Aug 23, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning ... The average price of a date in Maryland is about $200, apparently. Guys, I think you’re doing it wrong. Go sit outside and eat some crabs. It’s delightful, and it’s like $50

1 big thing: Amazon, the dominant disruptor

Plenty of tech companies are looking for ways to break into health care, but a recent survey suggests health care executives are focused squarely on just one tech company: Amazon.

  • And among the new technologies on the horizon, industry leaders have higher expectations for telemedicine than whiz-bang tools like artificial intelligence or blockchain.

What they’re saying: Healthcare Dive flags a recent survey of health professionals — mostly from hospitals, and mainly in senior corporate leadership roles — about the future of tech and health care.

  • Asked which new entrant would have the biggest impact on the health industry, 59% said Amazon. Apple placed second at 14%; no other company cracked double digits.
  • Just among CEOs, the results are even more stark — 75% of them said Amazon will have the biggest impact of any tech competitor.

As for specific technologies, 29% of those surveyed said telemedicine will have the biggest impact on their industry, followed by artificial intelligence at 20%, and interoperability at 15%.

My thought bubble: Health care is hard to disrupt — that’s part of the reason no one has done it yet. It’s a heavily regulated space dominated by large, well-established companies. So it makes sense that the industry would see a large, wealthy company like Amazon as its most likely disruptor, even if smaller, more nimble startups are a greater threat in other sectors.

2. Justice Dept. cracks down on fentanyl

My colleague Caitlin Owens rounds up the Justice Department's latest moves to combat the opioid crisis, all announced yesterday:

1) The government barred two Ohio doctors from prescribing medicine after finding that they overprescribed painkillers and other drugs.

  • These temporary restraining orders are the first-ever civil injunctions under the Controlled Substances Act against doctors accused of illegally prescribing opioids.

2) Attorney General Jeff Sessions announced an indictment charging two Chinese citizens with manufacturing and shipping fentanyl and other drugs to 25 countries and 37 states, allegedly killing two Ohioans.

3) DOJ also announced a series of arrests, charges and guilty pleas that were a result of a joint operation with multiple other law enforcement agencies. This included the arrest of a major U.S. fentanyl vendor operating on the "dark net."

Where it stands: DOJ has already supported the massive opioids lawsuit against opioid makers and distributors, which could cost the drug industry hundreds of billions of dollars.

3. Kasich champions Medicaid expansion

Ohio Gov. John Kasich has traveled a long road on Medicaid: from trying to limit it in Congress in the 1990s to expanding it as governor. And now he’s talking up the expansion to make sure the next Ohio governor doesn’t cancel it, NPR reports.

By the numbers: His Medicaid department commissioned a study that shows:

  • The number of uninsured Ohioans has been cut in half.
  • One third said they were in better health.
  • 96% of the people in an opioid addiction program got treatment.
  • Emergency room visits were reduced by 17%.

Why it matters: Kasich isn’t exactly in the mainstream of the Republican Party right now — he’s feuding with President Trump and hasn’t ruled out running against him in 2020 as an independent. But it’s still a striking turn for a former budget hawk, and he’s hoping to influence the Republican who’s running to replace him, Mike DeWine, who’s a Medicaid skeptic.

4. Colon cancer test gets big marketing push

Exact Sciences, maker of the colon cancer test Cologuard, has signed a multimillion deal with drug giant Pfizer to increase and share in the costs of marketing the test, Axios’ Bob Herman reports.

The big picture: This marketing blitz inevitably will push more people to get checked for colon cancer, which public health experts say is a good thing. Colon cancer is the second-leading cause of cancer death in the U.S.

Yes, but: Cologuard is pretty expensive. And when compared with cheaper tests, it was tied to "more false-positive results, more diagnostic colonoscopies, and more associated adverse events per screening test," according to the U.S. Preventive Services Task Force.

Go deeper.

5. Health groups press FDA on biosimilars

More than 15 health care organizations, including consumer advocates and industry groups, are pressing the Food and Drug Administration to finalize guidance that could beef up the savings from biosimilars.

How it works: Biosimilars are comparable to generic drugs, but for the new and highly complex class of drugs known as biologics.

  • When your doctor writes you a prescription for a traditional drug, pharmacists can automatically fill it with the generic instead of the brand-name product.
  • But because biologics and biosimilars are more complex, the FDA doesn't always allow that automatic substitution.

"We are concerned that this continued dynamic will discourage further investment from biosimilar developers, and ultimately reduce the number of interchangeable biologics that reach the market," the coalition of health care organizations writes in a letter to FDA Commissioner Scott Gottlieb today.

  • The coalition is asking the FDA to finalize a guidance on interchangeability, which would give the companies developing biosimilars a clearer understanding of what they have to do in order to meet the FDA's standards.
  • Signatories include the Campaign for Sustainable Drug Pricing, along with other consumer advocates, as well as industry stakeholders representing insurers, pharmacy benefit managers and hospitals.
Caitlin Owens

What we're watching today: The Senate is still working on its HHS spending bill, and the Senate health committee holds an oversight hearing on the National Institutes of Health. (10am; livestream)

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