News & Commentary

Briefly Noted June 2019


Axios reported that Lispro, Eli Lilly’s “authorized generic” of Humalog, is not on the Express Scripts national formulary. Insulin with a lower list price could mean a significant cost savings for patients who pay out of pocket. But, as Axios pointed out, for a PBM that advantage may be more apparent than real if the rebate is small or eliminated altogether.

About 840,000 fewer children were covered by Medicaid and the CHIP program in 2018 than the year before, according to Georgetown researchers. Proportionally, the biggest drop was in Tennessee, which saw a 10.1% decrease (88,305 fewer children). As is so often the case, agreeing on the why of a matter is harder than calculating the what. In a series of tweets, CMS Administrator Seema Verma pointed to fewer people needing public assistance because of a strong economy and wage growth

Ezekiel Emanuel cooked up a formula for a just price for drugs based on some common principles and average lifetime earnings in April’s Health Affairs. It’s all theoretical but could play into arguments about value-based pricing for drugs. By Emanuel’s reckoning, the average lifetime costs for health care in this country are 31% of disposable income, with drugs accounting for 17% of health care expenses. He tacks on an extra 10 percentage points to both the health care percentage (so it is 41% of disposable income) and to the drug cost share (so it comes to 27%). The simple math, then, is that a person’s lifetime drug costs should be no more than 11% of lifetime disposable income. Emanuel applies this 11% figure to $638,797—his calculation of the average lifetime disposable income (average lifetime earnings minus the cost of raising a child, basic necessities, and so on) to arrive at a figure of $70,715 in health care spending.

A study published in Communications Biology details the discovery by an international team of scientists of a new broad-spectrum antibiotic containing arsenic. Arsinothricin (AST) is a natural product produced by soil bacteria that is effective against many types of bacteria. It’s the first and only known natural antibiotic that contains arsenic. Although arsenic can be a toxin and carcinogen, the use of arsenicals as antimicrobials and anticancer agents is well established, noted the researchers. Arsenicals are used to treat tropical diseases, to prevent infectious diseases in poultry, and as a chemotherapeutic treatment for leukemia.

At Eyeforpharma’s meeting in Philadelphia, DOLs were a topic of conversation. DOL stands for digital opinion leaders—health care folks, mainly doctors, who have attracted huge followings on various social media platforms. There’s still a role for the old-­fashioned KOL who sits on advisory boards and publishes peer-reviewed articles, but in pharma marketing, DOLs may be the hotter ticket.

A prospective cohort study published in the journal Heart said that 51% of people with high LDL levels don’t respond to statins, and they have a hazard ratio for getting cardiovascular disease of 1.19, after adjusting for competing risks and other factors. Like any prospective cohort study, this one has limitations, including unidentified confounding factors. But its size (a million-plus person-years of follow-up) is a virtue and lend the findings credibility.

Geriatric emergency departments, a fairly new idea, focus on the special needs of the elderly, and more hospitals around the country offer them, the Wall Street Journal notes. “A key goal of geriatric ERs is to save the patients from being admitted to the hospital, where they face a greater risk for hospital-acquired infections, delirium, and falls,” reports the WSJ. Geriatric EDs can be found in St. Joseph’s University Medical Center in Paterson, N.J., Holy Cross Hospital in Silver Spring, Md., UC San Diego Health in La Jolla, Calif., Mount Sinai Health System in New York, and five Aurora Health Care hospitals in eastern Wisconsin.

UnitedHealth Group and Rally Health, a recently acquired subsidiary, keep a healthy distance from each other, and that’s just the way both like it, the Star Tribune of Minnesota reports. Rally began life as a wellness vendor through is digital health platform, steering people toward wellness programs and tracking their progress. About four years ago it began offering more. “To display cost information, Rally Health must get access to some of the most sensitive information in health care—the negotiated payment rates between health insurers and health care providers,” the w reports. “That means health insurers and health care providers must trust that Rally will not turn around and share the information with UnitedHealthcare”.

PBMs and pharmaceutical companies, feeling the heat from public outrage over soaring drug prices and pressure from President Trump and Congress to do something about it, spent heavily on lobbying the first quarter of 2019. In fact, the Pharmaceutical Care Management Association, the PBM lobbying group, spent $1.49 million on lobbying in the three-month span, the most it has ever spent in one quarter, according to an analysis of lobbyist spending by Stat. Meanwhile, the Pharmaceutical Research and Manufacturers of America (PhRMA) spent $9.91 million on lobbying in the first quarter of 2019.

About half of total drug spending in Medicare Part D in 2017 can be chalked up to 77 of the nearly 2,900 drugs covered by the program, according to an analysis of CMS data by the research company Bloomberg Government. In addition, the per-dose cost of 22 drugs increased more than 500% from 2013 through 2017. “The drug with the sharpest increase per dose was Thiola, which is used to treat a painful, rare genetic condition called cystinuria that causes frequent recurring kidney stones,” according to Bloomberg Government. “Medicare spent 24 times as much per dose on Thiola in 2017 than in 2013.

The rate of autism spectrum disorder among 4-year-olds in the United States jumped from 13.4 per 1,000 children in 2010 to 17 per 1,000 children in 2017, according to a study by CDC researchers published April 12 in the CDC’s Morbidity and Mortality Weekly Report.

The threshold for hypertension should be lowered to 130/80 mm Hg for Medicare beneficiaries in keeping with current medical guidelines, CMS proposes. In addition, CMS would extend Medicare coverage of ambulatory blood pressure monitoring to patients thought to have masked hypertension, which is not always apparent during examinations.