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This Week in Health Care Reform - June 10th, 2016

Concern mounts over cancer drug prices; new rules aimed at shoring up the stability of the insurance exchange marketplace are issued; patient engagement may hold the key to substantive delivery reform; and, analysis of the GOP’s latest health care law proposal continues.


Week in Review

Cancer Drug Spending: Global spending on cancer drugs hit $107 billion last year and is expected to reach $150 billion by 2020, according to a new report from IMS Health.  The increase is largely owing to the dramatic expansion of drugs in the oncology pipeline, which, over the past decade, has seen the number of drugs in clinical development rise by over 60 percent.  Meanwhile, a separate study took aim at evaluating the cost of major cancer drugs in seven different countries.  Presented at the American Society of Clinical Oncology (ASCO) annual meeting, the results found that, across the board, the median prices for cancer drugs in the U.S. are the highest, with the lowest being found in India and South Africa.  However, in a separate measure of affordability, the study found that, despite being less expensive in low-income countries, those drugs were, in fact, less affordable to patients there.  Geography notwithstanding, the financial burden associated with the cost of cancer drugs is of growing concern for patients and oncologists.  A different survey, also presented at the ASCO annual meeting, found that 1-in-10 patients skipped doctor visits, while nearly 1-in-5 didn’t fill prescriptions due to cost.

Rules Issued: In an effort to strengthen the insurance exchange marketplace, the Centers for Medicare & Medicaid Services (CMS) on Wednesday issued a proposed rule targeting the loopholes weakening the risk pool, the mix of healthy and sick enrollees critical to the vibrancy of a sustainable insurance market.  In short, the proposed rule would eliminate the loopholes that allow short-term plans to operate outside the requirements established by the Affordable Care Act, while limiting these transitional policies to three months.  Abuses of these short-term plans, which can be leaner and less expensive than the traditional plans offered through the exchanges, are believed to be siphoning-off healthier enrollees from the risk pool, adversely affecting the stability of the marketplace.  While a necessary step in shoring up the exchanges and protecting them from further gaming of the system, it remains to be seen whether the new rule from CMS does enough to address the long-term stability of the marketplace.

Engaged Patients:
As our relationship to health care delivery continues to evolve, the focus has shifted away from traditional fee-for-service to one of value-based design.  Integral to that shift is the voice that we, as consumer-patients, have in our own health care needs.  Former Department of Health & Human Services (HHS) Secretary Kathleen Sebelius believes that the industry listening to that voice will be the real breakthrough for health care.  In a recent appearance, Sebelius, who headed up HHS from 2009-2014, spoke of her belief that engaged patients will “be one of the biggest elements to change delivery systems.”  That engagement, she elaborated, included patients gaining greater access to more health information and using that knowledge and transparency to ask questions and raise concerns.  When asked about what the future holds, she went on to say that interoperability represents a huge goal, while cybersecurity remains a troublesome challenge.

GOP Plan:
As covered in last week’s newsletter, a new proposal offering up an alternative to the Affordable Care Act was introduced late last month by Rep. Pete Sessions (R-Texas) and Sen. Bill Cassidy (R-Louisiana).  What sets their bill apart from Republicans’ previous attempts at dismantling the health care law, is the emphasis on providing an alternative to the Affordable Care Act, rather than a replacement.  Regardless of how their goal lines have changed, though, experts are quick to remind us that the differences between opponents’ objectives and those that remain steadfast in their support of the health care law are less about different means to the same ends, but, rather, different means to different ends, each legitimately grounded in political and policy priorities and, not to be discounted, each with their own compromises.

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