The Centers for Medicaid and Medicare Services, which includes the HHS agency responsible for ACA implementation, CCIIO, has issued a request in the Federal Register seeking "recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets." The comment deadline is July 12, 2017. Comments can be submitted on regulations.gov. It's another step in the right direction.
Last Friday, the FEHBlog noted a recently filed putative class action lawsuit against prescription benefit managers over Epipen pricing. An Epipen is a device that allows a layperson, e.g., a parent, or patient to self-inject a generic antihistamine drug to control a violent allergic reaction. Mylan, the Epipen manufacturer, took advantage of an effective monopoly position to crank up prices. The effective monopoly was on the delivery device which is FDA approved, not on the drug, as explained in this New York Times article.
The lawsuit raises an ERISA challenge to the current PBM pricing methodology which involves negotiation prices and manufacturer rebates. The plaintiffs, who likely are enrolled in high deductible plans, would prefer to see the rebates converted to lower drug prices, rather than lower health insurance premiums. This lawsuit, if successful, which the FEHBlog tends to doubt, has wide-ranging ramifications.
Morning Consult discusses some steps that the new FDA Commissioner Scott Gottlieb is contemplating to address drug pricing concerns. Specifically,
Gottlieb, a former deputy FDA commissioner, said he wants to improve the process for approving generic versions of “complex” drugs such as EpiPens, which consist of an old medication that has a new delivery system. Another step the FDA will take, he said, is to publish a list of drugs that are off-patent and lack generic competition.The FEHBlog also was impressed by this New York Times article about the innovative efforts undertaken by an Albany NY regional health plan, the Capital District Physicians' Health Plan, to promote the use of generic drugs by network doctors. (Capital District Physician's Health Plan is an FEHBP carrier.)
As a drug salesman, Mike Courtney worked hard to make health care expensive. He wined and dined doctors, golfed with them and bought lunch for their entire staffs — all to promote pills often costing thousands of dollars a year.A templatable idea, indeed.
He’s on a different mission now: When he calls on doctors, he champions generic drugs that frequently cost pennies and work just as well as the kinds of expensive brands he used to push.
Instead of Big Pharma, he works for Capital District Physicians’ Health Plan, an Albany, N.Y., insurer. Instead of maximizing pill profits, his job is to save millions of dollars by educating doctors about expensive prescription drugs and the stratagems used to sell them.
“Having come from Big Pharma, I do really feel my soul has been cleansed,” Courtney said with a laugh. He formerly worked for Pfizer and Johnson & Johnson. “I do feel like I’m more in touch with the physicians” and plan members, he added.