Dec 16, 2019

A new cataract surgery drug gets a quiet agreement

Dexycu has a $595 list price. Photo: EyePoint Pharmaceuticals

A new agreement between a small drugmaker and Kaiser Permanente will allow for the use of a new, pricey cataract surgery drug in Kaiser facilities, except there's one major issue: Nobody's admitting Kaiser is the distributing system.

Why it matters: When it comes to transparency, the health care industry is a black box — even on seemingly small things.

Driving the news: EyePoint Pharmaceuticals recently touted in a press release that it locked in a deal with an "integrated delivery system" to offer its new eye treatment, Dexycu, which is injected into patients' eyes after cataract surgery as a means to replace post-surgery eyedrops.

  • The release said this health system operates in "California, Washington, Georgia, Colorado and mid-Atlantic states" and has more than 8.5 million patients.
  • The only system that is big enough and is in those locations is Kaiser Permanente.

What they're saying: Scott Jones, chief commercial officer at EyePoint, said he could "neither confirm nor deny" that Kaiser is the system that will start offering Dexycu because "we're not allowed to use [the system's] name."

  • Meanwhile, a Kaiser spokesperson said: "We do not comment on the details of our pharmaceutical contracts. In general, our contracting strategy — like all of our services — is focused on ensuring that our clinicians can provide the high-quality, affordable care that is at the heart of our mission."

The big picture: Dexycu has a list price of $595, and Jones said this deal opens the door to roughly 70,000 to 100,000 cataract surgeries within the network every year.

  • Drugs like Dexycu, which are part of bigger procedures, usually garner payment that is close to or even above their list prices. So it's reasonable to expect this deal is worth tens of millions of dollars.
  • This treatment also costs a lot more than typical prescription eyedrops, but the cost will be more hidden because it will be covered by insurance premiums.

Go deeper

The health care debate we ought to be having

Photo Illustration: Sarah Grillo/Axios. Photos: Scott Eisen/Getty Images and Erik McGregor/LightRocket via Getty Images

Americans worry a lot about how to get and pay for good health care, but the 2020 presidential candidates are barely talking about what's at the root of these problems: Almost every incentive in the U.S. health care system is broken.

Why it matters: President Trump and most of the Democratic field are minimizing the hard conversations with voters about why health care eats up so much of each paycheck and what it would really take to change things.

Cigna's big divestiture on its life and disability insurance business

Photo: Julia Rendleman/Getty Images for Eventive Marketing

Cigna finally pulled the trigger on selling its life and disability insurance business, netting $5.3 billion after taxes from New York Life.

The big picture: Health insurers have been divesting products that have less to do with actual medical care and instead combining with companies that sell drug benefits

Go deeperArrowDec 19, 2019

Private insurance's costs are skyrocketing

Reproduced from Kaiser Family Foundation; Chart: Axios Visuals

The cost of private health insurance is out of control, compared to Medicare and Medicaid. You see that clearly if you take a long-term view of recently released federal data on health spending.

Why it matters: This is why the health care industry — not just insurers, but also hospitals and drug companies — is so opposed to proposals that would expand the government's purchasing power. And it’s why some progressives are so determined to curb, or even eliminate, private coverage.

Go deeperArrowDec 16, 2019