Wednesday, 30 May 2018

Re-Tweeting Sanofi’s Tweet: Inclusion Matters for Health, Wellness, and the Body Politic

The communications team at Sanofi, the France-based global pharmaceutical company, quickly responded to a tweet by Roseanne Barr issued this morning about how her use of Ambien was related to her offensive tweet lobbed yesterday on Twitter about Valerie Jarrett, President Obama’s senior advisor.

Barr’s comment on Twitter late last night was that, “I was ambien tweeting.”

Ambien is Sanofi’s prescription drug used by patients to deal with insomnia and sleeplessness. Data provided to the FDA from patients who have used the product demonstrate a variety of side effects including but not limited to nausea, headache, slowed breathing, and amnesia — but not racism as far as the post-marketing surveillance has revealed.

Kudos to Sanofi for their fast reaction to Barr’s blaming the company’s product for somehow addling her judgment. That, after a many tweets responding to fans’ supporting her right to free speech and at least two apologies for her “mistake.”

Health Populi’s Hot Points:  The uniquely American challenge of health disparities, especially relating to race, is a topic I’ve covered many times since the launch of Health Populi in 2007. As a child I grew up in metropolitan Detroit, and witnessed as a little girl the Detroit Riots of 1967 which I soberly discussed in this blog post written last July on the 50th anniversary of that event. That summer made a profound impact on me and my world view, from a very young age, that racism had no place in my own life. I hoped as I grew up that somehow, in some way, I could work in the future to help allay disparities based on race and ethnicity.

That’s the America I had envisioned and hoped for, the political home my parents, Kennedy-Humphrey Democrats at that moment, had made for us.

Sanofi, Disney and ABC, and MSNBC’s special programming on Racism in America broadcast last night (ironically timed) are bright spots at this moment in time when we need them. Any of us using Twitter and other social media should be mindful that words matter, and social networks can be used for good…or ill.

America’s healthcare system, the public’s health and individual health outcomes, all depend on us bolstering social determinants. Loving one another is the ultimate social determinant of health. That may be too much for me to ask today. For now, civil discourse, respect, transparency, trust, and social inclusion can help bolster the body politic for both political discourse and the public’s health.

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Tuesday, 29 May 2018

How to Make Healthcare More Intelligent and Trustworthy: Accenture’s Digital Health Tech Vision 2018

“Do no harm” has been the professional and ethical mantra of physicians since the Hippocratic Oath was first uttered by medical students. The origins of that three-word objective probably came out of Hippocrates’ Corpus, which included a few additional words: “to do good or to do no harm.”

The proliferation and evolution of digital technologies in health care have the potential to do good or harm, depending on their application.

Doing good and abstaining from doing harm can engender trust between patients, providers, and other stakeholders in health. Trust has become a key currency in provider/patient/supplier relationships: 94% of health executives say treating customers as partners is important to gain trust, according to the Digital Health Tech Vision 2018 from Accenture.

Accenture’s vision this year is built on five pillars:

  • Citizen AI
  • Extended Reality
  • Data Veracity
  • Frictionless Business, and
  • The Internet of Thinking.

Together, these factors can bolster personalization and improve consumers’ experience in healthcare, but also have the power to invade, disrupt, and encroach on peoples’ physical and intimate lives in unwelcome ways.

The first trend is Citizen AI. Artificial intelligence, AI, is fast becoming part of the workflow across all industries. AI enables enterprises to take in a lot of data and make sense of it, with the power of better informing decisions. “The more data an AI is given, the better its predictions become,” Accenture notes.

But there’s a data stewardship role that’s crucial when an organization takes in peoples’ personal information: 81% of health executives agree that organizations aren’t prepared to deal with societal and liability issues that AI-based decisions may raise. How to be responsible, equitable, transparent as a good AI citizen? That’s part of “doing no harm” with data in healthcare. And the more good AI behavior will lead to greater adoption and more trust, in a virtuous cycle of data-sharing, data-using, greater productivity, and better health outcomes. That’s why 73% of health executives told Accenture they plan to develop internal ethical standards related to the use of AI to bolster responsible use of patients’ personal health information.

Extended reality here covers three forms of technology “realities:” virtual reality (VR), augmented reality (AR), and extended reality (XR). Together, these three concepts blur lines across physical and simulated, immersive worlds. For healthcare, these platforms enable virtual and telehealth in new ways that transcend bricks-and-mortar settings, getting care and new forms of it to people where they live, work, and play. Accenture classifies XR’s potential in three ways: as,

Distance to people, so “patients can enjoy the removal of distance when it comes to their care,” extending telehealth and virtual care to people regardless of that distance.

Distance to information and insights, bringing patients’ information to clinicians’ fingertips wherever that clinician is located.

Distance to experiences, enabling virtual reality that helps both clinicians and patients gain insights and empathy for healthcare – for example, how the progression of Alzheimer’s disease might feel, or what PTSD seems like. 83% of health executives believe that XR will provide a new foundation for interaction, communication and information, Accenture learned, and most agree that XR will impact every industry over the next five years.

Data veracity speaks to the old adage, “garbage in, garbage out.” The quality of data is more important than its volume of “Big”-ness. “Inaccurate data leads to corrupted insights and skewed decisions,” Accenture warns. One in 4 health care executives say they’ve been the target of AI bad behaviors like falsified location data and bot fraud more than once. Unsurprisingly, then, 3 in 4 health execs aren’t ready to deal with the “impending waves” of corrupted insights as faked data comes into healthcare databases.

The solution calls for “data intelligence,” which is a must-do as more artificial intelligence is adopted as a normal course of business. Here, blockchain may be a valuable tactic to underpin cybersecurity and manage risks.

Frictionless business is the vision for streamlining healthcare and lubricating the value-chain for healthcare collaborators. As organizations come together from different parts of the healthcare ecosystem, there’s the potential for the partnerships to become cumbersome and complicated. “Legacy systems weren’t built to support this kind of rapid and robust expansion” we expect to help improve healthcare, so Accenture points to two approaches to deploy that can address friction: blockchain and microservices.

The microservices mindset looks at a program, project, or service in a modular way so that solutions can be created more nimbly. Consider the use of APIs (application programming interfaces) that help to make data more liquid from one application to another.

Why is this trend so important? Because the use of data exchanged between health/care ecosystem partners will increase in the next two years, Accenture learned from 9 in 10 health executives. These technologies will be key for healthcare stakeholders who want to collaborate, cross-business, and more quickly and effectively scale solutions.

Finally, the Internet of Thinking rounds out Accenture’s five themes in the 2018 Health Tech Vision. Consider the “Internet of Things” morphing to the “T” of “Thinking” (IoTh). In healthcare, this IoTh envisions embedded intelligent tools “everywhere,” and especially “at the edge.” I’m not talking about U2’s outstanding lead guitarist and songwriter, David Howell Evans, but the phenomenon that doing healthcare better requires data accessed where patients and people “are.” Data can be processed and stored at the edge or in the cloud.

This concept is important because bandwidth, storage and computational power costs resources, and healthcare is notoriously cost-constrained. But healthcare decisions can be better informed through AI, and AI requires a lot of data to feed the analytics process. Consider “the edge” as a strategic asset will help healthcare organizations engage with greater intelligence, Accenture believes. The report discusses the opportunity-example for an Alexa-like device to alert a person, living and aging at home, of an elevated heart rate (or it could be blood glucose other medical metric) and alert the patient to sit, rest, eat, or phone 9-1-1. “The technology is liberating for the patient, and potentially lifesaving,” Accenture says.

The vast majority of health executives see the important role of computing at the edge, where data is generated.

Health Populi’s Hot Points:  Join Dr. Kaveh Safavi, MD, JD, Senior Global Managing Director with Accenture Health, Lisa Suennen, Managing Director for GE Ventures, and me on July 24th when we brainstorm these ideas, live via webcast at 11 am Eastern time, from Accenture studios on Wednesday, July 18, 2018. You can register here on this link.

 

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Monday, 28 May 2018

Dental Care and Latex Allergies

Most of us have or are close to someone with any allergy. Many allergies are commonly food-related, like nuts, dairy or eggs, but others range from environmental triggers like grass, pollen or ragweed, to man-made substances such as latex. A latex allergy affects between 1-6% of the general population; however, health care workers who are exposed to latex regularly report a higher occurrence of the allergy. If this is something you haven’t heard about, you aren’t alone. Keep reading to learn more about latex allergies and how it affects your trip to the dentist!

 Latex gloves in dental care

What is a latex allergy? 

 

A latex allergy is the result of certain proteins found in the natural rubber latex reacting poorly to your skin. If you have the allergy, your body mistakes this product as a foreign invader and works to fight it off. This can cause a reaction that results in itchy skin, hives, or serious life-threatening issues like anaphylaxis. 

 

The exact cause of latex allergy is unknown, but repeated exposure to latex and rubber products is thought to trigger symptoms. Understanding and knowing the basics of a latex allergy will help you be able to identify symptoms and guide you in seeking help. Naturally, this comes into play in the dentist office, with latex gloves and other products in regular use. That’s why we’re extra equipped to help you identify next steps. 

 

Whos at risk? 

 

Individuals in the health care industry are almost twice as likely to develop a latex allergy as the general population. In addition to those in health care, other workers like those in food preparation or technicians that are commonly exposed to latex have just as high of a risk. Many of these allergies develop after wearing and being exposed to latex for some time. Most reactions occur within minutes of exposure; however, it is possible for a delay onset of symptoms up to almost two days after contact is made. 

 

If you are diagnosed with a latex allergy by your doctor, it’s recommended to look for products that are labeled as “not made with natural rubber latex.” The FDA warns that there is no product that is truly latex free since they have not found any product that does not contain at least some natural latex rubber proteins. 

 

I have an allergy—now what? 

 

If you have a latex allergy, going to see your dentist can be anxiety inducing due to the dental use of latex. It is important to call your dentist prior to your appointment so the office can follow their latex-free protocol. It’s important to give them as much notice as possible to ensure all surfaces you will come into contact with are sanitized. Since there is no cure for a latex allergy, the best option is prevention. In addition, wear a medical alert bracelet to let others know about your allergy even if you aren’t able to.  

 

Isn’t latex in everything? 

 

If you are allergic to latex, there is a strong possibility you’re allergic to other things as well since these proteins are widely found in other products. Similar proteins found in latex are also found in avocados, bananas, chestnuts, kiwis and passion fruit. Also, it’s important to refrain from touching products that have latex in them like dishwashing gloves, balloons, rubber toys, erasers, and swim goggles. If you suspect an allergy, it’s important to get it diagnosed, since latex is such a prevalent component of products on the market today. 

 

If you have a latex allergy, or even just a sensitivity, call our office today. We will be happy to walk through our protocol with you and ensure you visit to our office is safe!

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Thursday, 24 May 2018

The US Covered Nearly 50% of Global Oncology Medicine Spending in 2017 – a market update from IQVIA

“We are at a remarkable point of cancer treatment,” noted Murray Aitken, Executive Director, IQVIA Institute for Human Data Science, in a call with media this week. 2017 was a banner year of innovative drug launches in oncology, Aitken coined, with more drugs used more extensively, driving improved patient for people dealing with cancer.

This upbeat market description comes out of a report on Global Oncology Trends 2018 from the IQVIA Institute for Human Data Science. The subtitle of the report, “Innovation, Expansion and Disruption,” is appropriately put.

The report covers these three themes across four sections: advances in therapies, spending, pipeline and new product innovations, and an outlook through 2022.

The “innovation” and advances section discusses the 14 therapies for cancer that were launched in 2017, all targeted therapies 11 of which had breakthrough status from the FDA indicating substantial improvement over existing therapies in the market. The total number of new oncology therapies approved since 2012 hit 78 new drugs related to one or more of 24 tumor types, shown in the detailed Vitruvian Man diagram.

Aitken expects a “surge of innovation” for therapies that target both solid and liquid tumor types in the near-term. These will have clinical advances with the potential to contribute to patients’ overall survival rates based on the clinical trial data available.

Spending levels tell a financially compelling, if sobering, story, as global spending for both therapeutic purposes to treat cancer and supportive aftercare for patients rose to $133 bn in 2017 up from $96 bn in 2013, globally.

In the US, spending on oncology doubled from 2012 to 2017, to $50 bn.

The top 35 cancer drugs account for 80% of total global spending on oncology products.

Of concern is that the list prices of new drugs launched has steadily risen over the past decade. All oncology products launched in 2017 had ;ist prices above $100,000 per year in the U.S.; the 2017 median annual cost for an oncology product exceeded $150,000, compared with $75,000 10 years ago.

As cancer drugs have advanced from a clinical profile and end-point perspective, we have also seen their list prices increase, as well. One aspect of this pricing, Aitken explained, is that 87% of oncology drugs in 2017 were used by fewer than 10,000 patients each. Small, more focused patient populations make it more difficult to scale in volume so prices can fall, the rationale goes.

This is the reality of the precision medicine field, where drugs are tailored to specific patients’ sub-type and sub-group. “What we see is relatively few patients treated with each of the drugs due to the segmentation of market,” Aitken said,

In terms of access, the US has the most open availability of oncology medicines compared with the rest of the world. “Once you get beyond 4 countries,” IQVIA’s research found, “in the rest of the world, patient populations have access to fewer of the recently launched drugs from the past 5 years.”

The pipeline of oncology innovations is at an historic high level, with over 700 molecules in late stage development (Phase 2 or later). This is up more than 60% in 2017 from a decade ago. We also see the growing adoption of biomarkers to stratify patients (to better target medicines to the “N of 1”) at 35%. There are 60 separate mechanisms now being evaluated in the immunotherapy area in Phase 1 or Phase 2 clinical trials. These are being tested against 27 different tumor types – as broad based applications for an immuno-oncology approach to cancer treatment that can better personalize treatment and lead to, hopefully, positive outcomes for longevity and quality of life for the patient dealing with cancer.

Many drugs reaching the market in 2017 had breakthrough designations. If we look to the total time from when a molecule for oncology was first patented to the time it reaches the market with a cancer indication, the median time for 2017 approvals was 14 years. That is the time lapse from recognizing the intellectual property and protection of the IP to the launch of the product.

The outlook to 2022 forecasts the global spending on oncology therapies will reach $200 bn globally. That calculates to 10 to 13% growth annually over the five-year period. The U.S. is expected to reach $100 bn of the global total – that is one-half of oncology product spending versus the rest of the world’s healthcare systems and health citizens.

Over the five years, oncology will leverage advances in technology and the use of information that is already getting baked into oncology treatment and diagnosis.

Health Populi’s Hot Points:  It should be no surprise that the costs of oncology therapies will play a larger role over next decade.

For context, I turn to the report, Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care from the Commonwealth Fund. This study compares health system performance across 11 developed nations, including the U.S.

Overall, U.S. health system performance across seventy-two indicators is relatively poor, especially considering America spends more money both in raw dollar terms and per person.

There are a few bright spots in U.S. health system performance, and one is with breast cancer and prostate cancer mortality.

 

 

 

 

 

 

The red-boxed area of this appendix from the Fund’s report compares American’s five-year survival rates for breast cancer and colon cancer (based on OECD 2015 data). All of the countries in the study have breast cancer survival rates in the 80-90 percent range, with the U.S. at a high of 89% along with Norway and Sweden. The lowest in this peer group was the UK at 81%,

For colon cancer, the U.S. survival rate of 64% fell more in the middle of peer country outcomes, ranging from a high of 68% in Australia to a low of 56% in the UK.

Take a look at the last chart detailing the number of oncologists across countries. Note that the U.S. has a higher rate of clinicians per 1 million population compared with the next-in-line, the UK, Italy, and Germany, with roughly one-half or fewer in Japan, France, Australia, and other nations identified by IQVIA in the report.

Consider that the U.S. spends more per capita on health care and has appreciably more oncologists per million health citizens, and yet outcomes for cancer are on par with other nations who spend far less on therapies and specialists to deal with the disease.

As President Trump and Secretary Azar might look to other countries to shoulder a greater financial burden of health care costs, it begs the question: who will pay for innovation in oncology, and who bears the benefits of that spending? This conversation has been elusive in the pay-for-volume health financing environment in the U.S. The U.S. has reached an unsustainable spending level on healthcare; see Health Populi‘s post yesterday on the $28,166 PPO plan for a typical U.S. working family of four.

IQVIA calculated that in 2017, oral oncology drugs had significant costs for patients, with 37% of patients using coupons to offset an average cost of $526 a month. That’s $6,312, just to cover oral cancer drugs on an annual basis. [It’s important to note that Rx coupons are a uniquely American concept].

Cancer is a global scourge impacting health citizens the world over. We need a domestic U.S. conversation on the financial toxicity of new-new cancer drugs, and a global one on sharing the burden of and opportunity for financing innovation to cure cancer for all.

 

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Wednesday, 23 May 2018

The Healthiest Communities Are Built on Education, Good Food, Mindfulness, and the Power of Love

Be the change you wish to see in the world, Gandhi has been attributed as saying. This sentiment was echoed by Lauren Singer as we brainstormed the social determinants of health and the factors that underpin healthy communities.

Our Facebook Live session was convened by the Aetna Foundation, which sponsored research on the Healthiest Communities in 2018.  In addition to Lauren, founder of Trash Is For Tossers, Dr. Garth Graham, CEO of the Aetna Foundation, Dr. Pedro Noguera, Distinguished Professor of Education at UCLA, and I joined the quartet, moderated with panache and sensitivity by Mark J. Ellwood, journalist.

Each of us four participants came to the conversation with a point-of-view:

  • Lauren is a zero-waste advocate, sharing knowledge and hacks about how to simplify life to reduce personal, physical, and financial friction, and simply ask, “what makes you happy?” on a daily basis – then live that authentic life.
  • Garth, a board-certified physician in internal medicine and cardiologist by training, is a long-time researcher on health equity and disparities that compromise public and personal health.
  • Pedro’s life work as a sociologist has been in education’s role for enriching peoples’ lives, and how schools are influenced by social and economic conditions as well as by demographic trends in local, regional and global contexts.

My own lens as a health economist informs my view that health is shaped where we live, work, play, pray, learn, and shop – in our communities. We each have the opportunity to make health — but too often our ZIP code and neighborhood prevents us from doing so relative to the quality of schools, access to healthy food, air and environmental quality, and limits on our ability to “walk with our feet” and find healthy opportunities each day.

Some of the key points were covered were that:

  • Education, from the earliest age, is key to lifelong health and well-being.
  • Adverse childhood events (ACEs) can stay with people their whole life long, compromising their ability to learn, get a job, work productively, and self-care for health and healthy relationships.
  • Life expectancy can significantly vary in a matter or a few neighborhood blocks, meaning “the difference between living like it’s 2017 or 1917,” Garth recently wrote in U.S. News.
  • The research of Christakis and Fowler in their book, Connected, demonstrates that our own behaviors, every single day of our lives, inspire other people in our social circle/network. This then inspires folks in their networks, and so on. That is the viral nature of social networks, so that our own healthy behaviors can initiate a virtuous cycle of health for ourselves, our families, our friends, our work colleagues, and our communities. This is truly being and living out the change for good, for our own health and the health of our communities.

In fact, social connections are at least as powerful as exercise and diet for health, research published in the Proceedings of the National Academy of Sciences has found.

The Healthiest Communities study analyzed a wide range of factors influencing health. I learned that in my region of Chester County, PA, we have many health factor blessings: relatively high life expectancy compared with other U.S. areas and a lower smoking rate. But my home county is also the richest and poorest in the state of Pennsylvania. I sit on board of our town’s free clinic so am aware of our local health challenges based on our own clinic’s patient demographics and my detailed review of our local hospitals’ community assessment reports.

However, the Aetna Foundation study revealed some light-bulb moments that are under the radar in the typical community health assessments: the racial disparity in education in our county is double the national rate, local food sites are less prevalent (which is ironic as we are a heavily agricultural county), we have greater airborne cancer risks, and while the area is relatively walkable, people undergo long commutes.

Health Populi’s Hot Points:  I was so moved by the Episcopal Church Bishop Michael Curry’s remarks at the wedding of Prince Harry and Meghan Markle this weekend. Here are some snippets from the sermon that resonated with me, especially in the context of social determinants of health and our Healthiest Communities discussion just hours before (Reverend Curry’s words are in italics, and I’ve bold-faced my separations):

Quoting Dr. Martin Luther King:

“We must discover the power of love, 
 the redemptive power of love. 
 And when we discover that, we will be able to make of this old world 
 a new world.  Love is the only way.”

There’s power in love. Don’t underestimate it. Don’t even over-sentimentalize it. There’s power, power in love.  If you don’t believe me, think about a time when you first fell in love.  The whole world seemed to center around you, and your beloved.  Oh there’s power, power in love.  Not just in its romantic forms, but any form, any shape, of love.  There’s a certain sense, in which when you are loved, and you know it, when someone cares for you and you know it, when you love and you show it, it actually feels right.  There’s something right about it.  And there’s a reason for it.  

Later…

There’s power in love.  
There’s power in love to help and heal when nothing else can.  
There’s power in love to lift up and liberate when nothing else will.  
There’s power in love to show us the way to live

Then on the power of love:

I’m talking about some power.
Real power.
Power to change the world.  

And if you don’t believe me, well, there were some old slaves in America’s Antebellum South, who explained the dynamic power of love and why it has the power to transform.  They explained it this way – they sang a spiritual, even in the midst of their captivity.  It’s one that says:

    “There is a balm in Gilead”

A healing balm, something that can make things right – 

    “There is a balm in Gilead
     To make the wounded whole
     There is a balm in Gilead
     To heal the sin-sick soul.”

And finally, channeling John Lennon from his anthem, Imagine

Think, and imagine.  
Well, think and imagine a world where love is the way.

Imagine our homes and families when love is the way.
Imagine neighborhoods and communities when love is the way.
Imagine our governments and nations when love is the way.
Imagine business and commerce when love is the way. 
Imagine this tired old world when love is the way.

When love is the way, unselfish, sacrificial, redemptive.
When love is the way, then no child would go to bed hungry in this world ever again.
When love is the way, we will let justice roll down like a mighty stream and righteousness like an ever-flowing brook.
When love is the way, poverty would become history.
When love is the way, the earth will be a sanctuary.
When love is the way, we will lay down our swords and shields down by the riverside 
to study war no more.

My brothers and sisters, that’s a new heaven, a new earth, a new world.
A new human family.

So the great and good Reverend Curry was delineating the social determinants of health to inspire all of us.

Or succinctly put by Tim Sanders, #LoveIsTheKillerApp.

A postcript, added on 22nd May –  In ironic bittersweet timing, I note the passing of great American artist, Robert Indiana, best-known for his LOVE sculptures featured in gardens and museums all over the world. He passed away yesterday at the age of 89. The photo here is of his LOVE sculpture located in my Philadelphia town’s John F. Kennedy Plaza, commonly known as Love Park.

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Tuesday, 22 May 2018

Health Care for a Typical Working Family of Four in America Will Cost $28,166 in 2018

What could $28,166 buy you in 2018? A new car? A year of your child’s college education? A plot of land for your retirement home?

Or a year of healthcare for a family of four?

Welcome to this year’s edition of the Milliman Medical Index (MMI), one of the most important forecasts of the year in the world of the Health Populi blog and THINK-Health universe. That’s because we’re in the business of thinking about the future of health and health care through the health economics lens; the MMI is a key component of our ongoing environmental analysis of the health/care landscape, and we include it in nearly every presentation and talk we give to every audience.

The MMI represents what a typical employer-sponsored preferred provider organization (PPO) plan covering a family of four will cost in 2018. The $28,166 includes inpatient facility care (e.g., hospitalizations), outpatient facility care (e.g., hospital clinic visits, ambulatory surgeries), professional services (e.g., physician office visits), pharmacy (e.g., outpatient prescription drugs via mail order, retail pharmacy), and other services (e.g., home healthcare, ambulance services, durable medical equipment).

The good news, Milliman says, is that the annual rate of cost increase was the lowest in 18 years at 4.5%. Last year’s rate of growth was 4.6%. Some of the factors that have helped to moderating healthcare spending growth included provider engagement through aligning financial incentives (via accountable care, value-based payments, among other tactics), the impact of high-deductible health plans on patient’s spending (such as shopping for lower-cost imaging services and growing use of retail clinics), and the role of public/government programs.

Note in the second chart that inpatient care is the largest component of medical spending, closely followed by professional services which, together, equals 60% of spending.

The pharmacy line item among the five cost components has grown to 17% of spending, which has risen as a component of spending in the MMI over the past few years. Milliman points out that this pharmacy number does not include drugs administered in the hospital, outpatient infusion centers, and doctors’ offices. Thus, the total pharmacy spend for families is over 20%, the Milliman team calculates. 

Milliman notes that pharmacy initiatives have helped to bring costs down over the past 18 years in terms of “trend” of cost increases, driven down through the massive adoption of generics when available on the market. But the specialty drug pipeline is rich with new-new products like gene therapies and combination products whose prices may dampen efforts to reduce spending, Milliman points out. An actuary quoted in the report warned, “specialty drugs and medical pharmacy continue to trend at high rates, both on unit cost and utilization. Many of these drugs provide great social value, treating disease. At the same time, rates for certain drugs can seem unduly inflated,” a sentiment that consumers shared in recent polls. The recent announcement of the prescription drug cost regulation blueprint, “American Patients First,” speaks to President Trump’s and Secretary Azar’s focus on regulatory reforms targeting the prices of medicine.

Health Populi’s Hot Points:  The MMI is a sobering reminder that health care spending is the #1 pocketbook issue for most American families. This crosses political parties: healthcare costs hit family budgets hard, and force people of all political stripes to make tough decisions about paying for food, housing, utilities, and saving for future needs.

We know that, ironically, one-half of U.S. families could not afford to pay $1,000 for an emergency medical bill in one study; in another, that inability to pay is as low as a $400 emergency to cover.

This year, Milliman notes, “employers pay more; employers pay a lot more” for healthcare spending. Employees’ share of health care costs now reach 44% of that $26,144. That equals $11,503.

The median income for a family of four in the U.S. was $59,214 in February 2018. Thus, employees’ share of health care costs will approach 20% of family income in 2018 for the typical working family covered by health insurance, based on this year’s Milliman Medical Index.

What working people know is that their wage increases stagnated for over a decade, as they traded off paycheck growth for health care coverage. The latest wage increase data shows that Americans’ wages grew by about 4.5% in March 2018 — roughly the rate of growth of healthcare spending for a family of four between 2017 and 2018, as the Milliman Medical Index noted.

In America, spending for healthcare will remain a top pocketbook issue.

A few days ago, TransUnion, the credit agency, announced plans to acquire Healthcare Payment Specialists. The company, “helps healthcare providers maximize Medicare reimbursement by focusing on payment areas where superior technology and deep domain expertise can drive significant improvements,” the press release states, focusing on helping hospitals recover Medicare bad debt as well as helping hospitals, “serving low-income populations maximize their DSH (disproportionate share hospital) reimbursement by integrating multiple data sources to identify all DSH-eligible patients and patient days.”

There will be no small number of such medical banking efforts developed to work on the provider side of the equation, as hospitals and physicians face a consumer/patient base cash-strapped to pay for healthcare.

 

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Monday, 21 May 2018

The Healthiest Communities Are Built on Education, Good Food, Mindfulness, and the Power of Love

Be the change you wish to see in the world, Gandhi has been attributed as saying. This sentiment was echoed by Lauren Singer last Friday 18th May as we brainstormed the social determinants of health and the factors that underpin healthy communities.

Our Facebook Live session was convened by the Aetna Foundation, which sponsored research on the Healthiest Communities in 2018.  In addition to Lauren, founder of Trash Is For Tossers, Dr. Garth Graham, CEO of the Aetna Foundation, Dr. Pedro Noguera, Distinguished Professor of Education at UCLA, and I joined the quartet, moderated with panache and sensitivity by Mark J. Ellwood, journalist.

Each of us four participants came to the conversation with a point-of-view:

  • Lauren is a zero-waste advocate, sharing knowledge and hacks about how to simplify life to reduce personal, physical, and financial friction, and simply ask, “what makes you happy?” on a daily basis – then live that authentic life.
  • Garth, a board-certified physician in internal medicine and cardiologist by training, is a long-time researcher on health equity and disparities that compromise public and personal health.
  • Pedro’s life work as a sociologist has been in education’s role for enriching peoples’ lives, and how schools are influenced by social and economic conditions as well as by demographic trends in local, regional and global contexts.

My own lens as a health economist informs my view that health is shaped where we live, work, play, pray, learn, and shop – in our communities. We each have the opportunity to make health — but too often our ZIP code and neighborhood prevents us from doing so relative to the quality of schools, access to healthy food, air and environmental quality, and limits on our ability to “walk with our feet” and find healthy opportunities each day.

Some of the key points were covered were that:

  • Education, from the earliest age, is key to lifelong health and well-being.
  • Adverse childhood events (ACEs) can stay with people their whole life long, compromising their ability to learn, get a job, work productively, and self-care for health and healthy relationships.
  • Life expectancy can significantly vary in a matter or a few neighborhood blocks, meaning “the difference between living like it’s 2017 or 1917,” Garth recently wrote in U.S. News.
  • The research of Christakis and Fowler in their book, Connected, demonstrates that our own behaviors, every single day of our lives, inspire other people in our social circle/network. This then inspires folks in their networks, and so on. That is the viral nature of social networks, so that our own healthy behaviors can initiate a virtuous cycle of health for ourselves, our families, our friends, our work colleagues, and our communities. This is truly being and living out the change for good, for our own health and the health of our communities.

The Healthiest Communities study analyzed a wide range of factors influencing health. I learned that in my region of Chester County, PA, we have many health factor blessings: relatively high life expectancy compared with other U.S. areas and a lower smoking rate. But my home county is also the richest and poorest in the state of Pennsylvania. I sit on board of our town’s free clinic so am aware of our local health challenges based on our own clinic’s patient demographics and my detailed review of our local hospitals’ community assessment reports.

However, the Aetna Foundation study revealed some light-bulb moments that are under the radar in the typical community health assessments: the racial disparity in education in our county is double the national rate, local food sites are less prevalent (which is ironic as we are a heavily agricultural county), we have greater airborne cancer risks, and while the area is relatively walkable, people undergo long commutes.

To hear all of the conversation and ask questions about your own community and healthy lifestyle, please tune into the Facebook Live session tomorrow 19th May at 1 pm Eastern time here.

Health Populi’s Hot Points:  I was so moved by the Episcopal Church Bishop Michael Curry’s remarks at the wedding of Prince Harry and Meghan Markle this weekend. Here are some snippets from the sermon that resonated with me, especially in the context of social determinants of health and our Healthiest Communities discussion just hours before (Reverend Curry’s words are in italics, and I’ve bold-faced my separations):

Quoting Dr. Martin Luther King:

“We must discover the power of love, 
 the redemptive power of love. 
 And when we discover that, we will be able to make of this old world 
 a new world.  Love is the only way.”

There’s power in love. Don’t underestimate it. Don’t even over-sentimentalize it. There’s power, power in love.  If you don’t believe me, think about a time when you first fell in love.  The whole world seemed to center around you, and your beloved.  Oh there’s power, power in love.  Not just in its romantic forms, but any form, any shape, of love.  There’s a certain sense, in which when you are loved, and you know it, when someone cares for you and you know it, when you love and you show it, it actually feels right.  There’s something right about it.  And there’s a reason for it.  

Later…

There’s power in love.  
There’s power in love to help and heal when nothing else can.  
There’s power in love to lift up and liberate when nothing else will.  
There’s power in love to show us the way to live

Then on the power of love:

I’m talking about some power.
Real power.
Power to change the world.  

And if you don’t believe me, well, there were some old slaves in America’s Antebellum South, who explained the dynamic power of love and why it has the power to transform.  They explained it this way – they sang a spiritual, even in the midst of their captivity.  It’s one that says:

    “There is a balm in Gilead”

A healing balm, something that can make things right – 

    “There is a balm in Gilead
     To make the wounded whole
     There is a balm in Gilead
     To heal the sin-sick soul.”

And finally, channeling John Lennon from his anthem, Imagine

Think, and imagine.  
Well, think and imagine a world where love is the way.

Imagine our homes and families when love is the way.
Imagine neighborhoods and communities when love is the way.
Imagine our governments and nations when love is the way.
Imagine business and commerce when love is the way. 
Imagine this tired old world when love is the way.

When love is the way, unselfish, sacrificial, redemptive.
When love is the way, then no child would go to bed hungry in this world ever again.
When love is the way, we will let justice roll down like a mighty stream and righteousness like an ever-flowing brook.
When love is the way, poverty would become history.
When love is the way, the earth will be a sanctuary.
When love is the way, we will lay down our swords and shields down by the riverside 
to study war no more.

My brothers and sisters, that’s a new heaven, a new earth, a new world.
A new human family.

So the great and good Reverend Curry was delineating the social determinants of health to inspire all of us.

Or succinctly put by Tim Sanders, #LoveIsTheKillerApp.

The post The Healthiest Communities Are Built on Education, Good Food, Mindfulness, and the Power of Love appeared first on HealthPopuli.com.


The Healthiest Communities Are Built on Education, Good Food, Mindfulness, and the Power of Love posted first on http://dentistfortworth.blogspot.com

Your Other Floss Options

How many of you remember the show Supermarket Sweep? If you were told to scour the grocery store aisles in search of interdental cleaners, would you know what you were looking for? 

 

Even without the pressure of television cameras or a countdown clock, interdental cleaners could stump even the savviest shopper. On the other hand, if you were asked to look for dental picks or floss, our guess is that you would know exactly where to go. 

 

Well, you guessed it, interdental cleaners describe a category of tooth cleaning products that help remove debris and plaque that collect in between your teeth. Keep reading as we unpack these devices and highlight their effectiveness in doing the job of keeping your teeth clean! 

 Other floss options

 

Examples of interdental cleaners  

 

While the vast majority of the population brushes their teeth twice a day (or so we like to think), it’s still somewhat shocking that less than 40% of people admit to flossing once a day, with 20% of people admitting they never floss at all. If you are only brushing, you’re only getting your teeth 60% clean. Ask yourself, why would you only bathe half your body? 

 

Flossing is a vital component to your oral health routine. When picking dental floss, it’s important to pick a product that is most comfortable to you and that is easy to use. In other words, pick whatever gets you to feel more inclined to do it. If flossing is a struggle, you’re more likely to skip it in your daily routine. 

 

The main difference between traditional stringed floss types is whether it’s waxed on not. Waxed floss can easily slip between the teeth and is something usually flavored with mint. Floss picks are another option. Unlike stringed floss, a roughly ¾-inch stretch of floss is strung like a harp onto a plastic, handheld device. While easy to handle, some dentists are afraid they aren’t as good at removing plaque, since it’s difficult to complete a “C” around the tooth to completely clean it. You probably hadn’t stopped to think about this before, but the ability to curve the floss around each tooth is one of the important dental floss tricks! 

 

Nonetheless, the reasons to use interdental cleaners are still many. Keep on reading to learn our top five reasons to hit this shelf at the store the next time you shop! 

 

Top five reasons to use interdental cleaners  

 

  1. Prevents tooth decay: Tooth decay is totally preventable. And, left unchecked it can cause pain, infection and even tooth loss. Flossing helps prevent decay by removing hard-to-reach particles of food and plaque that brushing can leave behind. Prevention is key, and flossing is an essential element.
  2. Prevents plaque buildup: Plaque moves fast and can start affecting teeth just hours after eating. Plaque hardens in 48 hours and is then firmly stuck on your teeth. Skipping a few days of flossing can be incredibly detrimental, and a professional cleaning would be needed to get all the hardened plaque off.
  3. Helps prevent gum disease: Even the best of tooth brushes can’t reach in between all of your teeth. Plaque can build up settle on your gum line and between teeth, and create a bacteria that can harm your gums. If that doesn’t make you want to floss, the bacteria can also affect the gum tissue and bone that support your teeth. This can lead to loose and falling-out teeth.
  4. Keeps your whole body healthy: Studies have shown a link between gum disease and heart attacks and strokes. It’s thought that since gum disease is caused by bacteria it can enter your bloodstream, and where they attach to the fatty deposits in the blood vessels they end up causing bigger problems. This can cause blood clots and may lead to heart attacks.  In the absence of gum disease, scientists have found, there is actually less bacteria in the heart.
  5. Prevents bad breath: Bad breath is normally caused by your teeth, tongue or gums. Small pieces of food can become lodged between your teeth, and over time breed bacteria that omits odoriferous gasses (this means the stinky kind). In addition to flossing to remove the food particles, drinking lots of water will also help you keep bad breath at bay.   

The post Your Other Floss Options appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.




Your Other Floss Options posted first on http://dentistfortworth.blogspot.com

Friday, 18 May 2018

Quotation of the Day: On quality measurement

At Healthcare Economist, we talk a lot about quality metrics.  What they can and cannot do.  One of our gurus of health care quality measurement, Avedis Donabedian, weighed in on his thoughts on how best they should be used:

“Systems awareness and systems design are important for health professionals, but they are not enough. They are enabling mechanisms only. It is the ethical dimensions of individuals that are essential to a system’s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system.”

― Avedis Donabedian


Quotation of the Day: On quality measurement posted first on http://dentistfortworth.blogspot.com

Thursday, 17 May 2018

Consumers Shop Food for Health, But Cost Is a Barrier to Healthy Eating

One-third of Americans are following a specific eating pattern, including intermittent fasting, paleo gluten-free, low-carb, Mediterranean diet, and Whole 30, among dozens of other food-styles in vogue in 2018.

It’s mainstream now that Americans are shopping food for health, with eyes focused on heart health, weight, energy, diabetes, and brain health, according to the 2018 Food & Health Survey from IFIC, the International Food Industry Council Foundation.

But underneath these healthy eating intentions are concerns about the cost of nutritious foods, IFIC reports. And this aspect of home health economics can sub-optimize peoples’ health.

Consider the first graph on consumers’ interests in the health benefits accruing from food and nutrients. Cardiovascular health ranks at the top among one-fifth of people, followed closely by using food with the goal of weight loss and maintaining a healthy weight.

Weight loss, energy, and disease prevention are on a plurality of peoples’ minds when adopting a specific eating pattern like paleo or the DASH diet.

Consumers say the number one food factor is sugar, followed by carbohydrates which are increasingly blamed. 3 in four people are limiting or avoiding sugars in their diet, using tactics like drinking more water than soda or juices and no

longer adding table sugar to beverages.

With these good intentions, most people could not connect a food to a health goal. Only one-third of consumers could name a food they would seek for a top

health issue. Among those who could connect these dots, they named protein, vegetables, fruits, and oils.

While taste ranks the top purchase driver for food shopping, price and health tie for second-place.

That price issue is central to consumers’ perceptions about their ability to afford healthy food. One-half of Americans have purchased less healthy food than they would otherwise do because they don’t have enough money to buy healthier food options. Nearly 1 in 2 people have also delayed grocery shopping due to other expenses in their household like utility bills and rent, or purchased less food overall because they didn’t have enough money in their budget.

As a direct result of medical or prescription expenses, one-third of Americans delayed buying food or purchased less food, the survey found. Look carefully at this chart on food insecurity.

To mitigate cost challenges for food buying, more than half of Americans use coupons, and nearly half purchase more products on sale. 40% of Americans have cut back on eating out in restaurants, and have shifting purchasing generic or store brands versus brand named products.

More women than men are taking on these cost-cutting strategies to manage food expenses.

IFIC surveyed 1,009 American online adults ages 18 to 80 in March 2018.

You can read my take on IFIC’s 2017 survey here on Health Populi – Shopping Food for Health is Mainstream, but Confusion is Super-Sized.

 

Health Populi’s Hot Points:  With consumers focusing their food consumption in the context of their health, it’s important to note that most consumers trust clinical professionals first as sources for what foods to eat or avoid. Registered dietitians and nutritionists, personal healthcare professionals, wellness coaches and reading scientific studies rank at the top as trusted sources of healthy food information. This chart on the relationship between trust and reliance illustrates this issue, with the upper right quadrant of high trust coupled with reliance as a source capturing the evidence-based, clinical value in the eyes of healthy-minded consumers.

This is an opportunity for the legacy healthcare system, hospitals and physicians, to address the food-as-medicine gap that consumers (patients) want and need. IFIC found that 54% of consumers get information from their healthcare professionals, and when doing so, 78% of those consumers made a change like eliminating certain types of foods from their diets or increasing consumption of vegetables.

Clinicians can leverage their trust-factor with patients and in local communities to counsel patients on the food-health opportunity, and work with organizations in their towns to connect people to grocery stores and Big Box retailers as well as food pantries that go that last mile for convenient consumer touch-points.

Be aware that primary care providers are already switched-on to this idea. The first employee-hat that primary care doctors would bring on staff if they had resources to do so wouldn’t be another doctor or nurse — that person would be a dietitian or nutritionist, based on a recent PwC survey on re-imagining primary care, Building the Primary Care Dream Team. That individual would be hired ahead of a mental health professional — recognizing that perhaps the obesity epidemic is top-of-mind for clinicians, coupled with behavioral health, as the bar graph suggests.

Innovative healthcare providers are already on this opportunity, like Geisinger who is working both the precision medicine/genomics technology angle as well as the social determinants of health approach to nutrition through the organizations Fresh Food Farmacy.

In October 2018, IFIC will publish a supplement to this report focusing on people enrolled in Medicaid, partnering with the Root Cause Coalition. I look forward to this research, which will be an important contribution to our understanding the cost-health trade-offs people make in daily life which can sub-optimize our individual and community health and wellness.

 

The post Consumers Shop Food for Health, But Cost Is a Barrier to Healthy Eating appeared first on HealthPopuli.com.


Consumers Shop Food for Health, But Cost Is a Barrier to Healthy Eating posted first on http://dentistfortworth.blogspot.com

Health Wonk Review: Instagram-style

In this version of the Health Wonk Review, I find the latest greatest from around the web related to health policy.  Since more an more people consume their web through photos (see Instagram’s popularity), for each post, a carefully curated picture has been selected to further entice you to read through this great selection of articles.  And so without further ado…

Editor’s Choice

Patient access within provider networks is an important concept but difficult to visualize. How did Jay Norris of Colorado Health Insurance Insider make these maps measuring provider networks in Colorado? Read his article “2018 Essential Community Provider Maps” to find out.

Best of the rest

What are the societal and political consequences if we see continued flat wage growth, the accelerating decline of private-sector unions, a rising CPI and an increasingly costly health care burden for families? To find the answer, visit Tom Lynch’s Worker’s Comp Insider.

 

Partners and Harvard Pilgrim aren’t really going to merge, are they?  To find out the answer, go to David Williams Health Business Blog.

 

What does Dan Burton, CEO of Health Catalyst, think about the evolution of value-based payment and how technology can help?  Find out at David Harlow’s HealthBlog.

 

Joe Paduda of Managed Care Matters provides some fast facts about work comp pharmacy, based on CompPharma’s Annual Survey of Prescription Drug Management in Workers’ Comp.

 

Ethical issues with Donald Trump may be nothing new, but Roy Poses of Health Care Renewal looks at the latest healthcare-related ethical misadventure to hit the headlines.

 

Even though the individual mandate may be dead at the federal level, Andrew Sprung of xpostfactoid notes that New Jersey may be instituting its own individual mandate as well as a reinsurance program.  In part this effort is to stave off the 22% increase in premiums in NJ.

 

At Healthcare Economist, yours truly gives my take on President Trump’s American Patients First plan.

 

One component of the American Patients First focuses on discounts, rebates and targets pharmacy benefit managers (PBMs). How big a deal are these rebates and discounts? According to Adam Fein from Drug Channels, brand-name drugs in 2017 reduced list price revenues by an astonishing $153 billion, largely due to these rebates and discounts. To find out more–and learn why Adam used this picture–go to his website.


Health Wonk Review: Instagram-style posted first on http://dentistfortworth.blogspot.com

My take on American Patients First

In broad strokes, the American Patients First plan aims to lower list prices, lower patients’ out-of-pocket costs while maintaining incentives for innovation.   In short, this is a sensible strategy, although there are some concerns about how more restrictive formulary designs could restrict consumer choice.

American Patients First in brief

To maintain manufacturers incentives to innovate, the plan insures that if manufacturers of brand-name drugs do lower their prices, they will keep a larger share of this price through a reduction in mandatory government discounts, such as the 340B program. Further, the government aims to incentivize other countries (outside the US) to increase their drug prices to incentivize innovation.

Consumers will pay less as well because any rebates received would be credited to their cost sharing, some/all Part B drugs would be moved to Part D, and there would be an out-of-pocket maximum.  Further, the administration is considering $0 cost sharing for generic treatments for low-income seniors. Additionally, approvals for low-cost generic and biosimilar products would be expedited and Part C/D plans would be able to substitute generic onto their formularies mid-year.

Why would list prices fall?  The American Patients First blueprint would allow Part D plans to negotiate similar to drug plans in the private sector.  Further, the administration is considering limiting cost increases to inflation after brand names launch.

Defining price/cost/what we pay

The first quotation from President Trump in the American Patients First blueprint is the following:

One of my greatest priorities is to reduce the price of prescription drugs. In many other countries, these drugs cost far less than what we pay in the United States.

Clearly drug prices/cost are important here.  However, you will note a number of price/cost related concepts: price, cost, what we pay.   Let’s take each in turn:

  • Price: I’ll define this as the list price for a drug
  • Cost: Health plans rarely pay the list price.  Through negotiated rebates with manufacturers, government mandated discounts (e.g., the 340B program; Medicare best price), and other factors, health plan’s costs is much less than the list price manufacturers charge.  Conversely, one could say that manufacturer’s do not keep the full price.  One study from USC found that manufacturers keep only 41% of the list price, an amount similar to the amount intermediaries keep.
  • What we pay.  This is patient out-of-pocket cost.  This varies by insurance plan, type of drug (oral vs. injectable), but out-of-pocket costs include coinsurance, copayments and deductibles.

What should we be paying?  In an ideal system, prices would be high to incentivize innovation, but patient out-of-pocket costs would be low to maximize use of high value treatment.  A paper by Lakdawalla and Sood (2013) argues that this two-part price mechanism is actually accomplished though the health insurance system.  Health insurance increases dynamic market efficiency.  Since most of the cost to develop a drug is R&D and production costs are relatively low, economic theory says that price and marginal cost should be equal implying that patient out-of-pocket costs should be low.  This is exactly what health insurance does (or is supposed to do).

Key components of the American Patients First Plan

Incentivizing innovation

A key argument in American Patients First is that manufacturers should keep a higher share of the list price.  The President’s plan would consider eliminating the ACA’s “excise tax [on brand drugs], an increase in the Medicaid drug rebate amounts, and an extension of these higher rebates to commercially-run Medicaid Managed Care Organizations.” Additionally, the administration seems to want to limit the scope of 340B discounts which would result in more revenue in the hands of manufacturers.

The administration also wants to raise the price that other countries pay. This proposal echoes a recommendation from the Council of Economic Advisors. Life science firms R&D decisions depend on their expected global revenue.  As prices in non-US OECD counties are much lower than the US, the US consumer is footing most of the bill for innovation.  In short, non-US developed countries are getting a great deal at the expense of US consumers.  The Trump plan would “assess the problem of foreign free-riding”, however it is not entirely clear how the US would incentivize/compel other countries to increase reimbursement for drugs.

On the downside, the administration would facilitate introduction of generics and biosimilars.  These would include faster regulatory approval and fewer “loopholes” that branded product manufacturers could use to delay the introduction of generics.  While this is good for current consumers, it would drive down life sciences revenue and could be an impediment to innovation.

Despite the threat from increased generic competition, on net this is a sensible approach.

Moving toward value-based payment

The administration is also considering novel approaches that link prices more closely to the value they prescribe. Some drugs are used to treat multiple diseases, but these drugs may be more effective for one of the diseases than another.  The Trump plan would consider the use of indication-specific pricing whereby high-value treatments are paid more.  Outcomes-based contracts would also be considered as well as value-based insurance design.  In fact, there is already a value-based insurance design pilot study in Medicare that began in January 2017.

These approaches make sense as high-value treatments would receive higher reimbursement.  This would incentivize life sciences firms to focus on developing high-value innovations

Lowering patient cost

This would occur through increased access to generics and biosimilars and an out-of-pocket maximum on Part D drugs.  Generic manufacturers would have easier access to brand samples.  It appears that the FDA would ease the path for biosimilar regulatory approval.  A report from my former colleagues at Acumen explores the impact of moving some Part B drugs to Part D (and vice versa).   The plan calls for lowering patient cost-sharing for 340B drugs.

Additionally, if rebates that lowered drug costs were applied to a patient’s coinsurance, this would lower out-of-pocket costs as well.

Transparency

Sharing the actual list prices more readily would help consumers better know treatment prices.  The administration would also update “…Medicare’s drug-pricing dashboard to make price increases and generic competition more transparent.”

Lowering list prices through increased competition (and government mandates)

The administration would allow drug plans more negotiating leverage with drug manufacturers.  As stated in American Patients First, they are looking to reform Medicare Part D in order to “…give plan sponsors significantly more power when negotiating with manufacturers.”  For instances, some Part B drugs could be moved over to Part D and Part D plans could negotiate prices.  In addition, plans could negotiate when there is a single drug available.  The proposed plan would “…require a minimum of one drug per category or class rather than two.”  The additional negotiating leverage would drive down prices, but it also could severely restrict patient access.

Another provision in the President’s FY2019 budget would establish “an inflation limit for reimbursement of Medicare Part B drugs.”  While this restriction would add predictability to drug prices, and would lower prices mechanically; manufacturers may respond by increasing the list price at launch.  Thus, the inflation limit may result in higher drug prices at the start of a drug’s patent period but lower prices towards the end.


My take on American Patients First posted first on http://dentistfortworth.blogspot.com