Overnight Health Care: Senators probing cancer drug price hike | Iowa governor signs law allowing plans outside ObamaCare | Study links legalized marijuana to fewer opioid prescriptions

Overnight Health Care: Senators probing cancer drug price hike | Iowa governor signs law allowing plans outside ObamaCare | Study links legalized marijuana to fewer opioid prescriptions
© Greg Nash

Happy Monday, and welcome to Overnight Health Care. Congress is still on recess (vacation) and the health care world is pondering what it would actually look like if Walmart bought Humana.

 

Three senators are launching a probe into why a 40-year-old cancer drug has increased in price by 1,400 percent since 2013.

The drug in question, lomustine, was introduced in 1976 to treat brain tumors and Hodgkin lymphoma.

Lomustine, which has no generic competition, cost $50 for a capsule with the highest dose in 2013. Now a capsule with the same dose costs $768.  

The scrutiny comes as the Trump administration and Congress look for ways to lower ever-escalating drug prices, and as drug manufacturers, insurers and pharmacy benefit managers (the middlemen) continue to battle over whose fault it really is.

 

Energy and Commerce Committee Republicans are asking the Trump administration for more information about nursing homes participating in Medicare and Medicaid following media reports detailing instances of abuse and neglect.

Committee leaders specifically asked about the Florida nursing home that lost 14 residents in the wake of Hurricane Irma, after the facility's air conditioning failed.

"These reports raise serious questions about the degree to which the Centers for Medicare and Medicaid Services (CMS) is fulfilling its responsibility to ensure federal quality of care standards are being met, as well as its duty to protect vulnerable seniors from elder abuse and harm in facilities participating in the Medicare and Medicaid programs," Chairman Greg WaldenGregory (Greg) Paul WaldenHouse GOP blocks Trump-supported drug pricing provision from spending bill GOP turns its fire on Google Hillicon Valley: Twitter chief faces GOP anger over bias | DOJ convenes meeting on bias claims | Rubio clashes with Alex Jones | DHS chief urges lawmakers to pass cyber bill | Sanders bill takes aim at Amazon MORE (R-Ore.) and others wrote in a letter to CMS.

 

In the states

Iowa's governor signs law allowing plans outside ObamaCare

States are continuing to try to see if they can let insurers sell plans that don't comply with ObamaCare's consumer protections. Idaho tried, but was shot down by the Trump administration because it essentially decided it was going to ignore that ObamaCare exists. But Iowa could signal a path forward.

Iowa's governor on Monday signed into law that allows insurers to sell cheaper plans that don't comply with certain ObamaCare requirements, like covering mental health care, substance abuse treatment or even pre-existing conditions.

While critics say this would send Iowa back to the pre-ObamaCare days when insurers could discriminate, there may not be much of a legal recourse. These self-funded "health benefit plans" would not actually be considered health insurance, so they wouldn't have to comply with ObamaCare's requirements.

It's a loophole to be sure, but as the Trump administration is looking for ways to ease the ObamaCare "burden," alternative coverage arrangements could be the next big innovation from states.

 

California is suing one of the state's largest hospital networks over high health costs.

Here's a case state attorneys general will be watching: California on Friday sued Sutter Health for "anticompetitive practices" that increase health care costs.

California Attorney General Xavier Becerra (D) alleges Sutter Health has used its power to exclude competition and increase prices for patients substantially.

"Sutter Health is throwing its weight around in the healthcare market, engaging in illegal, anti-competitive pricing that hurts California families," Becerra said in a statement. "These tactics are risking Californians' lives by driving up the cost of healthcare for everyone."

However this case goes, it will have an impact on consolidation in the health care industry.

 

Fewer opioids prescribed in states that have legalized marijuana, study finds.

States that have legalized marijuana for medical or recreational purposes have seen fewer opioid prescriptions for Medicaid patients, according to a study published in the Journal of the American Medical Association.

This isn't exactly surprising. Research has shown similar correlations between legal marijuana and the number of opioid prescriptions and overdoses.

But as the U.S. continues to fight the opioid epidemic that killed 42,000 people last year, states should consider legalizing marijuana, the authors argue.

"The potential of marijuana liberalization to reduce the use and consequences of prescription opioids among Medicaid enrollees deserves consideration during the policy discussions about marijuana reform and the opioid epidemic," the authors of the study wrote.

 

The Trump administration on Monday released a sweeping final Medicare rule that included some policy changes intended to combat the opioid epidemic.

Specifically, the rule will allow Medicare Part D plan sponsors to implement drug management programs, which can limit at-risk beneficiaries' access to coverage for frequently abused drugs.

Sponsors will be allowed to "lock-in" certain beneficiaries to a selected prescriber and/or pharmacy in order to limit their access to frequently abused drugs.

Opioid abusers often try to obtain drugs from multiple doctors or pharmacies; this provision attempts to prevent that.

The policy was included as part of the Comprehensive Addiction and Recovery Act, which was signed into law in 2016.

 

What we're reading:

NIH rejected a study on alcohol advertising while pursuing industry funding for other research (Stat)

Grindr is letting other companies see user HIV status and location data (Buzzfeed)

Schools struggle with vaping explosion (The New York Times)

 

Op-eds in The Hill

'Right to try' preserves patient freedom, puts regulators on right path  

Americans want cheaper, generic drugs -- time for Congress to deliver