Overnight Health Care: Senators seek CBO input on preventing surprise medical bills | Oversight panel seeks OxyContin documents | Pharmacy middlemen to testify on prices | Watchdog warns air ambulances can put patients at ‘financial risk’
Welcome to Thursday’s Overnight Health Care.
Today, the bipartisan leaders of the Senate health committee took a step forward on possible legislation for surprise medical bills. Meanwhile, the Senate Finance Committee confirmed that it will hear from executives of pharmacy benefit managers (PBMs) next month. Also, a watchdog is warning that air ambulance bills can put patients at financial risk, and the House Oversight Committee is digging into the Sackler family.
We’ll start with some news on surprise medical bills:
Alexander, Murray ask CBO to review options for preventing surprise medical bills
Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are working together again… but not on ObamaCare.
This time they’re taking on surprise medical bills.
The pair sent options to the CBO for analysis, according to Senate aides.
Why it matters: It’s the latest sign that lawmakers are serious about moving forward on legislation to stop surprise medical bills, a rare issue where there could be bipartisan action this year.
{mosads}The goal is to stop instances like a viral story last year of a teacher in Texas who got a $108,951 bill from the hospital after his heart attack because the hospital was not in his insurance network.
Senate panel to hear from pharmacy middlemen on drug prices
The Senate Finance Committee said Thursday that it has secured commitments from executives of five major pharmacy benefit managers (PBMs) to testify next month about the high costs of prescription drugs.
Committee Chairman Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) said executives from Cigna, CVS, Humana, OptumRx and Prime Therapeutics have agreed to appear on April 9.
Both lawmakers have been critical of PBMs, which are often referred to as “middlemen.” PBMs administer prescription drug plans for large employers and are tasked with negotiating discounts on drugs with pharmaceutical firms and insurers.
Here we go again: This will be the third time this year the Finance Committee has held a hearing on high drug prices. Last month, drug industry executives were under the microscope.
Finger pointing: But the pharma execs did not commit to lowering list prices, and instead blamed the convoluted system of PBMs and insurers for not passing savings on to customers. Expect the PBMs to pin the blame on drug companies instead.
Read more on the hearing here.
African-Americans, Hispanics, dying at a faster rate of fentanyl overdoses than whites: analysis
Rates of overdose deaths for African-Americans increased 140 percent on average per year between 2011 and 2016, according to CDC data, and by 118 percent on average per year for Hispanics during that same time period.
Overdose deaths among whites increased by an average of 61 percent per year between 2011 and 2016.
Context: Increases in drug overdose deaths in the U.S. have largely been driven by fentanyl and other synthetic opioids in recent years. The number of drug overdose deaths involving fentanyl was stable in 2011 and 2012 and began increasing in 2013 before rising to 18,335 deaths in 2016.
Government watchdog: Costly air ambulances can put patients at ‘financial risk’
Air ambulances can be life-saving for critically ill patients who need to get to a hospital quickly, but they can also put patients in financial risk, according to a study conducted by the Government Accountability Office (GAO).
The median price charged by air ambulance providers in 2017 was from $36,400 to $40,600, and those costs aren’t always covered by insurance, according to the report.
Sixty-nine percent of the 20,700 air ambulance transports taken in 2017 by privately insured patients were out of network, meaning their insurance companies had not contracted with that provider and the costs may not be fully covered, the GAO says.
One customer in North Dakota told the GAO they received a $34,700 bill for an air ambulance transport. The patient’s insurance company only paid $6,700 of the $41,400 charged by the air ambulance provider.
Context: This is another example of how “balance billing” or “surprise billing” can impact patients. Patients who get care out-of-network often get stuck paying for what their insurance companies won’t.
Oversight Committee seeks Purdue OxyContin documents
The House Oversight and Reform Committee is seeking documents from Purdue Pharma related to how the Sackler family aggressively marketed OxyContin, a powerful painkiller that has been blamed for its role in the national opioid crisis.
In a letter to Purdue’s president and CEO, Craig Landau, Oversight Committee Chairman Elijah Cummings (D-Md.) and Rep. Mark DeSaulnier (D-Calif.) asked for a list of all members of the Sackler family who had served on the board of Purdue or worked as company officers.
They also asked for all documents prepared for the Sackler family about the company’s sales and marketing strategy for OxyContin.
The document request represents a potential new investigation for the Sackler family to deal with. Lawmakers said they are responding to reports that the Sackler family, which purchased Purdue Pharma in 1952 and continue to own a controlling share of the company, sought to drive up sales of OxyContin and other addictive painkillers while simultaneously expanding the market for medications to treat addiction.
Lawsuits upon lawsuits: Purdue is facing a host of lawsuits over its alleged role in driving the country’s opioid crisis, especially through its marketing of OxyContin. Purdue has denied the allegations and is mounting a vigorous defense.
Wisconsin asks to withdraw from ObamaCare lawsuit
Wisconsin on Thursday asked a court to withdraw from the lawsuit brought by a range of GOP-led states against ObamaCare.
The move comes after Democrat Tony Evers was elected governor in November, defeating Republican Scott Walker, under whom the state had joined the lawsuit.
The new administration took the action on Thursday after a court ruling blocked a controversial state law passed by the GOP legislature after the election that limited the incoming Democratic governor’s powers.
Public advocacy group Public Citizen called on HHS to stop approving new opioid formulations
In a letter to HHS Secretary Alex Azar and FDA Commissioner Scott Gottlieb, the group notes that between 2009 and 2015, the FDA approved 27 new or reformulated opioids, none of which could be described as a “breakthrough” opioid with benefits that exceeded the risks, according to Public Citizen.
In 2016, the agency asked for advice from the National Academy of Medicine on developing a regulatory framework for opioid review, approval and monitoring.
In a report, the National Academies concluded the FDA had not “incorporate[d] public health considerations into opioid-related regulatory decisions” and recommended an independent review of all currently approved opioids, which could lead to the removal of some opioid formulations or dosages from the market.
“Absent a currently nonexistent effective regulatory framework for opioids that incorporates public health considerations, the FDA cannot be relied upon to approve any more new opioids,” wrote Sidney M. Wolfe, founder of Public Citizen’s Health Research Group. “The FDA must impose a moratorium on approval of opioids until the regulatory framework envisioned by the National Academies is in place.”
What we’re reading
ObamaCare exchanges grew more competitive in 2019 (Modern Healthcare)
The big barrier to a Medicare for all vote isn’t Republicans, it’s Democrats (Buzzfeed News)
White House officials attend Hungarian Embassy event urging women to have more children (The Washington Post)
FDA chief calls for stricter scrutiny of electronic health records (Kaiser Health News)
State by state
Alaska Medicaid cuts, while aimed at access, still raise concerns (Alaska Public Radio)
Kansas lawmakers take big step toward expanding Medicaid (The Wichita Eagle)
Mississippi bans abortions if heartbeat can be heard. Expect a legal fight. (The New York Times)
From The Hill’s opinion page
Proposed FDA e-cigarette ban disproportionately impacts veterans and service members
Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
