Dec 12, 2018

Axios Vitals

Good morning ... If you're attending Axios' health care event this morning, stop by and say hello!

And, keep the party rolling on Thursday, when Axios managing editor Kim Hart will interview both chairs of the Artificial Intelligence Caucus: Reps. John Delaney and Pete Olson, as well as Rep. Debbie Dingell. RSVP here.

1 big thing: HHS edited

Photo: Karen Bleier/AFP/Getty Images

The Health and Human Services Department edited in a way that seems to subtly steer people toward other, private enrollment options, according to a review by the Sunlight Foundation.

Details: The edits, which were made roughly 2 weeks into the 6-week enrollment period, affect the “How to Apply & Enroll” page on

  • 2 enrollment options — phone and mail — were removed altogether. Unpaid enrollment “assisters,” whose budgets have been cut significantly, were rolled in with agents and brokers.
  • The option to use went from the first option listed to the last.
  • Above it are links to external enrollment sites run by for-profit companies, including insurers’ websites. That’s consistent with HHS’ desire to open up more “direct enrollment” pathways, but some of those pathways may not list all of consumers’ options.

My thought bubble: On the merits, this does not seem particularly likely to set back overall enrollment very much. Hardly anyone enrolls by mail, and other parts of, including its homepage, still list the number of the call center for people who want help over the phone.

  • Still, coming as it does on top of outreach cuts and policy changes that weaken the Affordable Care Act, don’t be surprised if this sparks new criticism from the law’s supporters.
2. House passes a baby step on drug prices

The House yesterday overwhelmingly passed a bill cracking down on some of the tactics Mylan used to pay lower Medicaid rebates for the EpiPen. The Senate is hoping to pass the bill this year, Axios' Caitlin Owens reports.

The big picture: EpiPen was misclassified as a generic drug within Medicaid, which resulted in Mylan paying less in rebates and causing taxpayers to overpay as much as $1.27 billion over 10 years, according to one government estimate.

  • The new bill gives HHS the explicit authority to reclassify drugs, recover incorrect rebate payments, and fine drugmakers that knowingly misclassify drugs.
  • While this bill is small, it's also a sign of at least some bipartisanship on drug prices.

By the numbers: Only about 3% of drugs in the Medicaid rebate program were potentially misclassified in 2016, according to an HHS report.

  • Medicaid reimbursement for these drugs totaled about $813 million.
  • While 54 drugmakers may have misclassified drugs, 4 were responsible for more than half of all potential misclassifications.
  • Between 2012 and 2016, drugmakers may have owed an additional $1.3 billion in rebates for just 10 potentially misclassified drugs.
3. Envision and United make a deal

The feud between insurance giant UnitedHealthcare and staffing giant Envision Healthcare has come to an end, at least for now.

Driving the news: UnitedHealthcare announced yesterday that it has renewed its contract with Envision, after threatening earlier this year to quit doing business with the ER-staffing firm due to a pricing dispute.

  • If the breakup had stuck, its millions of customers could have been on the hook for big surprise bills if they were treated by Envision doctors.
4. There's a new generic version of naloxone

Kaléo is introducing a generic version of its naloxone drug, EVZIO, which is used to revive people who have overdosed on opioids, Caitlin reports.

  • The generic will be available in mid-2019 and will cost $178 for 2 auto-injectors.
  • The company is also making EVZIO available for the same price to government agencies, first responders and health departments.
  • "We recognize that more needs to be done to improve access for patients,” Spencer Williamson, the company's president and CEO, said in a press release.

Between the lines: This announcement follows an investigative report by Sens. Rob Portman and Tom Carper that found Kaléo increased the price of EVZIO by more than 600% since it went to market in 2014.

  • The price has increased from $575 per unit (1 unit = 2 injectors) to the current price of $4,100.
  • The report pointed to company documents showing its distribution model sought to “capitalize on the opportunity” of “opioid overdose at epidemic levels” and “a well established public health crisis."
  • Narcan, a version of naloxone that can be administered as a nasal spray, is a more commonly prescribed overdose remedy.
5. 4.2 million could get $0 ACA coverage

Roughly 4.2 million people, or 27% of uninsured Americans, could get ACA coverage with a $0 premium, the Kaiser Family Foundation said yesterday. The poorest consumers are eligible for subsidies that would be big enough to cover the entire premium for a lower-tier “bronze” plan.

Yes, but: Bronze plans have high deductibles — more than $6,200 per year, on average, according to Kaiser.

  • Many of the people eligible for a bronze plan with a $0 premium would actually be better off going one level up, to a “silver” plan, where they’d have to pay part of the premium every month but could get help with their out-of-pocket costs.

My thought bubble: This is a pretty complicated calculation to ask people to do, especially those who don’t have a clear picture of how much health care they’ll need next year.