Aug 28, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. Even members of well-known bands can get hit with medical bills that they can't afford, as evidenced by this GoFundMe page for Janet Weiss, the drummer of Sleater-Kinney.

  • Weiss was in a car accident, and the fundraising page is for the bills that insurance doesn't cover. Donors appear to include Peal Jam's Matt Cameron, R.E.M.'s Peter Buck and Death Cab for Cutie's Ben Gibbard.

My colleague Shane Savitsky, who flagged this news, has a slightly different take: "It looks like things haven't changed that much from 2012, when Grizzly Bear's Ed Droste told New York magazine that 'indie-rock royalty' is often just getting by."

Today's word count is 909 words, or ~3 minutes.

1 big thing: Purdue has reportedly offered an opioids settlement

Illustration: Lazaro Gamio/Axios

Purdue Pharma and its owners, the Sackler family, have proposed a settlement in the nationwide opioids lawsuit that would be worth $10 billion–$12 billion, NBC News first reported yesterday.

Why it matters: Purdue is the focal point of this litigation, but the proposed settlement would amount to only a fraction of what the opioid epidemic has cost the U.S. — and only about a third of Purdue's OxyContin sales, my colleague Sam Baker writes.

What they're saying: While the plaintiffs didn't formally comment on the report, one of the lead attorneys, Paul Hanly, told Reuters in an email that the NBC report was, "Made up. Ridiculous."

  • But Reuters and other outlets confirmed NBC's reporting. A source told the Washington Post that the plaintiffs are seriously considering the offer.

The big picture: The total settlement would include donations of life-saving anti-overdose drugs and the proceeds from the sale of other drugs. The Sacklers would also sell off a separate business to contribute another $3 billion.

  • The family is worth an estimated $13 billion, and Purdue made more than $35 billion from OxyContin sales, per NBC.

Go deeper: Why the first opioids lawsuit verdict is both big and small

2. Opioid manufacturers' new market: India

As all of this is being sorted through in court, opioid manufacturers are fueling the rise of India's painkiller market, the Guardian reports with Kaiser Health News.

The big picture: Indians have in the past viewed pain as something to be suffered through, but that mindset is changing, and the result is eerily similar to the early stages of what Americans now consider a crisis.

  • The spread of pain clinics across the country has also been aided by the relaxation of India's narcotics laws.

The very same drug companies being sued by communities ravaged by the opioid epidemic are selling opioid products in India.

  • A subsidiary of Johnson & Johnson, which was found responsible for Oklahoma's opioid problem earlier this week, is selling a fentanyl patch.
  • The Sackler family also controls a network of companies selling buprenorphine.

The other side: Pain relief is no doubt a good thing for Indians who previously suffered from excruciating cancer pain or died horribly painful deaths, an argument made by palliative care advocates to government officials who permitted the sale of opioids.

  • But as the U.S. has proven, there is a very fine line between compassionate health care and opioid overuse and abuse.
  • "Are people going to figure out every trick in the game to make [opioid painkillers] widely available?" Bobby John, a leading Indian public health expert, asked the Guardian. "Of course it will happen."
3. The provider lobby takes on Congress

Illustration: Aïda Amer/Axios

Ending surprise medical bills inspires bipartisan kumbaya in a way nearly unheard of these days, and yet a brutal lobbying and public relations blitz by doctor and hospital groups is threatening to kill the entire effort.

Driving the news: Provider-backed groups are spending millions of dollars to sway lawmakers and the public opinion against Congress' efforts to ban surprise billing, according to a handful of recent reports.


  • A dark money group called Doctor Patient Unity has spent more than $13 million on advertising in states where senators are up for re-election, Bloomberg Government reported on Monday — the most expensive campaign on any congressional health care topic this year.
  • Modern Healthcare's Susannah Luthi wrote yesterday that some congressional staffers worry that the provider onslaught will cause the entire surprise billing effort to collapse. The staffers say that may be what the groups want; providers insist this isn't the case.
  • My colleague Bob Herman reported last week that physician outsourcing companies — which are often the source of surprise medical bills — and private equity firms have flooded Congress with lobbyists.

The other side: Other congressional aides are less worried. "If anything, [providers'] tactics are backfiring. Compassion is winning. Members are more concerned for patients than a profit fight between industries," a GOP aide familiar with the effort told me.

  • Instead, "members are beginning to question private equity's interest in this. What is it they're willing to invest $13 million to save and why are they hiding behind dark money?"
4. Tobacco giants consider a merger

Philip Morris International and Altria are in talks for an all-stock merger, the former confirmed on Tuesday morning. The companies cautioned that there's no guarantee a deal would be struck, my colleague Kia Kokalitcheva reports.

Why it matters: This would result in a mega-tobacco company, reuniting PMI and Altria more than a decade after they split. While Altria has focused on the U.S. market, PMI has been mostly selling overseas. Both have made moves into e-cigarettes.

The bottom line: "While Altria is helping Juul expand its reach in the U.S., the company has little help to offer overseas. Combining with PMI could change that," Angelica LaVito and David Faber write on CNBC.

5. Medicare is paying twice for hospice drugs

Medicare is wasting hundreds of millions of dollars every year by duplicating payments for prescription drugs used in hospices, a new report from the Office of Inspector General says.

How it works: Medicare pays hospices lump sums for each day someone gets care, and those amounts include any medicines used to help someone’s terminal illness, Axios' Bob Herman writes.

  • It turns out Medicare's prescription drug plans, run by health insurers and pharmacy benefit managers, and hospice patients themselves also have been paying for those same drugs — a problem that has endured for years now.
  • That double-dipping wasted $161 million in 2016 alone.

The bottom line: Dysfunction between the federal government, private health plans and hospices is unnecessarily forcing higher costs on taxpayers and people who may be nearing death.

Caitlin Owens