MD drug anti-gouging bill passes into law, CT Senate passes drug benefits fairness bill

On Friday, a Maryland bill to control generic drug prices passed into law without the Governor’s signature. Maryland’s Attorney General Frosh championed this first-in-the-nation anti-gouging bill. The issue was raised in response to extreme price increases in older drugs such as EpiPen, naloxone, and Daraprim. The bill requires Maryland’s Medicaid program to notify the Attorney General when an “essential” generic drug’s price rises by 50% or more over two years. The Attorney General may then require records and documents related to the price increase, seek penalties in court, or ask the court to compel the company to offer the drug to the state at the original price.   In his letter, Governor Hogan applauded the bill’s “laudable goal, to combat price-gouging of consumers for life-saving drugs” but raised legal and constitutional concerns. He also noted that the law only applies to generic and off-patent medications, missing important and costly treatments. He urged the legislature to return to the issue next session. States across the US are considering legislation to control drug costs.

Last Wednesday, Connecticut’s Senate unanimously passed SB-445, An Act Concerning Fairness in Pharmacy and Pharmacy Benefits Manager Contracts on the Consent Calendar. The bill prohibits “gag clauses” in contracts with pharmacists and allows them to disclose prescription costs, the reimbursement to the pharmacy, the prescription’s efficacy, and any alternative, less expensive medications. The bill also prohibits charging consumers more than the drug costs. Right after the bill passed, Governor Malloy sent a letter to Senate leaders criticizing the bill and an “antagonistic approach” to the insurance industry. Senate leaders are confident the bill will pass the House and, if necessary, override a veto by the Governor.

CBO estimates that AHCA would cause 23 million more uninsured in ten years

In more federal health news, the nonpartisan Congressional Budget Office released their analysis of the impact of the House’s American Health Care Act yesterday. CBO predicts that 23 million more Americans would lose health coverage in the next decade, 14 million just next year, if the AHCA becomes law. The law would reduce the federal deficit, largely by cutting $834 billion from Medicaid over the next ten years. CBO also predicts that insurance markets would become very unstable for about one in six Americans who live in states that elect the AHCA option to remove community rating and Essential Health Benefit standards now required by the Affordable Care Act. Young, healthy residents of those states would benefit with lower premiums but residents with higher-than-average health costs would see a large increase in premiums if they could even find coverage. According to the CBO, benefits that would likely be cut in those states include maternity, mental health and substance abuse, rehabilitation and habilitation, and pediatric dental care. Residents of those states that need the services removed from Essential Health Benefit standards would face very large increases in out-of-pocket costs or would have to forgo care.  Plans in those states may re-institute annual and/or lifetime caps on coverage which would also significantly raise costs for residents with high-cost health needs such as expensive prescriptions, according to the CBO. The AHCA has not been taken up by the Senate; leaders there have stated they intend to start over with a new health reform bill.

President’s budget proposal includes large cuts to state Medicaid funding, among other health programs

President Trump’s FY 2018 budget proposal includes $610 billion in mandatory savings over the next decade by instituting state Medicaid block grants or per capita caps starting in FY 2020. This goes beyond cuts included in the American Health Care Act passed by the House of Representatives three weeks ago, that is estimated to cost Connecticut $1 billion/year when fully implemented.  According to the proposal, “The Budget ensures that Medicaid and other programs focus on the most vulnerable Americans that they were intended to serve—the elderly, people with disabilities, children, and pregnant women.” The proposal also includes $250 billion net deficit savings over ten years from repealing and replacing the Affordable Care Act. Other ten-year cuts include a $5.8 billion reduction in CHIP funding and approximately 20% cuts to both the NIH and the CDC. The budget proposes shifting more of the FDA’s budget to industry fees and away from taxpayer funding. The President’s budget estimates $55 billion in federal savings over the decade, including $339 million in Medicaid savings, from nine specific medical liability proposals including caps on damages, safe harbors for providers based on clinical standards, and a three-year statute of limitations. The budget proposes expanding Direct Primary Care in Medicaid, a relatively new capitation model for primary care providers. The proposal includes some expanded funding for emergency preparedness and continues funding to address the opioid epidemic but cuts almost $400 million from the Substance Abuse and Mental Health budget. It’s important to remember that the President’s proposal has to be approved by Congress and likely will be changed significantly.

Alert: CMS seeking public comment on new informed consent payment proposal

Some good news -- ^th. Click here for more info, links to the proposed rule and the measure specifics, a customizable template for comments, and directions on how to submit comments.

There is an exciting new opportunity to support patient-centered care and make a meaningful impact on the quality of care in hospitals across the US. CMS is seeking public comment on a proposed Medicare rule (regulation) for how hospitals are paid that includes a new measure assessing the quality of hospital informed consent documents given to patients before elective procedures. Unfortunately, the current state of hospital informed consent documents is embarrassingly poor. If adopted, the 4,700 US hospitals that treat Medicare members would be paid, in part, based on the quality of their informed consent documents. The measure could also be included in public quality comparisons such as Hospital Compare, allowing patients to use this measure in choosing between hospitals for their care. Comments are due by 5:00 pm EDT on June 13

As promising as the proposed rule is, it is only a proposal. CMS has not made a decision whether to support the informed consent document measure for implementation. CMS is seeking feedback to help with their decision. Public comment from patients and consumer advocates is essential.

Health care has highest job opening rate in US

At 5.2% in March, the health care and social assistance sector had the highest rate of job openings in the US labor market, according to the Bureau of Labor Statistics. However the rate of hiring in health care and social assistance was only average. At 19.3 million the health care and social assistance sector had more total US jobs than all sectors but professional and business services or state and local government. While professional and business services had relatively healthy job openings and hire rates, state and local government was among the lowest in both rates.

2016 estimate finds CT uninsured rates going down

Early estimates of health coverage finds that 3.9% of CT residents were uninsured last year, well below the US average of 9%, according to the CDC’s National Health Interview Survey. CT’s uninsured rate fell by 7.2% between 2013 and 2016, very close to the national 8.0% drop. Last year 41.6% of state residents had public coverage and 62.2% had private insurance. As in past years, states like CT that elected to expand Medicaid and/or develop a state-based insurance exchange under the Affordable Care Act had lower uninsured rates. The survey also found that high deductible health plans are growing nationally from covering 25.3% of Americans under age 65 in 2010 to 39.4% last year.

New state health comparison tool shows challenges and opportunities for CT

In good news, CT is 11^th best among states in the number of people who had no trouble finding a doctor in 2015 according to State Health Compare. But CT is also 17^th worst among states in the percent of residents with high medical cost burdens. Depending on how you look at it, it may be good or bad news but CT is 19^th lowest among states in the percent of state budget devoted to Medicaid, and 28^th lowest in state public health spending per person. Created by SHADAC, State Health Compare is a new online comparison tool with state-level estimates across 46 measures of health and health care from six federal agency sources. Categories include health insurance coverage, cost of care, health behaviors, outcomes, access, utilization, quality of care, public health, and social and economic factors. Metrics include costs of potentially preventable hospitalizations, percent of residents who needed but did not get care due to cost, chronic disease prevalence, weight assessment in schools, and adult cancer screening rates. Data for most measures is available for multiple years, allowing trend analysis. Within most of the 46 measures, the tool allows visitors to dive deeper into the data by subpopulations such as by age, race/ethnicity, and education level. The tool provides a map, state rank and trend display for each metric. The data can be downloaded and exported.

Health Care Cabinet tackles drug costs

At yesterday’s meeting, CT’s Health Care Cabinet agreed to create four working groups to develop recommendations and options to control drug spending in the state. We also reviewed a report from CT’s APCD on the Top 50 Highest Total Cost Drugs in CT. The Cabinet has been taking a deep dive into rising prescription drug costs for the last three months with presentations from academics, drug company and industry representatives, DSS, CT’s Attorney General, a Pharmacy Benefits Management company, wholesale drug distribution, and pharmacists. The Cabinet considered a draft summary document on the Cabinet’s activities to date, updates on legislative proposals, further reading, and potential themes and areas for further action. The group decided to create four working groups to develop strategies – pricing, price transparency, research initiatives in other states, and consumer/provider education. The subgroups will engage voices beyond the Cabinet’s membership.

CT rates well among states in public health emergency preparation, but room for improvement

This year CT earned 7.3 points out of 10 possible in the latest assessment of preparedness for community health emergencies, a small increase from 7.2 over last year. But CT did better than the US average at 6.8. The National Health Security Preparedness Index has measured states’ ability to respond to health security threats such as a Zika outbreak or a natural disaster for the last four years. The Index includes metrics such as vaccination rates, hazard plans for public schools, the number of paramedics and hospitals. Compared to the US average, CT performed best for Incident and Information Management – public health alerts to communities and multi-agency coordination --  but worst for Health Security Surveillance – monitoring and identification of disease outbreaks. Vermont scored best among all states with 7.8 points. The report includes detailed information on Connecticut’s performance and challenges on many metrics. The report concludes with areas that need work to ensure public safety in public health emergencies.

May CT Health Reform Dashboard – Medicaid U turn, federal relief premature

CT’s May Health Reform Dashboard is unsettled again. Mistrust remains at the core of problems in CT. Medicaid policy development and implementation have taken a very disappointing turn away from collaboration, transparency, and data for reasons that don’t make any sense (there are a few theories). Just a few of the persistent problems in PCMH+, Medicaid’s current risky experiment with payment reform, include ineffective consumer notices, blocking access to meetings, no evidence of a system to even detect underservice, and the plan to move ahead pushing another 200,000 people into the experiment January 1^st before there is any meaningful information (much less a proper evaluation) of what happened to the first 137,000 people. If there’s a problem, we won’t know for at least six months after it’s too late. No one is listening to cooler heads. We just keep hearing that they are watching things and we have to trust them. (see mistrust brief) Conflicts of interest are getting worse as is the state budget outlook.