Weekend update

Congress is out of town until January 7, 2020. The President has signed into law the final two spending bills and the defense authorization act for fiscal year 2020 whose provisions the FEHBlog has been discussing over the past few weeks.

In an interesting development, according to Forbes, the prescription benefit managers, Express Scripts, which insurer Cigna owns, and Prime Therapeutics which a group of Blue Cross licensees owns, have formed a partnership.

The three-year collaboration is “designed to deliver more affordable care for clients and their members by enhancing pharmacy networks and pharmaceutical manufacturer value.” The collaboration will allow Prime’s member Blue Cross health plans to gain leverage through Express Scripts’ buying clout and large pharmacy network."

The Wall Street Journal included a heartbreaking healthcare story over the weekend.

When she was in her early 30s, Katy Mathes decided to check her cancer risk. A genetic test showed a mutation on a BRCA gene, which significantly raises a person’s lifetime risk of developing hereditary breast or ovarian cancer. 

Thirteen people in the family got tested—her mother, her sister, cousins and aunts. Eleven had the mutation. Almost all did their testing with Myriad Genetics Inc., which introduced the first BRCA tests in 1996. 

“I treated my test results like the Bible,” said Ms. Mathes, now 37, an elementary-school art teacher in Colorado. “There was no questioning the report.” 

Ms. Mathes, who has one child, decided she would have no more. To reduce her cancer risk, she underwent surgery to remove her ovaries and fallopian tubes. So did her younger sister, their mother and four other relatives. Ms. Mathes and her sister also had double mastectomies. 

This year, their mother sat them down at the table of their parents’ winter home in Florida. Two weeks earlier, her genetic counselor had called. The lab was no longer sure the variant is a significant problem. 

The article explains how many variables are at play in these genomic tests. Patients should be better educated about the risks of misdiagnosis.  If you have not done so, read Russ Roberts' interview with Adam Cifu MD about being a medical conservative on the Econtalk podcast. (You can read the interview or listen to it at the link.)

[W]e need to slow down at this point. We need to think about the evidence behind what doctors are offering patients. And we need to consider the cost/benefit of this.

N.B. In addition to being the FEHBlog's birthday, this is his 2700th post since 2006.