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HEALTH ACTION NETWORK - ADVOCATES FOR BETTER HEALTH CARE SOLUTIONS

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This Week in Health Care Reform - September 11th, 2015

As a new, expensive cholesterol drug makes its way to the market, the alarm goes up over its price and the debilitating toll that drug prices are exacting on the health care cost curve; a bill aimed at protecting small- and mid-size employers from a harmful definition change takes center stage; and, new consumer-centricity tools look to make each of us more engaged participants in our health care.

Week in Review

Rx Worries: Two new drugs targeting high cholesterol both find themselves at the center of an already overheated debate concerning the unsustainable prescription drug pricing trend currently decimating budgets across the health care landscape.  Those drugs, belonging to a new class of injectable cholesterol fighters called PCSK9 inhibitors, will each cost more than $14,000 a year.  Given that these medicines are prescribed for a lifetime, the actual costs of the drugs could be staggering.  As has been the case with other drug classes, critical analysis has already surfaced, questioning the value of these new inhibitors.  Stakeholders, from states to insurers, have also drawn a line in the sand, recognizing that the rising price of these increasingly-costly medicines poses perhaps the greatest threat to the overall health of our system.  After all, some argue, the efficacy of these new drugs is rendered irrelevant if no one can afford to use them.  Whether or not there’s a solution remains to be seen, but with the cost of prescription drugs projected to keep rising, just where our health care system goes from here is a question in desperate need of an answer. 

Small Group Bill:
A potentially disruptive definition change called for under the health care law would expand the small group employer market to include businesses with up to 100 employees, up from the current 50.  Originally designed to help small businesses, expert analysis estimates that 64 percent of employers with 51 to 100 workers would actually see an average premium increase of 18 percent as a result of being shoehorned into the small group market.  Earlier this week, the House Energy & Commerce Committee’s Subcommittee on Health held a hearing looking into the bipartisan (and bicameral – a similar bill has also been offered up in the Senate) proposal currently on the table that would instead inject stability into this market by doing away with the definition change and allowing states to decide for themselves whether or not to expand this market.  Given the partisan rancor that seems to hamstring so much of the legislative momentum nowadays, many believe that these bills are the most likely ‘fix’ to break through the Congressional morass providing much-needed relief to these employers.

Empowering Consumers:
The pace of change in the health care space has accelerated these past few years.  From the implementation of the Affordable Care Act to the ubiquity of telehealth, how and when and where we access health care has undergone a tectonic shift.  It should come as no surprise, then, that the advent of all this change has resulted in the need for each of us to become better educated, savvier consumers when it comes to our health needs.  And, for their part, stakeholders across the health care spectrum have responded.  Recognizing the important role that data and access to more resources play in making for a more engaged, more empowered health care consumer, health plans have implemented a wide range of tools to provide consumers with the meaningful information they need to make better informed, value-based decisions regarding their own health.  With health expenditures projected to grow at a faster annual rate than overall economic growth over the next decade, this focus on consumer-centricity promises to make sure that those dollars are spent wisely.

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Looking Ahead

A packed agenda greets Congress as they return to town with health care at the top of the list. 


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