DCMedical News: Thursday, June 9, 2022
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Thursday, June 9, 2022
DRUG PRICES, PHARMA AND PBMS
A study in JAMA (here) on 1230 new drug products 2008-2021 found that “Median launch prices increased from $2,115 per year in 2008 to $180,007 per year in 2021. The proportion of drugs priced at $150,000 per year or more was 9% in 2008-2013 and 47% in 2020-2021. Unadjusted mean launch prices increased exponentially by 20.4% per year.” This increase was still over 11% per year, taking into account discounts and changing drug characteristics.
Background from the study: “Prescription drug spending in the US exceeded half a trillion dollars in 2020. Spending is driven by high-cost brand name drugs, for which manufacturers freely set prices after approval. Rising brand-name drug prices often translate to payers restricting access, raising premiums, or imposing unaffordable out-of-pocket costs for patients. We evaluated recent trends in prices for newly marketed brand-name drugs.”
The authors concluded: “The trend in prices for new drugs outpaces growth in prices for other health care services. Even after drugs are marketed, manufacturers routinely increase prices over time; in another analysis, net prices increased by 4.5% per year from 2007 to 2018. In response to the current trends, the US could stop allowing drug manufacturers to freely set prices and follow the example of other industrialized countries that negotiate drug prices at launch.”
The Federal Trade Commission is aiming its scrutiny at pharmacy benefit managers (PBMs), announcing (here) a major inquiry into the six largest pharmacy benefit managers to provide information and records regarding their business practices. As part of this inquiry, the FTC will send compulsory orders to CVS Caremark; Express Scripts, Inc.; OptumRx,Inc.; Humana Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc.
A significant price problem, according to the FTC, is that “The largest pharmacy benefits managers are now vertically integrated with the largest health insurance companies and wholly owned mail order and specialty pharmacies. In these roles, pharmacy benefit managers often have enormous influence on which drugs are prescribed to patients, which pharmacies patients can use, and how much patients ultimately pay at the pharmacy counter. Many of these functions depend on highly complicated, opaque contractual relationships that are difficult or impossible to understand for patients and independent businesses across the prescription drug system.”
The agency said their “Inquiry is aimed at shedding light on several practices that have drawn scrutiny in recent years including: fees and clawbacks charged to unaffiliated pharmacies; methods to steer patients towards pharmacy benefit manager-owned pharmacies; potentially unfair audits of independent pharmacies; complicated and opaque methods to determine pharmacy reimbursement; the prevalence of prior authorizations and other administrative restrictions; the use of specialty drug lists and surrounding specialty drug policies; the impact of rebates and fees from drug manufacturers on formulary design and the costs of prescription drugs to payers and patients.”
The FTC began this work with a “request for information” from the public and interested parties, issued February 24, 2022, in response to which 24,000 public comments have been received.
InsideHealthPolicy (here) reported that “West Virginia Democratic Sen. Joe Manchin on Monday (June 6) reiterated that if the Senate is unable agree on climate and energy policies to include in a reconciliation package, lawmakers should simply move forward with drug pricing reforms . . . He also suggested that a cap on prescription drug pricing would be an ‘easy one for us to do,’ since Democrats already agreed on the drug policies as part of the now-stalled Build Back Better plan . . . The new comments echo what Manchin said during a recent AARP event, when he also suggested that, if nothing else can get done this session, Democrats must pass drug pricing reforms.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Surgeon General Issues Advisory on Health Worker Burnout—A System Problem, Not a Mental Health Problem
The nation’s top health official has issued a 76-page advisory (here) on health worker burnout, noting “Even before the COVID-19 pandemic, the National Academy of Medicine found that burnout had reached “crisis levels” among the U.S. health workforce, with 35-54% of nurses and physicians and 45-60% of medical students and residents reporting symptoms of burnout . . . People in any profession can experience burnout, yet it is especially worrisome among health workers given the potential impacts on our health care system and therefore, our collective health and well-being. Burnout is associated with risk of mental health challenges, such as anxiety and depression—however, burnout is not an individual mental health diagnosis. While addressing burnout may include individual-level support, burnout is a distinct workplace phenomenon that primarily calls for a prioritization of systems-oriented, organizational-level solutions.”
He added, “Burnout among health workers has harmful consequences for patient care and safety, such as decreased time spent between provider and patient, increased medical errors and hospital-acquired infections among patients, and staffing shortages.”
A commentary on the Advisory in JAMA Health Forum (here) cites these recommendations: “Providing living wages and paid sick and family leave; evaluating workloads and working hours; offering family friendly policies, including child care and care for older adults for all health care workers; ensuring that staffing is adequate (including for surge capacity in public health emergencies) and that workers have sufficient protective equipment; taking steps to protect health workers from workplace violence; reducing documentation and other administrative burdens; and providing support for educational debt. Other recommendations included identifying key work stressors that can put workers at a higher risk of suicide and removing punitive policies for workers who seek mental health or substance abuse treatment.”
Additional recommendations regarding health worker burnout are coming, per the JAMA commentary: “On June 24, the National Academy of Medicine is releasing a new report, the National Plan for Health Workforce Well-Being . . . The plan is the work of the academy’s Action Collaborative on Clinician Well-Being and Resilience (also known as the Clinician Well-Being Collaborative), a network of more than 200 organizations “committed to reversing trends in clinician burnout.”
Not Unrelated . . .
Epic examined nurse staffing through shifts recorded in its eponymous automated medical record systems (here), finding that the “new nurse” is the “new normal” in hospitals. “Between March 2021 and March 2022, median nursing tenure fell by 19.5%; Shifts covered by nurses new to the organization in the last 30 days increased in all regions; The number of 12-hour shifts filled by nurses new to the organization within the last year also rose by 55.5%.”
Background: “With COVID-19's increased demands on healthcare workers, nursing staff shortages have been widespread. We evaluated data from more than 26 million 12-hour nursing shifts across 189 U.S. healthcare organizations to determine how much nursing staff turnover healthcare organizations are experiencing. One measure of turnover is the median length of time nurses have been at their current organization. We found that from March 2021 to March 2022, median tenure dropped 19.5% across all U.S. regions.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
SEIU Presses TJC to Include “Safe Staffing” in Accreditation Reviews
Becker’s reports (here) that “Hospital workers and allies in Illinois and Indiana are urging The Joint Commission to add staffing standards to its accreditation and licensing process for healthcare facilities. The campaign is being led by Service Employees International Union Healthcare Illinois, which represents 90,000 hospital, nursing home, home care and child care workers in the Midwest. The workers driving the campaign include nurses, environmental services workers, technicians and nursing assistants. A petition delivered to The Joint Commission June 7 asks the organization to examine hospitals on their overall staffing as part of their accreditation and licensing process.”
More on the union presentation and activities here.
READINGS & REFERENCES
Select Coronavirus Public Health Resources and References may be found here.
The JAMA Patient Page explains the current status of oral anti-viral medications for COVID-19, here.
2022 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
June 10, 13, 14, 15, 16, 21, 22, 23, 24
July 12, 13, 14, 15, 18, 19, 20, 21, 26, 27, 28, 29
August, Congress adjourned, no editions of DCMN
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org