Good morning ... We'll get to health care in a second, but first, some news I am incredibly excited to be able to share with you...
Axios has signed a deal with HBO to produce a limited docu-news series airing this fall. The series will feature breaking news, interviews with the world’s most influential leaders, and short documentaries on the topics that matter most. Axios will work with HBO and a cast of Emmy®-winning producers to help viewers better understand the collision of politics, technology, business and the world.
President Trump and HHS Secretary Alex Azar. Photo: Nicholas Kamim/AFP/Getty Image
The Trump administration is making another incremental move toward lower drug prices, opening up a new part of Medicare to well-established competitive pressures.
"Step therapy" allows insurance companies and pharmacy benefit managers (PBMs) to set up a system under which patients have to start with a cheaper drug first, switching to a higher-cost alternative only if they need to.
How it works: The idea behind step therapy is partially just to switch patients to cheaper drugs. But there’s also a hope that it will prod more expensive products to offer bigger discounts, so that insurers won’t subject them to step therapy.
The impact is hard to predict. The new rules only apply to Medicare Advantage, not to traditional Medicare. MA accounts for about a third of all Medicare beneficiaries.
Why it matters: The Trump administration’s top health officials have said they’re going to bring down drug prices through greater competition, and they’ve acknowledged a lot of that will have to happen without Congress.
What’s next: PBMs cheered yesterday’s announcement, but they’re next on the chopping block. The administration is working on regulations to roll federal protections for PBMs’ highly lucrative rebates.
NBC News reported yesterday that the Trump administration is preparing a new, harder line on legal immigration — one that would also steer immigrants away from public health care programs.
The proposal would make it harder for legal immigrants to gain citizenship if they have used certain public programs, including the Children’s Health Insurance Program or coverage through the Affordable Care Act.
Last night's primaries didn't shake anything up on health care. What was true yesterday remains true today:
1. The left is insurgent, but it has not fully taken over the Democratic party.
2. Democrats want to talk about health care. Look no further than Missouri, and the race between Democratic Claire McCaskill and Republican Josh Hawley.
Finding the lowest premium is becoming less important to people shopping for coverage in the ACA’s insurance exchanges — maybe because fewer people are aware that their premiums are going up.
By the numbers: Just 23% of people who bought a plan last year said finding the lowest premium was their top priority, according to McKinsey’s annual survey of the exchange market. That’s down from roughly 60% when the exchanges first opened in 2014.
My thought bubble: All of this is consistent with what we know about the changing ACA marketplace. Unsubsidized consumers — the ones you’d expect to be most attuned to their premiums— are leaving the exchanges.
Express Scripts, the country's biggest PBM, will stop covering 48 brand-name drugs next year, directing patients instead to lower-cost alternatives.
Why it matters: Express Scripts covers more than 3,800 medications on its largest formulary, which is the basis for about 25 million Americans' prescription drug coverage. So it's an important list.
The details: Express Scripts said it cut 22 drugs because they have a cheaper generic competitor, and 12 due to brand-0n-brand competition.
Losers: AbbVie, whose hepatitis C drug Mavyret got the boot in favor of products from Merck and Gilead. But Gilead lost coverage for one of its HIV drugs to a competitor from Mylan.
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