Friday, December 19, 2014


Although this is not an FEHBP matter, the FEHBlog was pleasantly surprised to read this ACA regulators' press release issued today announcing their intent to allow employers to supplement ACA marketplace coverage for employees who fall outside the ACA's employer shared responsibility mandate, e.g. employees of employers with 50 employees (100 for 2015) and employees who work less than 30 hours for employers subject to that mandate a/k/a part-time employees:
The proposed rules would allow group health plan sponsors, in limited circumstances, to offer wraparound coverage to employees who are purchasing individual health insurance in the private market, including through the Health Insurance Marketplace. The rule proposes two pilot programs for wraparound coverage. One pilot would allow wraparound benefits only for Multi-State Plans in the Health Insurance Marketplace and another would allow wraparound benefits for part-time workers who could otherwise qualify for a flexible savings arrangement who enroll in individual market plan.
Ihealthbeat reports that CMS has added more healthcare quality data to the Hospital Compare and Physician Compare websites. Those websites cover care rendered to all patients, not just Medicare patients.

Following on a couple of recent FEHBlog posts, not surprisingly health information technology groups are at odds over the CRomnibus's electronic medical record interoperability mandate.  The underlying problem in the FEHBlog's view is embedding technology requirements in law. However, the government could not be expected to shell out $30 billion on electronic medical record systems without attaching strings. Unfortunately the 2009 law omitted an interoperability string which has created the current problem,

Also, the Wall Street Journal's Pharmalot blog predicts that the Philadelphia public transit health plan's price gouging lawsuit against Gilead Sciences, which manufactures the only FDA approved Hepatitis C drugs, won't be successful:
“Monopolists, themselves, are not unlawful. They are allowed to charge any price they want. It’s only if they take any anticompetitive conduct that a problem may exist,” says Ankur Kapoor, an attorney at the Constantine Cannon law firm who specializes in antitrust law. He notes that antitrust laws do not have price-gouging provisions, “I can’t recall seeing a case like this,” he says.  As a result, the Gilead pricing is unlikely to be considered illegal, experts say
The FEHBlog was intrigued by the health plan's offensive use of the ACA's anti-discrimination law, PHSA § 1557 in this lawsuit, a point that the WSJ article did not discuss. In any event, according to another WSJ article, the Food and Drug Administration may soon deprive Gilead of its monopoly status by approving a competitive drug manufactured by AbbieVie.  
Analysts don’t expect AbbVie to overtake Gilead in the hepatitis C market, but believe it can capture a decent share of a market that continues to grow. AbbVie hasn’t disclosed pricing for its regimen, but some expect that the company could gain market share by selectively discounting it versus Gilead’s Harvoni, which costs about $94,500 for a 12-week regimen. Gilead’s Sovaldi hepatitis C drug, which was introduced a year ago, costs $84,000 for a standard course of treatment.
Have a good weekend.

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