Tuesday, December 26, 2017

Boxing day tidbits

The FEHBlog trusts that his loyal readers are enjoying the holidays.

Last Friday, the Internal Revenue Service ("IRS") announced that "Insurers, self-insuring employers, other coverage providers, and applicable large employers now have until March 2, 2018, to provide Forms 1095-B or 1095-C to individuals, which is a 30-day extension from the original due date of Jan. 31." These are the forms that confirm for IRS purposes compliance with the ACA's individual and employer shared responsibility mandates. The IRS is not extending the deadline for submission of those forms to the agency itself.  Because Congress has zeroed out the ACA individual mandate for tax years beginning after 2018, there will be one more round of full 1095 reporting after this one.

The Wall Street Journal reports today that "Since 2013, the price of a 40-year-old, off-patent cancer drug in the U.S. has risen 1,400%, putting the life-extending medicine out of reach for some patients. Introduced in 1976 to treat brain tumors and Hodgkin lymphoma, lomustine has no generic competition, giving seller NextSource Biotechnology LLC significant pricing power." Of course, this is nothing new and the Food and Drug Administration is trying to encourage competition in these situations. However, this is not a widely prescribed drug. The Wall Street Journal explains that
In 2015, the most-recent year for which data were available, Medicare Part D prescription-benefit plans paid for 1,694 prescriptions in the U.S., according to the Centers for Medicare and Medicaid Services. But because of the price increase, Part D spending on the drug jumped to about $608,000 in 2015 from $163,000 the year before.
That's a drop in the proverbial bucket but as the article further explains the Medicare Part D cost sharing on this drug is stiff. The FEHBlog does not believe that price controls are the answer. The federal government already imposes price controls on drugs sold to the Defense Department, the Veterans' Administration, and the Indian Health Service. There also is a pricing floor for Medicaid sales that other purchasers except for Part D plans can't drop below. These federal price controls shifts costs to other purchasers such as the FEHB plans.

Waiving cost sharing for the unfortunate members would reward the buccaneer drug company. It's shameful that those companies cannot find a way to exercise self-control over their pricing. Before long we may see the federal government engaged in the drug manufacturing business, just like in olden times when the federal government ran the arsenals that manufactured weapons.

Finally, the Wall Street Journal tells us about six health stories that readers should follow next year --.targeted breast cancer treatments, advances in genetic-based medicine (via Crispr gene editing),  the conclusion of a five year long trial of the expensive PCSK9 inhibitor drugs to lower cholesterol,  continuing concern about antibiotic overuse and resistance, a new class of injectable drugs under development which has shown promise in preventing migraine headaches, and a focus on flu and measles.  

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