Jun 4, 2019

Axios Vitals

D.C. readers: Join Axios' Bob Herman at 8am ET tomorrow for Beyond 2020: Making Care Affordable.

  • He'll sit down with Sens. Chuck Grassley (R-Iowa) and Debbie Stabenow (D-Mich.), along with former FDA commissioner Scott Gottlieb, and the Association for Accessible Medicines president and CEO Chester "Chip" Davis Jr. to discuss the future of health care and drug pricing in America. 
  • RSVP here.

Today's Vitals is 819 words, ~3 minutes.

1 big thing: Keeping biosimilars off the market
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Adapted from a chart by IQVIA; Chart: Axios Visuals

Yesterday, I told you about how Coherus's Udenyca — a biosimilar competing against Amgen's Neulasta — will soon be disadvantaged by UnitedHealthcare, the result of Amgen offering United a larger rebate then Coherus.

Why it matters: This is just one example of how the drug industry finds ways to keep biosimilars off the market.

  • Pfizer is suing Johnson & Johnson over similar practices. It says J&J has created exclusionary deals with insurers, using rebates as leverage to win preferred coverage of J&J's Remicade over Pfizer's biosimilar version.
  • "To date Pfizer has failed to demonstrate sufficient value to patients, providers, payers and employers," J&J told Reuters.

Lawsuits filed by biologics manufacturers also create a hurdle for biosimilars — well before they're in any position to negotiate with insurers.

What they're saying: J&J's "strategy could serve as a blueprint for every brand name biologic drug maker seeking to maintain monopoly power and profits indefinitely in the face of competition from a lower-priced biosimilar," the Biosimilars Council wrote in a court filing in support of Pfizer.

2. The charity eradicating medical debt

Nonprofit charity R.I.P. Medical Debt, which buys and absolves people’s health care debt in bulk, has wiped away $700 million since its inception in 2014 — and that number should hit $1 billion later this year, co-founders Jerry Ashton and Craig Antico told my colleague Bob Herman.

How it works: R.I.P. Medical Debt rose to fame in 2016 after it helped comedian John Oliver forgive $15 million of medical debt.

  • Hospitals pursue patients' bills, occasionally threatening legal action, but if they think it's a lost cause, they sell the uncollected debt to debt buyers for pennies on the dollar.
  • Debt buyers become the new collectors, and they "get very aggressive," said Ashton, who used to work in the bill collections industry but now calls himself a "predatory giver."
  • R.I.P. Medical Debt jumps in and buys the debt from the debt buyers using donated funds, and immediately abolishes the debt.
  • The organization focuses on the poor: debtors have to earn less than twice the federal poverty level, are insolvent, or have medical debt that makes up at least 5% of their annual income.

What they're saying: "There's no such thing as great health insurance," Ashton said. "If you and I think this paper-thin safety net of insurance is going to save us, that's not going to be the case."

Go deeper: "A drop in the bucket" of medical debt

3. Hospitals notch a Supreme Court win

Hospitals that treat low-income patients won a long-fought victory yesterday at the Supreme Court, and Axios' Sam Baker is on it.

The court threw out Medicare's attempt to cut payment rates for disproportionate share hospitals, which treat a large number of low-income patients.

  • Medicare had changed its payment formula without soliciting public comments. The court, in a 7-1 decision, said that shortcut was illegal.

Why it matters: The ruling itself is a big win for safety-net hospitals, who would have taken a pretty steep pay cut under the change Medicare tried to make.

  • Other parts of the industry could also benefit over time. Generally, the more Medicare has to do through notice-and-comment rulemaking, the more chances industry groups will have to fight proposed payment cuts.

Read the ruling.

4. The unpaid cost of long-term care

Photo: Inga Kjer/Photothek via Getty Images

The new issue of Health Affairs is focused on long-term and end-of-life care, and one particular article jumped out as a sort of "Why it matters":

  • Family members, especially spouses, are providing an awful lot of end-of-life care right now, with little or no support, Sam writes.

By the numbers: Nearly 15 million Americans act as unpaid caregivers for older patients, often family — and spouses, especially, often have to go it alone.

  • 55% of spouses who are married to someone with a disability and who’s not living in a nursing home serve as solo caregivers, according to the Health Affairs study.
  • Among those who had help, most got it from their children, rather than trained professionals.
  • Looking after an older family member is a full-time job — solo caregivers averaged more than 40 hours a week.

"Solo caregiving was also common among spouses of people with dementia in the last years of life, despite the fact that dementia caregiving poses unique difficulties … especially toward the end of life," the authors write.

Silver lining: Among people whose spouse had recently died, people who had been solo caregivers at the end of their spouse's life were no more prone to depression than people who had help.

Go deeper: The unofficial health care system

5. Quest Diagnostics patients at risk in data breach

An "unauthorized user" at the collections firm American Medical Collection Agency may have accessed information on 11.9 million Quest Diagnostics patients, according to a securities filing by Quest, my colleague Joe Uchill reports.

Why it matters: Quest Diagnostics is a major national provider of lab work, and the information stored by AMCA included "financial information (e.g., credit card numbers and bank account information), medical information and other personal information (e.g., Social Security Numbers)," according to the filing.