Enemy of the Employer, or Protector of the Constitution: The U.S. Chamber of Commerce
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The U.S. Chamber of Commerce has sued the federal government (Complaint, here), challenging the new Medicare power to negotiate drug prices with pharmaceutical companies.
In its Complaint, the Chamber said the pricing program violated drugmakers' due process rights under the Constitution by giving the government "unfettered discretion" to dictate maximum prices. It said the program would impose exorbitant penalties on drugmakers that don't accept those prices.
From the Complaint, “The IRA [Inflation Reduction Act] uses the term ‘negotiation’ to mislead the public into believing that a voluntary and fair bargaining process will take place between the government and pharmaceutical companies. The reality, however, is that Congress has not set up a negotiation at all. Congress created an unprecedented, one-sided regime that forces manufacturers to sell drugs at government-set prices.”
“If all that Congress wanted to accomplish was to limit the price paid by the government for prescription drugs in federal healthcare programs, the IRA’s unprecedented approach would be wholly unnecessary. But openly legislating price controls on critical prescription drugs would be politically untenable. And creating a genuine ‘negotiation’ process could lead to prices that are reasonable and market-based, rather than confiscatory or arbitrary. Congress wanted price controls without incurring a political cost for imposing them.”
“So Congress crafted the IRA’s sham ‘negotiation’ scheme to hide that reality, empowering HHS to transform the nation’s drug markets without taking political responsibility for the inevitable upheaval or facing judicial scrutiny.”
U.S. Government Sets Price Hike Penalties on 43 Drugs
Reuters reports that “The Biden administration on Friday announced it would impose inflation penalties on 43 drugs for the third quarter of 2023, having fined 27 earlier this year, in a move it said would lower costs for older Americans by as much as $449 per dose.” A report from BioPharmaDive is here.
“Drugmakers hiked the price of these 43 drugs by more than the rate of inflation and are required to pay the difference of those medicines to Medicare, the federal health program for Americans over age 65.”
The “Inflation Reduction Act” includes a provision that penalizes drugmakers for charging prices that rise faster than inflation for people on Medicare. In March, the administration said it would impose fines for 27 drugs for the second quarter of this year; this new list of 43 replaces that list of 27 for the third quarter of 2023.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Young People Dying at a Faster Rate
The Wall Street Journal (here) reports on death rates among the young, including a study in JAMA (here) [which] finds that “Between 2019 and 2020, the overall mortality rate for ages 1 to 19 rose by 10.7%, and increased by an additional 8.3% the following year . . . That’s the highest increase for two consecutive years in the half-century that the government has publicly tracked such figures.”
The Journal adds, “The U.S. is the only place among peer nations where firearms are the No. 1 cause of death in young people. Suicides among Americans age 10 to 19 began increasing in 2007, while homicide rates for that age group started climbing in 2013.”
The Cost of Intervening to Address Social Determinants of Health
A study in JAMA Internal Medicine (research here, accompanying commentary here) focus on the cost of implementing evidence-based interventions to address social needs identified in primary care practices.
The study found that “food and housing interventions were limited by low enrollment among eligible people, whereas transportation and care coordination interventions were more limited by narrow eligibility criteria. Screening and referral management in primary care was a small expenditure relative to the cost of interventions to address social needs, and just under half of the costs of interventions were covered by existing federal funding mechanisms.”
“These findings suggest that many resources are necessary to address social needs that fall largely outside of existing federal financing mechanisms.”
Navigating Home Care Is No Easier
David Grabowski, former MedPAC Commissioner, and colleagues describe the difficulty of navigating home care, for patients, their families, and for providers, in JAMA Internal Medicine, here. “The reality is that getting patients the care they need at home in the US is complex and under resourced. Most people do not plan ahead. Rather, they think about home care after their health deteriorates or a crisis ensues. Physicians sometimes suggest it, but office visits are short, and few of us have been formally trained on the topic. Even when physicians are equipped, we lack the bandwidth to walk patients adequately through the maze.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospice Care Worse in For-Profit Facilities
A profile of hospice care, in The New York Times (here), finds that “Researchers have for years reported that there are, indeed, substantial differences overall between for-profit and nonprofit hospices; a new study based on family caregivers’ experiences provides additional evidence.”
“Medicare began covering hospice care four decades ago, when most hospices were nonprofit community organizations relying heavily on volunteers. It has since become a growth industry dominated by for-profit businesses. In 2001, 1,185 nonprofit hospices and just 800 for-profits provided care for Americans with terminal illnesses who were expected to die within six months. Twenty years later, almost three-quarters of the nation’s 5,000-plus hospices were for-profits, many affiliated with regional or national chains.”
“Roughly half of Americans who die each year now turn to hospice. The number of Medicare beneficiaries enrolling in hospice rose to 1.7 million in 2020 from 580,000 in 2001.”
“The most recent report from MedPAC, the independent agency advising Congress on Medicare spending, found that in 2020, for-profits received 20.5 percent more from Medicare than they spent providing services. The margin for nonprofits, whose daily per-patient expenditures are higher, averaged 5.8 percent.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Unwinding, Continued
HHS Secretary Becerra urges best efforts by the States (here) in the multi-month process of redetermination of eligibility of Medicaid beneficiaries to continue to receive health care. The National Association of Medicaid Directors provides a guide (here).
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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