Mar 12, 2019

Axios Vitals

Good morning ... Roses, chocolate, plastering a 40-foot-tall photo of your wife's face on the side of a building — so many ways to say "I love you." So many normal, balanced, just-the-two-of us ways ...

1 big thing: Lawsuit calls Johnson & Johnson an opioids "kingpin"

Illustration: Lazaro Gamio/Axios

Johnson & Johnson was the "kingpin" that fueled the country's opioid crisis, serving as a top supplier, seller and lobbyist, according to a state official leading the legal fight against the companies that helped create the crisis.

Driving the news: Oklahoma Attorney General Mike Hunter has asked a state court to publicly release millions of pages of confidential J&J documents, Axios' Bob Herman reports this morning.

  • Oklahoma's lawsuit against opioid makers is set to go to trial in May. It'll be the first such trial in the country, and therefore a model for other states.

The intrigue: Johnson & Johnson has an extensive history with prescription painkillers.

  • J&J produced raw narcotics in Tasmanian poppy fields, created other active opioid ingredients, and then supplied the products to other opioid makers — including Purdue Pharma.
  • The company boasted at the time that one of its opium poppies "enabled the growth of oxycodone," and said the morphine content of a different poppy was "the highest in the world," according to investor slides obtained by Axios.

That's not all: Oklahoma is alleging J&J targeted vulnerable populations, including children and older adults, for painkiller prescriptions. The state also says J&J funded groups that aggressively advocated for easy access to opioids.

The other side: J&J urged the Oklahoma court to deny the attorney general's request, saying the state is seeking "sensationalistic headlines and to poison potential jurors."

  • J&J's attorneys also wrote that "even if the motion advanced a legitimate purpose," it would violate the court's processes.
  • In statements to Axios, J&J said its subsidiaries "met all laws and regulations" and that all allegations are "baseless and unsubstantiated."

The bottom line: Purdue Pharma has become the primary villain in opioid litigation so far. But Oklahoma clearly sees J&J as another prime target.

Go deeper.

2. What matters in Trump's budget

Presidential budget proposals — all of them, no matter the president — are aspirational. They are not bills with the potential to be signed into law; they are statements about an administration's priorities.

With that in mind, here are the health care highlights from the budget proposal the White House released yesterday.

Things that only matter politically:

  • The budget still embraces Republicans' failed repeal-and-replace policy, including its enormous Medicaid cuts.
  • That's not going anywhere in Washington, but it'll be a big deal for Democrats on the 2020 campaign trail.

Ideas to watch:

  • Trump's budget proposes big payment cuts for brand-name drugs that enter into "pay for delay" settlements — agreements in which they pay a potential generic competitor to stay off the market, which keeps other generics at bay, too.
  • It proposes an annual fee on e-cigarette makers to help fund FDA regulation of their products. Cigarette companies already pay such a fee.
  • And it calls for capping seniors' out-of-pocket drug costs.

The details:

  • Budgets are about money, and this one would cut several HHS offices.
  • The National Institutes of Health would lose almost $5 billion (Congress will never go along with that), while the FDA would get a slight bump.
  • HIV/AIDS activists praised the budget for including nearly $300 million toward Trump's plan to "eliminate the HIV epidemic" within the U.S., but criticized its proposed cuts to housing and other social services, as well as international HIV prevention efforts.

What's next: HHS Secretary Alex Azar heads to Capitol Hill for hearings on the budget today (before House Energy and Commerce), tomorrow (House Appropriations) and Thursday (Senate Finance).

3. About those Medicare cuts

Democrats are already giddy over the opportunity to criticize Trump's budget for cutting more than $800 billion from Medicare.

Reality check: Yes, the budget proposes reducing Medicare spending by more than $800 billion over a decade.

  • But these are not reductions in seniors' benefits. They're (theoretical) cuts in Medicare's payments to health care providers, mainly hospitals.
  • I'm so old I remember the 2012 election, when the Romney campaign hammered the Affordable Care Act for cutting almost $800 billion from Medicare, and President Obama fought back on the grounds that cutting provider payments was not the same as cutting benefits.

Between the lines: Some of Trump's specific cuts are bipartisan.

  • Trump's budget projects about $260 billion in savings from policies designed to stop hospitals from boosting their payments by buying up doctors' practices — an idea Obama also embraced.
  • Some savings would come from the administration's plans to lower Medicare's spending on prescription drugs.

You can choose your hypocrite here — Democrats are criticizing something they've done; Republicans are doing something they've criticized.

  • My thought bubble: Providers and policymakers can duke it out over whether this or that payment reduction is bearable or not. But on the politics, Obama had a point in 2012 and the White House has a point now.
  • If you think health care in the U.S. is too expensive, solving that problem means somebody has to get less money.
4. Hospitals are a dangerous workplace

Photo: Jonathan Torgovnik/Getty Images

Hospitals can be volatile and dangerous places to work, and there's not necessarily any one solution to that problem.

By the numbers: Serious violence is 4 times more common in health care settings than in private-sector workplaces overall, Modern Healthcare reports — and that’s only counting violence severe enough to require time off.

  • "Daily, literally daily, we're exposed to violent outbursts, in particular in our emergency rooms," Cleveland Clinic CEO Tom Mihaljevic said.

What they're saying: Hospitals generally have to come up with their own solutions, because they each have to balance their specific risks against their specific facilities and operations.

  • They've tried "panic buttons, badge access to certain areas, limited guest hours, metal detectors, police presence, security cameras, de-escalation training, emergency preparedness and more," per Modern Healthcare.
  • There's a bill in the California legislature to increase the criminal penalties for attacking a health care worker inside a hospital. It would bring those consequences in line with the penalties for attacking a first responder in an emergency.
5. Fragmented care led to more overdoses

About half the veterans who get their care through the VA are also eligible for Medicare's drug benefit — and they're more likely to overdose on prescription opioids than patients who use either the VA or Medicare alone.

  • That's the finding from a new study published today in the Annals of Internal Medicine.

Why it matters: We obviously would prefer to have as few veterans as possible die from overdoses, and these findings are also a good reminder that care fragmentation is an issue throughout the system.

  • The study "underscores the importance of care coordination across health care systems to improve opioid prescribing safety," its authors wrote.