Editor’s Desk

Jimmy Kimmel on Graham-Cassidy, Peter Bach on CAR-T, Dan Diamond on Tom Price’s Private Jet Travel

Peter Wehrwein
Editor

The Graham-Cassidy Bill

Jimmy Kimmel on Jimmy Kimmel Live!

Tuesday, Sept. 19

OK, last week Bill Cassidy and Senator Lindsay Graham proposed a new bill, the Graham-Cassidy Bill. And this new bill actually does pass the Jimmy Kimmel test—but a different Jimmy Kimmel test. With this one, your child with a preexisting condition will get the care he needs if and only if his father is Jimmy Kimmel. Otherwise you might be screwed. I don't know what happened to Bill Cassidy, but when he was on this publicity tour he listed his demands for a health care bill very clearly. These were his words. He said he wants coverage for all, no discrimination based on preexisting conditions, lower premiums for middle-class families, and no lifetime caps. And guess what? The new bill does none of those things. Coverage for all? No. In fact it will take about 30 million Americans off insurance. Preexisting conditions? No. If the bill passes, individually states can let insurance companies charge you more if you have a preexisting condition. You'll find that little loophole later in the document after he says they can't. They can and they will. But will it lower premiums? Well, in fact, for lots of people, the bill will result in higher premiums. And as far as lifetime caps go, the states can decide on that too, which means there will be lifetime caps in many states.

So not only did Bill Cassidy fail the Jimmy Kimmel test, he failed the Bill Cassidy test. He failed his own test. And you don't see that happen very much. This bill he came up with is actually worse than the one that, thank God, Republicans like Susan Collins and Lisa Murkowski and John McCain torpedoed over the summer. And I hope they have the courage and good sense to do that again with this one.

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Sarah Kliff, health care writer for Vox

Wednesday, Sept. 20

I have spent the bulk of 2017 writing about the different Republican plans to repeal the Affordable Care Act. Graham-Cassidy, in my view, is the most radical of them all. While the other Republican plans essentially create a poorly funded version of the Affordable Care Act, Graham-Cassidy blows it up.

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Michael Tanner, senior fellow at the Cato Institute

Wednesday, Sept. 20, The National Review

Essentially, Graham-Cassidy would fold all current Obamacare funding, both premium subsidies and Medicaid-expansion funding, into a single block grant to each state. Keeping this money flowing means that Graham-Cassidy must keep most Obamacare taxes in place. Only the individual and employer mandates and the medical-device tax are repealed. This has led Rand Paul to warn that the bill simply “rearranges the furniture a bit, changes some names, and otherwise masks what is really going on—a redistribution of ObamaCare taxes and a new Republican entitlement program, funded nearly as extravagantly as ObamaCare.”

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Kymriah and CAR-T as a cure

Peter B. Bach, Sergio A. Giralt, and Leonard Saltz

Memorial Sloan Kettering Cancer Center

Wednesday, Sept. 20, JAMA

The term “cure,” bandied about all too often in the media, should be excluded from any serious conversation about CAR-T, replaced with discussions that focus on what is known of their potential today. The reason is that the term cure will connote to some patients that a single infusion of this scientifically mystifying, genetically driven therapy will first vanquish their disease and then reset their life expectancy to normal. Perhaps one day data will support such a hope; as of yet the available data are insufficient to claim much more than CAR-T treatments have large promise at an enormous price.

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Anti-competitive practices against biosimilars

Excerpt from Pfizer’s press release about its lawsuit against Johnson & Johnson alleging anti-competitive practices against Inflectra, its biosimilar to J&J’s Remicade

Wednesday, Sept. 20

The complaint describes how insurers originally classified Inflectra at parity with Remicade—meaning, there was no medical reason to favor Remicade over Inflectra. However, insurers reversed course after J&J threatened to withhold significant rebates unless insurers agreed to “biosimilar-exclusion” contracts that effectively block coverage for Inflectra and other infliximab biosimilars. In the absence of such coverage, providers—who depend on reimbursement from insurers—are reluctant to stock biosimilars, even to service Medicare and Medicaid patients where there is widespread coverage for Inflectra.

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FDA and its enforcement of postapproval study requirements

Steven Woloshin, Lisa M. Schwartz, Brian White, and Thomas J. Moore

Thursday, Sept. 21, New England Journal of Medicine

First, the FDA could do more to ensure that sponsors meet postapproval deadlines. Only half the studies established in 2009 and 2010 had been completed by the end of 2015, and some companies even failed to submit required annual status reports. According to the latest Federal Register report, which includes data from 2015, a total of 13% of annual status reports were filed at least 2 months late and 19% were not received. The FDA could use its FDAAA-established power to impose fines or other penalties on sponsors that fail to meet deadlines. To our knowledge, it has never imposed such fines.

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Tom Price’s Use of Private Jets

Dan Diamond, Politico

Friday, Sept. 22

Price has taken at least 24 flights on private charter planes at taxpayers’ expense since early May, including a flight on a private jet to Oklahoma this week, POLITICO reported on Thursday.

The frequency of the trips underscores how private travel has become the norm — rather than the exception—for the former Georgia Republican congressman during his time atop the federal health agency, which began in February. The cost of the trips identified by POLITICO exceeds $300,000, according to a review of federal contracts and similar trip itineraries.

A spokesperson for Price said that the HHS secretary began using charter jets after a delay of a commercial flight forced him to miss an official HHS event, but the spokesperson could not offer any details about the specific flight delay or missed event.

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