About pharma
Democrats’ new logic on drug pricing: Developing slightly fewer medicines is OK if it means lower prices: The Democrats are accepting the conclusions of a Congressional Budget study that forecasted “Pelosi’s bill would save taxpayers $345 billion in the next decade and cost the drug industry as much as $1 trillion in revenue… drug companies would therefore invest less in research, leading the number of new drug approvals could fall between 2.6% and 5%.” A classic tradeoff of lower cost for lower quality.
GlaxoSmithKline kick-starts first-of-its-kind late-stage antibiotic test: This story is interesting for three reasons. First, GSK is one of very few companies still actively involved in antibiotic research, highlighting the need for expanded efforts in this sector. Second, the drug being tested, called gepotidacin, is part of a new class of compounds called triazaacenaphthylene bacterial topoisomerase inhibitors. Finally, this effort is part of a public-private partnership between GSK, the U.S. government’s Biomedical Advanced Research and Development Authority and the Defense Threat Reduction Agency.
Biopharma's top broken, unfulfilled or abandoned promises: This article provides good insights into some of the inner workings at six large pharma companies.
About health insurance
Medicare Part C and D Performance Data: CMS has just issued its star (quality) reports for these Medicare plans. You can find out the individual plan ratings, but overall:
Approximately 52 percent of MA-PDs (210 contracts) that will be offered in 2020 earned 4 stars or higher for their 2020 overall rating.
Weighted by enrollment, approximately 81 percent of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2020.
Experience with New York’s arbitration process for surprise out-of-network bills: “The biggest concern raised about NY’s arbitration process is the state’s guidance that arbiters should consider the 80th percentile of billed charges (as calculated by FAIR Health, an independent insurance claims database) when determining the final payment amount. Providers’ billed charges, or list prices, are unilaterally set, largely unmoored from market forces, and generally many times higher than in-network negotiated rates or Medicare rates. And telling arbiters to focus on 80th percentile of charges—that is, an amount higher than what 80% of of physicians charge for a given billing code—drives this standard still higher.”
This process’ problem is the equivalent of the pre-RBRVS scheme of Usual, Customary and Reasonable charges. For this process to work there needs to be an objective reference, like the Medicare rates.
Freestanding Emergency Department [FrED]Entry and Market‐level Spending on Emergency Care: “Rather than functioning as substitutes for hospital‐based EDs, FrEDs have increased local market spending on emergency care in three of four states’ markets where they have entered.” When costs increased, it was due to both price and volume.
About access to care
What if you call 911 and no one comes? “Ambulance services are closing in record numbers, putting around 60 million Americans at risk of being stranded in a medical emergency.” This is a great article that highlights how emergency medical services are not considered essential as are police and fire.
About healthcare IT
Mastercard launches healthcare products aimed at cybersecurity, predictive analytics: Mastercard Healthcare Solutions is a new business for the credit card company that will, among other services, offer cybersecurity.
About the public’s health
Cleaning plant troubles could lead to hospital tool shortage: “The Food and Drug Administration flagged the issue in an online statement to medical professionals, saying the result could be years of shortages of supplies used in heart surgery, knee replacements, C-sections and many other procedures.” The reason is environmental contamination with ethylene oxide.