Feb 25, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

D.C. readers: Join Axios' David Lawler tomorrow evening at 5 pm ET for a screening of "The Price of Free" and a panel discussion.

  • He'll sit down with Reps. Chrissy Houlahan and Rep. Chris Smith, along with designer Rachel Roy and Nobel Peace Laureate Kailash Satyarthi, to shine a light on the reality of child labor and slavery in the US and abroad. 
  • RSVP here.
1 big thing: Peril and potential of DNA tests

Illustration: Sarah Grillo/Axios

The sudden ubiquity of home DNA kits is giving rise to a lot of new clinical potential — and a lot of privacy concerns at the same time, Axios’ Kim Hart writes this morning.

The big picture:  “I think there’s a future in which everyone is sequenced, prenatally or at birth, and their genomic data is part of their medical record and is continually analyzed and that information is integrated into your medical care,” NIH bioethicist Benjamin Berkman told Kim.

  • "We're getting better and better at understanding how different variants impact human health," he said. "But we have a long way to go before personalized medicine becomes a reality we're still learning how the genome works."

Drug companies clearly see that potential.

  • Ancestry.com and 23andMe — which, combined, store the DNA data of 15 million users — both sell anonymized genetic data to pharmaceutical companies. 23andMe is also working on its own line of potential treatments.
  • "It's not individual data that's interesting — it's the ability to look at large groups of people to see what's unique. It's the aggregate data, not individual data, that's meaningful," said Kathy Hibbs, 23andMe's chief legal and regulatory officer.

Yes, but: DNA-testing services aren't specifically covered by federal privacy rules, such as HIPAA. They are subject to the FTC’s privacy rules, and some FDA research standards.

  • But protections can get murky when genomic data is used for human-subject medical research, says Pam Hepp, a healthcare attorney at Buchanan Ingersoll and Rooney specializing in data privacy.

Go deeper.

2. Where Medicare Advantage is most popular
Expand chart
Data: Centers for Medicare & Medicaid Services; Map: Harry Stevens/Axios

States in the Midwest, South and West have the highest proportions of Medicare members enrolled in Medicare Advantage, my colleague Bob Herman reports.

  • Some states have more than 40% of their Medicare population in the taxpayer-subsidized private plans.

The big picture: Roughly a third of all Medicare enrollees are in MA, a program that has garnered bipartisan support despite its shortcomings, and some Wall Street estimates think MA will be the majority option by 2021.

By the numbers: The state with the highest proportion of private Medicare plan enrollees (57.3%) is Minnesota, although many people are enrolled in "Medicare cost" plans that function as a hybrid between MA and traditional Medicare.

  • MA is the choice of at least 40% of all Medicare enrollees in 6 other states (California, Florida, Hawaii, Oregon, Pennsylvania and Rhode Island).
  • MA is far less popular in states with sparse populations, like Alaska, Vermont and Wyoming.

What to watch: Health insurance companies will always aggressively pursue areas where there are a lot of seniors, like Florida and California, but the distribution shows there are pockets of the Midwest and Northeast that could be their next targets.

3. How Insys duped insurers

The Insys trial's latest allegation is that employees of the company often tricked insurers into approving reimbursements for Subsys, a potent fentanyl spray, the Boston Globe reports.

A former company manager testified Friday that employees at the company's "reimbusement center" learned the names of medications that patients needed to have tried and failed before being approved for Subsys.

  • They told insurers that patients had found other painkillers ineffective without knowing that patient's history, the former employee said.
  • Employees told insurers that patients had trouble swallowing because it increased the chances of approval, even though this wasn't true.
  • They were also told they could cite prior cancer diagnoses of patients who no longer had the disease as justification for the prescription.

Why it matters: Insurers would only pay for Subsys if the patient had an active cancer diagnosis, was in severe pain and had tried other painkillers that hadn't worked. This is a way of making sure the drug is only being used for its intended purposes.

  • Insys executives have been accused of bribing doctors to prescribe Subsys to patients who didn't need it, as well as conspiring to defraud insurance companies.
4. "Hot spots" of the opioid epidemic
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Data: JAMA Network report; Chart: Naema Ahmed/Axios

The opioid epidemic is most deadly and growing fastest in the eastern half of the United States, according to a new study in the Journal of the American Medical Association.

  • Synthetic opioids, like fentanyl, are far and away the leading contributor to the rising death toll.
  • The places hit hardest by synthetics are not necessarily the same ones hit hardest by prescription opioids in the first wave of the epidemic.

Why it matters: Recognizing how the opioid epidemic presents in each state — which drugs are being used and whether or not the problem is getting worse — is critical to getting the policy response right.

5. While you were weekending
  • A judge on Friday declined to block a former UnitedHealth employee from joining the new Amazon, Berkshire Hathaway and JPMorgan Chase venture, Bob reported.
  • Roche is getting close to a deal to buy Spark Therapeutics for nearly $5 billion, the Wall Street Journal reported.
  • The NYT dove into the powerful group of insurance and health care industries that are opposing Medicare for All.
  • California lawmakers have introduced a bill that would prevent hospitals from pursuing payments beyond a patients' normal cost-sharing requirements, even if the hospital is out-of-network, Vox reported.
  • Price-setting is gaining steam as a solution to growing health care costs, Modern Healthcare reported.
Caitlin Owens

Who's getting kicked off "The Bach" tonight? I already know (h/t Reality Steve) but send predictions anyways to caitlin@axios.com.