Taking Action Express: Choosing Wisely Interest Soars; Public Outcry Over Specialty Rx; Health Care Costs: The Public’s Right to Know..

January 20, 2015

choosingwiselylogoThe Weekly Buzz: The Weekly Buzz: Choosing Wisely® “Must-Read” Articles of 2014

In reviewing the reach of Choosing Wisely, the ABIM Foundation staff last week chose the “Top 5” must-read articles from 2014 for patients and physicians. This past year was significant for the campaign because conversations inspired by Choosing Wisely around reducing waste and overuse permeated the health care community, academic publications, and mainstream media as well. To learn about all the ways The Action Group is involved in this important campaign, visit our website and type in key words, “Choosing Wisely.”

downloadA Closer Look at the High Cost of Specialty Rx

Through The Action Group’s Care Delivery Learning Networks, members meet over several months with leading providers, health plans, and other vendors to take an in-depth look at particular topics that have a high impact on the cost of health care. The current Learning Network is focusing on specialty medications. The introduction of Hepatitis C drugs, which can cost over $84,000/patient, has caused a tremendous surge in public outcry over the untenable cost of specialty medications. Once the Learning Network meetings conclude, an Employer Purchaser’s Guide on Specialty Medications will be available to members. Here are some new articles about how the pressure is intensifying in the specialty drug pricing wars.

  • Pharmaceutical company executives say they may not enter new treatment areas because insurers are limiting Hepatitis C drug coverage to either Gilead Sciences or AbbVie, but not both.
  • Eli Lilly and Co says insurers are pressuring them with price negotiations over their diabetes medications, just like they are with specialty drugmakers like Gilead and AbbVie.
  • Express Scripts Holding Co. says they’re looking to start a new drug pricing competition among cholesterol and cancer drugmakers.

16Chaos Prevails When Price and Quality Information Withheld From the Public

“In one fell swoop, Blue Cross and Blue Shield of North Carolina has disproven all those who have falsely claimed that pricing information is proprietary and constitutes a significant competitive advantage,” says Francois de Brantes, executive director of the Health Care Incentives Improvement Institute. His thought-provoking commentarydiscusses the importance of releasing health care pricing information to the public so they can make informed decisions that will ultimately improve care delivery and contribute to better managed costs.

Minnesota_State_Capitol_5From the Capitol

The 2015 state legislative session is officially underway.

At the close of the 2014 election, Minnesota had divided control of the legislature and a Democratic governor for the first time since 1985. The Republican takeover of the House of Representatives will mean a different approach for health care issues, with some new faces leading the discussion.

Rep. Matt Dean (R – Dellwood) is the new chair of the Health and Human Services Finance committee, while Rep. Tara Mack (R – Apple Valley) will head up the Health Reform committee, which will focus mainly on policy issues. The new majority has expressed an interest in finding more efficiencies in the health care system and getting more input from the insurance industry, particularly on the topic of MNsure. Early bill introductions have backed that up, with House File 5 proposing to allow individuals access to federal tax credits, even if they purchase a Qualified Health Plan outside of MNsure. Here is the link to HF5.

At the same time the DFL-led Senate has proposed its own reforms for MNsure, suggesting that the insurance exchange be reformed as a state agency under the direct supervision of the Governor. A direct link to that language can be found here.

Regardless of political party, how and where health insurance is purchased will clearly be an ongoing topic at the Capitol.

The first few weeks of the Session have started off somewhat slowly, with committees using this time to bring newer members up to speed on various issues and information from state agencies. The legislature will largely focus on the biennial budget for FY2016-17 this year, with health care again being a big part of the conversation. While Minnesota is projected to have a budget surplus, inflationary considerations and other spending priorities have many predicting that health and human services areas could still see funding decreases. Governor Dayton’s budget proposal is expected to be released onJanuary 27, 2015, and will kick start months of discussion and negotiation.

We will keep you updated on items of interest throughout the legislative session.

Thought for the Week

“A highly anticipated set of medications that aggressively reduce cholesterol, known as PCSK9 inhibitors, will be the next big opportunity to pit drugmakers against each other to reduce costs. High-priced cancer drugs are expected to be next.”

George Paz
Chief Executive Officer of Express Scripts