Healthcare Policy Pop

Wayne Winegarden, Senior Fellow at the Pacific Research Institute, discusses the news that AbbVie still controls more than 97 percent of the market nearly a year after Humira biosimilars launched; Darius Lakdawalla, Co-Author of the GRACE Model and Director of Research at the Schaeffer Center for Health Policy and Economics at the University of Southern California, describes how his model is different from what we currently use; and Patients Rising Now is working on its latest report about Formulary Practices.

Endpoints News Article: Almost a year since Humira biosimilars launched, AbbVie still controls more than 97% of the US market

Pacific Research Institute Webpage

The GRACE Model

George Huntley, CEO of the Diabetes Leadership Council, explains a major victory for patients in a court case regarding Copay Accumulator practices; Cigna has agreed to pay $172 million dollars after allegations the submitted false diagnostic codes to boost reimbursements; and the unions that represent 85 thousand health care workers have reached a tentative agreement with Kaiser Permanente after a strike over wages and staffing.

Diabetes Leadership Council Webpage

Fierce Healthcare News Article: Court strikes down Trump-era rule that allowed insurers to not count copay assistance

Fierce Healthcare News Article: Cigna to pay $172M to settle claims it overcharged Medicare Advantage program

U.S. Department of Justice Office of Public Affairs Press Release: Cigna Group to Pay $172 Million to Resolve False Claims Act Allegations

AP News Article: Kaiser Permanente reaches a tentative deal with health care worker unions after a recent strike

Kirsten Axelsen, Senior Policy Advisor with global law firm DLA Piper, explains what Coverage with Evidence Development is and how it restricts patients access; the manufacturers of all 10 of the first drugs announced for Medicare drug negotiation have agreed to negotiate, but it’s not that simple; and a new study published in Annals of Internal Medicine says that discount card programs could save people money on out-of-pocket drug costs.

DLA Piper Webpage: Kirsten Axelsen

NPR News Article: All in – Drugmakers say yes, they'll negotiate with Medicare on price, so reluctantly

JAMA Network News Article: Discount Cards Could Save Patients Millions on Drug Costs

AI has impacted healthcare and where the technology might take us; Brad O’Neil, President and Managing Director of the ICHRA Shop, explains how an Individual Coverage Health Reimbursement Arrangement (ICHRA) works and what it offers to employers and employees; the FDA reopens the comment period on its paper about the use of AI in drug development; and a Kaiser Health News article examines new federal rules for Medicare Advantage plans that take effect in January.

The Data Economics Company Webpage

The ICHRA Shop Webpage

Endpoints News Article: Agency reopens AI discussion paper for comments amid two-day workshop

Kaiser Health News Article: Feds Rein In Use of Predictive Software That Limits Care for Medicare Advantage Patients

John O’Brien, President and CEO of the National Pharmaceutical Council, weighs in on ICER’s latest update that we are calling a “faux update”; The American Enterprise Institute has released its perspective on last year’s Inflation Reduction Act; and The National Institute on Minority Health and Health Disparities has officially designated people with disabilities as a population with health disparities.

National Pharmaceutical Council Webpage: NPC Evaluates ICER’s Revised 2023 Value Assessment Framework

American Enterprise Institute Webpage: What Does the Inflation Reduction Act Mean for Patients and Physicians?

National Institutes of Health Webpage: NIH designates people with disabilities as a population with health disparities

Jonathan Weiss, Founder and CEO of HealthEngine, discusses why The No Surprise Act so far isn’t serving its intended purpose; a new secret shopper study found that hospitals are failing at price transparency for imaging services; and if you want to keep up with the financial penalties levied since the implementation of the No Surprises Act there’s a list from CMS.

HealthEngine Webpage

Journal of the American Medical Association Article: Health Care Transparency—What You See Should Be What You Get

Radiology Business News Article: ‘Secret shopper’ study co-authored by Mark Cuban finds hospitals failing at imaging price transparency

CMS Webpage: Hospital Price Transparency Enforcement Actions

Bill Smith, Director of the Life Sciences Initiative at the Pioneer Institute, dives into the so-called update to ICER’s value assessment framework; Congresswoman Cathy McMorris Rodgers explained earlier this year why she was against the QALY measurement; and Patients Rising Now along with several other groups have issued statements denouncing the ICER update.

Pioneer Institute Webpage

Patients Rising Podcast Episode: Healthcare Protections for Rare Diseases with Rep. Cathy McMorris Rodgers

Patients Rising Now Webpage: Patients Rising Now Statement – ICER’s ‘Updates’ are Thinly Veiled Strategy to Continue Discriminatory Tactics

National Pharmaceutical Council Webpage: NPC Evaluates ICER’s Revised 2023 Value Assessment Framework – A Missed Opportunity for Patients and the Field

Biotechnology Innovation Organization Webpage: ICER’s updated treatment assessment still ignores patient concerns

Kirsten Axelsen, Senior Policy Advisor at DLA Piper, says some of the fallout from CMS announcing price controls is already happening; the E&C Oversight and Investigations Subcommittee held a hearing on the IRA’s price-setting; and Patients Rising Now reacted with a statement on the hearing. 

DLA Piper Webpage: Kirsten Axelsen

E&C Subcommittee Hearing: At What Cost – Oversight of How the IRA's Price Setting Scheme Means Fewer Cures for Patients

Patients Rising Now News Release: Patients Rising Now Issues Statement on E&C IRA Hearing

Gavin Clingham, Public Policy Director for the Alliance for Patient Access, discusses reasons behind drug supply shortages and some possible solutions; Patients Rising Now submitted questions to the E&C Oversight and Investigations Subcommittee pertaining to the IRA’s drug price setting; and CMS will host listening sessions for the first 10 drugs named for price setting, but Patients Rising Now says more needs to be done.

Alliance for Patient Access

E&C Oversight and Investigations Subcommittee Hearing: "At What Cost: Oversight of How the IRA's Price Setting Scheme Means Fewer Cures for Patients"

CMS Webpage: Medicare Drug Price Negotiation Program Patient-Focused Listening Sessions

Peter Kolchinsky, Managing Partner at RA Capital Management, breaks down a new white paper with Entity rRisk that aims to get the math correct when measuring the value of new medicines; a new report says the HHS Office for Civil Rights wants an update to a 50-year-old law to prevent disability-based discrimination; and Patients Rising Now is supporting The Protecting Health Care for All Patients Act.

RA Capital Management

U.S. Department of Health and Human Services Webpage: HHS Issues New Proposed Rule to Strengthen Prohibitions Against Discrimination on the Basis of a Disability in Health Care and Human Services Programs

Congressional Budget Office Webpage: H.R. 485, Protecting Health Care for All Patients Act of 2023