Jun 14, 2018

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning from Minneapolis, where I’m town for the Piper Jaffray Heartland Summit. If you’re here too, say hello!

1 big thing: House's most important opioids bills

House Republicans at a news conference about opioids. Photo: Zach Gibson/Getty Images

The House this week is voting on a slew of measures to combat the opioid crisis, and will likely pass even more bills before the end of the month.

Most of them are pretty small — requiring studies or reports or encouraging cooperation — but Axios’ Caitlin Owens rounded up some of the proposals that could make the biggest difference.

They include …

  • Lifting the so-called “IMD exclusion” — a ban on federal Medicaid funding for mental health treatment facilities with more than 16 beds.
  • Allowing more providers to use buprenorphine, a type of medication-assisted therapy.
  • Measures to reduce the supply of prescription opioids, through new packaging and prescribing options and by looking for ways for consumers to get rid of unused pills.

What to watch: Public health experts consistently say the most important thing is access and funding for treatment.

2. ACA lawsuit could hit employer coverage

The Trump administration’s effort to roll back protections for people with pre-existing conditions is focused on the individual market for health coverage, but could also spill over to affect the larger and more popular market for employer-based insurance, the Wall Street Journal reports.

The details, per WSJ:

  • “If the courts toss some [Affordable Care Act] provisions linked to the insurance-coverage mandate, elements of the requirements that also apply to employer plans would likely be halted or reversed as well, analysts said.”
  • “Employers would again be able to impose lengthy waiting periods for health coverage on new hires.”
  • “Employers could also opt not to cover a new hire’s specific health problem, like cancer, for up to a year even if they provide them insurance.”

ICYMI: The New York Times ran through some of the potential implications for the ACA’s subsidies and the shopping process, if the administration successfully persuades a court to toss out the ACA’s coverage guarantees.

3. Actuaries: Trump rules are raising premiums

The American Academy of Actuaries reiterated yesterday what so many analyses have found: The Trump administration's regulatory moves on health care are contributing to rising premiums for ACA coverage.

  • New rules expanding access to sh0rt-term policies and association health plans could result in "market segmentation and adverse selection ... leading to higher premiums," the actuaries said.
  • And those effects "would be exacerbated given the elimination of the individual mandate penalty," they said.

Yes, but: Premium increases are a reflection of how a particular market performed relative to insurers' expectations. Some companies anticipated a lot of regulatory turmoil when they set their rates for this year; those plans may not need to raise their rates as much next year.

4. Another health care antitrust battle to watch

The pending CVS-Aetna and Cigna-Express Scripts megamergers aren’t the only big antitrust cases in health care right now. More companies are accusing Johnson & Johnson of foul play with its blockbuster drug Remicade, Axios' Bob Herman reports.

Driving the news: Pharmacy chains Walgreens and Kroger last week sued J&J by alleging the drugmaker “willfully maintained its monopoly power in the relevant market using restrictive or exclusionary conduct.”

  • Pfizer and Merck have cheaper (though still relatively pricey) biosimilar drugs that are more or less identical to Remicade, which is used to treat certain chronic immune disorders.
  • However, like Pfizer’s original lawsuit, Walgreens and Kroger allege J&J crafted contracts with major health insurers to exclude biosimilars in favor of Remicade.
  • The pharmacies allege that, because of those deals, they are forced to pay for the more expensive Remicade.

The bottom line: Biosimilars are viewed as a way to lower prices for people who take dominant biologic drugs, but their existence will not immediately provide relief to the system. 

Caitlin Owens

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