Today's News and Commentary

About pharma

Oral GLP-1 Drug Wins FDA Nod: In this class of diabetic treatments (such brands as Victoza, Trulicity and Byetta), all drugs are currently injectable. This breakthrough medication can be taken orally. Barring unforeseen side effects, it should be a blockbuster- potentially replacing the injectables.

Pelosi unveils signature plan to lower drug prices: Here is the Speaker’s plan to lower pharma costs as previously reported. No surprise, the insurance lobbying group, AHIP, endorsed the plan. However, it may be difficult to get Senate Republican support.

About the public’s health

DHS formally backs off plans to deport sick immigrant children: The headline says it all, as the Trump administration reverses course on this issue.

Cumulative risk analysis of carcinogenic contaminants in United States drinking water: This article is particularly timely given the EPA’s relaxation of water pollution standards. The authors conclude that: “Cumulative risk analysis of contaminant occurrence in United States drinking water for the period of 2010–2017 indicates that over 100,000 lifetime cancer cases could be due to carcinogenic chemicals in tap water. The majority of this risk is due to the presence of arsenic, disinfection byproducts and radioactive contaminants. For different states within the U.S., cumulative cancer risk for drinking water contaminants ranges between 1 × 10−4 and 1 × 10−3, similar to the range of cumulative cancer risks reported for air pollutants.”

Trump signs order to improve flu-vaccine development: The President has given HHS 120 days to come up with a plan “to improve the country’s ability to prepare for a potential future outbreak of pandemic flu, and to develop better vaccines to protect against seasonal outbreaks.” Part of the goal is development of a universal vaccine that won’t depend on seasonal subtype variations.

About health insurance

Medicare Beneficiary Identifiers (MBIs): CMS just announced that the trial period of conversion to the new Medicare Identifiers will end December 31, 2019. After that date, providers “MUST submit claims using MBIs (with a few exceptions),” even if the date of service was prior to 2020.

Marketplace Pulse: A Long Look at the Individual Market: The Robert Wood Johnson Foundation published its latest look at the ACA marketplace. Overall, the news is good: “Based on the expansions for which county-level information is available, the number of one-carrier counties will decline by at least 13 percent in 2020. The final figure will be somewhat larger when all of the plans release the full extent of their expansions.” You can look up your county on an interactive map to find the offerings in your area.

Are Medicare Advantage Plans Using New Supplemental Benefit Flexibility to Address Enrollees' Health-Related Social Needs?: This research is based on focused interviews with Medicare Advantage plans about their decisions to introduce more flexible benefits. Some summary findings:

  • “In 2019, the average MA plan received $107 per member per month in rebates to spend on cost-sharing reductions or supplemental benefits. However, rebate amounts substantially varied across states.” Many plans said the amounts were not enough to cover the extra benefits and called for more funding.

  • The decision about which benefits to offer has been hampered by lack of data about the potential return on investment of each.

  • Sometimes there are no community organizations available that can offer the benefit they want to provide to their members.

  • CMS allows the expanded benefits to be offered based only on clinical criteria. However, many of these services should be determined by social needs. The plans are therefore calling on CMS to expand these need criteria.

About healthcare IT

Industry efforts to lift ban on federal funding for unique patient identifier hits roadblock in the Senate: Although the Senate Finance Committee increased NIH funding, it failed to allocate money to implement a unique patient identifier. As previously reported, Congress outlawed this identifier after it was included in the HIPAA. Leaders from across the healthcare industry have been calling for repeal of the ban in order to facilitate interoperability.