Sunday, July 08, 2012

Weekend update

The House and the Senate resume their sessions this week following the Fourth of July holiday.

The FEHBlog read lengthy healthcare articles this weekend in the Wall Street Journal and the New York Times. The Wall Street Journal article had a sad ending while the New York Times article had a happy ending but both concerned the collosal sums of money that flow through the heathcare system.

The Wall Street Journal regularly studies the Medicare claims database. It noticed that one patient at Johns Hopkins had consumed $2.1 million in Medicare dollars in 2009. It turns out that the patient was only 41 years old and was eligible for Medicare based on Social Security disability coverage stemming from a serious heart problem. Long story short -- the patient received a successful heart transplant in February 2009 but in his weakened state was hit with a savage infection that eventually killed him in December 2009.  In other words the spending was for naught unfortunately. The article focuses on the fact that the patient did not have a binding living will and his parents were unwilling to cut off care until the very end. It turns out that one of his doctors is a proponent of the so-called Medicare "death panels" that became so controversial in 2009 as the Affordable Care Act was being debated. The FEHBlog has a living will. If they make sense and they do, then why don't the American Medical Association and the American Bar Association team up and offer this service at no additional cost rather than complain that Medicare doesn't cover it. By the way, the article indicates that the Johns Hopkins doctors did their best to explain the situation to the parents who were grief stricken and unwilling to listen. It does make sense to address these issues before critical care is required.

The New York Times article discusses a topic of interest to the FEHBlog -- using the advances in genetic science to help cure disease.  This article discusses a young cancer research physician who was stricken with a virulent form of leukemia.  When it appeared that the end of life was approaching, his fellow researchers decided to put aside their own research for two weeks and do a complete sequencing of their colleague's genome. As the FEHBlog has noted the cost of this work is coming down but it's still very expensive.  The article reminds us that cancers are driven by genetic defects and the researchers were able to find the defect that appeared to be fueling the leukemia. It turns out that Pfizer has a very expensive biologic drug that can be used to block that genetic defect. The colleagues pooled their money to buy a short supply of the drug for this off-label use, and lo and behold the drug put the researcher's leukemia into remission. Pfizer then agreed to supply the doctor with the drug on a compassionate basis. (The health insurer had denied coverage for the experimental off-label use according to the article.)  The FEHBlog has read that a lot of work is being done on making gene sequencing affordable. This certainly was an encouraging article.Read them both.

Speaking of Pfizer, the FEHBlog nearly fell off his chair when he read an AP report that a group of pharmacies has sued Pfizer for conspiring to impede the release of a generic version of its blockbuster cholesterol lowering drug Pfizer.
The lawsuit, filed Thursday by Walgreen Co., the Kroger Co. and three other retailers in U.S. District Court in Trenton, N.J., claims generics should have been available nearly two years earlier, when Lipitor's original patent expired.
The suit accuses Pfizer of patent fraud as well as "illegal, anti-competitive conduct" with generic drugmaker Ranbaxy Laboratories of India to block other generic drugmakers from selling versions of Lipitor, called atorvastatin calcium, until recently.
The suit also accuses New York-based Pfizer of making deals with companies that manage prescription benefits, giving them big discounts on brand-name Lipitor in exchange for those companies limiting sales of generic versions. Generic pills generally bring pharmacies higher profit margins than brand-name medicines do.
Pfizer intend to "vigorously defend' its conduct. This lawsuit and follow on actions which are bound to come will be worth watching.

The FEHBlog is surprised that Walgreens and Express Script have not yet kissed and made up.  The Chicago Tribune reports that Walgreens has purchased a chain of 144 pharmacies in the heartland for $438 million dollars. 

Finally, here's a link to an interesting Washington Post interview with the CEO of CVS's MinuteClinics. The Wall Street Journal reports that CVS has about 600 of these urgent care centers operating in its stores, while Walgreen's has more than 350.  The Post article indicates that CVS wants to open 1000 MinuteClinics by 2016 and that 85% of MinuteClinic patients have health insurance coverage.





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