Situational awareness: Anthem has agreed to pay a $16 million settlement with the federal government over a series of 2015 hacks that exposed the records of nearly 80 million people.
The Department of Health and Human Services formally rolled out a proposal yesterday that would require drug companies to include their products’ list prices in their TV ads, similar to the way they disclose side effects.
The big picture: There’s a legitimate debate about how this would work and how big a difference it will make. But it is, notably, the first real showdown with the pharmaceutical industry since the administration released its drug-pricing plan earlier this year.
Details: Drugmakers will have to disclose the list prices — the wholesale acquisition cost, to be specific — in TV ads for every drug reimbursed by Medicare or Medicaid, as long as the price is more than $35 for a month’s prescription.
What’s next, from the industry side: The pharmaceutical industry suggested yesterday that it's likely to challenge the rules in court once they're finalized, alleging a First Amendment violation.
What's next, from the reg side: The administration is considering more rules cracking down on pharmacy benefit managers (PBMs). The White House is reviewing a proposal to rein in their lucrative rebates.
One big sticking point in the debate over price disclosures is whether a drug's list price is useful information, or even the right price to disclose, if you're going to disclose a price.
How it works: List prices are essentially sticker prices. Insurance plans negotiate discounts, and then the specifics of each consumer's plan determine how much of that price they actually have to pay out of pocket.
The other side: Drug pricing is enormously complex. But the sticker price for any product is obviously correlated to the final cost of that product.
"List prices matter to American patients," Azar said.
Johnson & Johnson and UnitedHealth Group are reporting third-quarter numbers this morning, batting leadoff per usual for the health care industry.
What we're watching, per my colleague Bob Herman:
The bottom line: Expect most health care companies to keep posting gigantic earnings because the broader system hasn’t really changed (and because of lower corporate taxes).
Mary Mayhew. Photo: Derek Davis/Portland Press Herald via Getty Images
Mary Mayhew, a former health commissioner under Maine Gov. Paul LePage, started yesterday as the director of the federal office that directly oversees Medicaid.
Why it matters: The Trump administration is focused intently on reframing Medicaid as something closer to a welfare program, and has arguably made more significant conservative policy changes to Medicaid than to any of the other programs it oversees.
Seema Verma, who oversees Medicare and Medicaid and is now Mayhew’s boss, came from a similar background — she was a consultant who helped red states write their proposed Medicaid waivers.
If the Obama administration had the legal authority to curtail “short-term” insurance plans, then the Trump administration has the power to expand them, according to the Justice Department via a new legal brief.
Where it stands: Judge Richard Leon is slated to hear oral arguments next week in a lawsuit over the Trump administration’s move to let consumers keep skimpy, inexpensive “short-term” plans for up to three years.
What they’re saying: The expansion of short-term plans “falls comfortably within [HHS’] authority,” the government's brief says.
To the extent consumers and insurers face premium increases, DOJ states, they can’t say for sure how much “will be attributable to the rule, as opposed to Congress’s recent decision to reduce the tax penalty to $0 for people who opt out of the ACA’s coverage mandate.”
Hip and knee replacements may be the next health care frontier for the Apple Watch, now that it can monitor users’ heart rates.
What's new: Reuters reports that 4 hospitals and a handful of other providers are working with Zimmer Biomet, a medical device company, to test an app that would transmit patients’ heart rate, steps taken and standing hours to their doctors.
Why it matters: There are plenty of concerns about just how effective Apple’s heart monitoring will be, and whether the risk of false warning signs outweighs the potential to catch legitimate irregularities.