Tuesday Tidbits

Modern Healthcare reports that the Congressional conference committee finished its work on the opioid crisis remedial legislation (H.R. 6) yesterday evening. Of note, the final bill does not include a pharmaceutical manufacturers proposal to partially restore the Medicare Part D donut hole (good outcome) or a healthcare industry proposal to align the unnecessarily complicated substance use disorder privacy law (42 CFR Part 2) with the generally applicable HIPAA Privacy Rule (mystifying outcome).

Healthcare Dive informs us about CVS Health's plans for its acquisition of Aetna.  For example,

Executives described how they could use its existing services to better serve Aetna's members. As soon as the deal closes, if it does, CVS believes it will have immediate access to 20% of Aetna's membership currently using the stores. That matters because CVS believes its pharmacists play a crucial role in shaping a patient's overall behavior. CVS said many investors underestimate the role of the pharmacist. 

The FEHBlog has long believed in the importance of the pharmacist to the health care system. Such mergers also will help improve health care quality scores by consolidating vital data. The FEHBlog expects to see group health plans administrators trending toward use of such linked health care networks / PBMs. 

Bloomberg tells us that Gilead Pharmaceuticals which made a fortune on Hepatitis C curative drugs like Harvoni is launching a generic version of those drugs at a significantly lower price. 

The new, cheaper versions of Gilead’s Epclusa and Harvoni will cost $24,000 for a course of treatment, the Foster City, California-based company said in a statement on Monday. When Harvoni came on the market in 2014, Gilead set a list price of $94,500. Epclusa was approved for sale in 2016, with a price of $74,760.

As the FEHBlog has previously noted, while the original list prices were stunning, curative drugs are taken for a relatively short time frame. Typical blockbuster drugs like statins are taken for years and years. Hopefully more curative drugs for potentially fatal illnesses were be forthcoming and in the meantime the market can figure out a Goldilocks solution.  Easier said than done.  But for now it's good to see generic level pricing for these drugs.

Health Affairs offers an interesting analysis of the bipartisan surprise bill legislation recently circulated for comment by a group of Senators (as noted in a recent FEHBlog post).

This bipartisan draft legislation marks an important step forward in putting an end to surprise out-of-network medical bills nationwide. As work proceeds on this issue, lawmakers should focus on:

• Determining the appropriate payment rate from the health plan to the provider in these instances, specifically considering a lower rate than the 125 percent of average allowed amounts in a region currently in the draft (and if using any percentile of average allowed or contracted amounts, pegging this calculation to a point in time before passage of the bill, inflated forward);
• Narrowing the protection for all out-of-network services at an in-network facility to those most likely to involve surprise bills; and
• Adding a protection for out-of-network ambulance bills.