Axios Vitals

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November 08, 2019

Good morning. Today's word count is 943, or ~3.5 minutes.

📺 Coming up on "Axios on HBO": The life-changing costs of being a whistleblower according to five who risked it all (sneak preview); Uber CEO Dara Khosrowshahi discusses the company's goals for profitability; and an exclusive poll on America's surging political anger. Tune in Sunday at 6pm ET/PT. 

1 big thing: Rural Americans can't catch a break

Data: CDC; Chart: Andrew Witherspoon/Axios
Data: CDC; Chart: Andrew Witherspoon/Axios

Preventable diseases are deadlier in rural America than in urban areas, a new CDC report says.

The big picture: More than 46 million Americans live in rural areas, and the system often works against them in nearly every dimension of care, Axios' Marisa Fernandez writes.

By the numbers: Percentages of preventable deaths in rural areas either mildly decreased between 2010 and 2017 or got worse, while urban counties saw significant decreases across the board.

  • Rural Americans tend to be older and sicker, with higher rates of cigarette smoking, high blood pressure and obesity.
  • Preventable deaths from cancer have gone down overall. Still, nearly two-thirds of deaths from unintentional injury in the most rural counties were potentially preventable in 2017.

Rural areas face access challenges, too, including a spate hospital closures and low retention of doctors.

Go deeper: The dire state of rural mental health care

2. HHS lawsuit puts patent rights on trial

The Trump administration's decision to sue Gilead Sciences — the maker of HIV prevention pills known as pre-exposure prophylaxis, or PrEP — pours gasoline on the debate about how patents and prices should work when important drugs are developed by both public institutions and private companies, Axios' Bob Herman writes.

Yes, but: "None of this will address drug pricing more generally or the unique circumstances of the HIV drug market," Jen Kates, an HIV policy expert at the Kaiser Family Foundation, said in a thread on Twitter. "And ultimately, the stakes are quite high given that PrEP can save lives."

Where it stands: The Department of Health and Human Services said in the lawsuit that Gilead has "exaggerated its role in developing" the HIV medicines and has willfully infringed patents owned by the federal government, leading to excess profits on the backs of taxpayers. The Washington Post detailed this backstory in March.

  • The government is asking for damages and royalties, which would be used to lower the prices and distribute the drugs to more people.
  • Gilead said in response that the government's claims are false and any dispute should be handled through the official patent review board, not the courts.

By the numbers: The two drugs in question, Truvada and Descovy, are significant moneymakers for Gilead.

  • Both drugs have price tags around $1,800 per month, before any discounts.
  • Generic versions of Truvada in other parts of the world cost as little $30 per person per year.

The bottom line: This lawsuit faces a long road in court, and pharmacies will soon stock generic versions of Truvada.

  • But these HIV medications remain unaffordable for a lot of people, and the lawsuit is the most direct action the Trump administration has taken to address affordability concerns and monopoly drug pricing.

3. Juul's very bad, no good rotten year

Gif of "Juul" where the u's turn upside down.
Illustration: Aïda Amer/Axios

In the past year, Juul has gone from exceeding its 2018 projections and becoming a venture capital fundraising machine to being regulators' favorite punching bag, Marisa reports.

Driving the news: Juul, the nation's largest maker of vaping products, announced Thursday it will freeze sales of its popular mint flavor, leaving only menthol and tobacco flavors available, as it tries to stay ahead of the looming crackdown on vaping by the Trump administration.

Where it stands: Juul has been pulling its flavored pods off the market for the past year.

The big picture: The Food and Drug Administration declared youth vaping an epidemic in 2018. This past summer, the Centers for Disease Control and prevention advised people to stop vaping entirely over the pulmonary lung disease from vaping.

  • Juul's executive team is undergoing massive change for the second time in two months — four executives are leaving and 500 jobs will be cut by the end of the year.
  • Juul's marketing practices are under scrutiny from the FDA, the Federal Trade Commission, several state attorneys general, the Justice Department and congressional committees.
  • The company suspended all broadcast, print and digital advertising of its products in the U.S.

Yes, but: Juul's self-policing and rapid campaign to convince America it does not target kids does not account for its international markets.

4. Walgreens' outsized role in opioid epidemic

Walgreens handled nearly one in five oxycodone and hydrocodone pills that were shipped to pharmacies between 2006 and 2012, as the opioid epidemic worsened, the Washington Post reports.

Between the lines: Walgreens is one of the companies being sued by thousands of communities across the country in federal court.

  • Unlike major drug distributors and manufacturers also being sued, it did not settle with two bellwether counties last month, and is scheduled to go to trial next year.

By the numbers: Walgreens — which bought the vast majority of its pain pills directly from manufacturers, bypassing distributors — bought about 13 billion pills over this time period. Its purchases grew over time.

  • CVS, its closest competitor, bought 3 billion fewer pills.

Because it served as its own distributor, Walgreens was also responsible for alerting the DEA to suspicious orders by its own pharmacies.

  • "Instead, about 2,400 cities and counties nationwide allege that Walgreens failed to report signs of diversion and incentivized pharmacists with bonuses to fill more prescriptions of highly addictive opioids," WashPost writes.

The bottom line: The opioid epidemic's roots run deep into the health care system, revealing profit-seeking behavior throughout the industry — which had deadly consequences.

  • The jury's still out as to whether it was illegal behavior and whether the companies involved should have to pay for the damage.

5. Air ambulance prices have skyrocketed

Air ambulances' use declined between 2008 and 2017 among people with employer coverage, but the average price of a trip more than doubled, according to new data from the Health Care Cost Institute, which is funded by insurers.

Why it matters: Air ambulances are a frequent source of surprise medical bills, and often aren't covered by private insurance. These bills can be for eye-popping amounts.

Details: There are 2 types of air ambulances, airplanes and helicopters. The use of helicopter ambulances declined by 14.3%, while the use of airplanes stayed about the same.

  • The average price of a helicopter ride increased from $11,414 in 2008 to $27,894 in 2017, or 144%. The price of a plane ride rose from from $15,684 to $41,674, or 166%.
  • However, prices varied widely.

Go deeper: How air ambulances got so expensive