. However, with payment methods like per diems and DRGs, the drug costs are part of the fixed costs of a hospital stay. So changing the method of payment instead of the site may offer more savings. Likewise, as more provider organizations change to value-based payments, payers will not have to worry how those firms handle internal charges.

Trump’s New Order For Medicare Packs Potential Rise In Patients’ Costs: A second look at last week’s executive order on Medicare reveals some surprises. One touted feature is that it makes it easier for individuals and physicians to contract outside of the Medicare system. Currently, that option is illegal unless physicians withdraw from the plan entirely (for a 2 year minimum). This action is supposed to help people find physicians who will take on Medicare patients. The problem with that reasoning is there is not a problem. Physician shortages (when they occur) are not caused by reluctance to see Medicare patients. The other issue is that all physicians who are part of the Medicare program must abide by CMS rules that limit the amounts they can charge patients. Making opt-out participation easier, patients may unknowingly be exposed to “surprise medical bills.”

Study: Coordinated care model cuts unscheduled hospital visits: Since 2012, Oregon has had a unique plan to care for its Medicaid population. It is based on Coordinated Care Organizations (CCOs), which have far more population control than Accountable Care Organizations. “Oregon’s 15 CCOs emphasize primary care, disease prevention and population health measurements, not just individual outcomes. They work with Medicaid patients under a lump sum payment system that rewards the CCOs for hitting certain quality standards, including efficient use of hospital emergency rooms.” This system has resulted in a decrease in preventable hospital admissions compared to pre-CCO implementation.

About healthcare quality and safety

Top 10 Health Technology Hazards for 2020: This annual list by the ECRI Institute is topped by “Misuse of Surgical Staplers.” See the article for the rest of the list.

About hospitals and health systems

Almost a year into rules requiring hospitals to post prices online, how are they doing?: The answer to the question posed by the headline emphasizes the great variability in actions. The article summarizes the responses. In addition to what they are (or are not doing), one problem is that some “hospitals made no or little attempt to translate medical jargon that describes what a procedure is into a format that patients could understand.”