Axios Vitals: What's killing Americans

Plus, a fight over drug co-pays | Wednesday, August 31, 2022

Open in app View in browser   Presented By Humana   Axios Vitals By Tina Reed · Aug 31, 2022 Good morning, Vitals readers. Today's newsletter is 741 words or a 3-minute read. 👀 What we're watching: The FDA could authorize Omicron-specific COVID vaccines as early as today.     1 big thing: The fight over drug copays Illustration: Sarah Grillo/Axios   Groups representing HIV and diabetes patients are trying to kill a Medicare rule they say leaves sick patients stuck with higher drug costs, by preventing them from applying billions of dollars in assistance against their insurance deductibles. The big picture: A federal suit filed by the groups on Tuesday takes up the bigger question of whether pharmaceutical companies can cover Medicare copays for expensive drugs, or whether covering patients' costs that way amounts to a kickback. Zoom in: The suit in U.S. District Court for the District of Columbia centers around "copay coupons" offered by drug companies to offer patients a better deal and ultimately boost sales of their drugs — at least, until their insurance deductibles are met. Insurers have begun using so-called co-pay accumulators to stop patients from applying those discounts toward their deductibles. But the patient groups — including the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition — argue federal regulations define cost-sharing as "any expenditure required by or on behalf of an enrollee with respect to essential health benefits." "It should not matter whether the assistance comes from a friend, charity, or drug manufacturer," they write. A CMS spokesperson said the agency does not comment on pending litigation. What they're saying: Due to increasing deductibles and cost-sharing requirements, patients often rely on copay assistance to help them afford their prescriptions, said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. The other side: Studies have shown drug coupons raise costs across the board, by encouraging patients to seek specific companies' drugs. Physicians are willing to prescribe them, knowing patients won't be burdened by cost. But taxpayers could pick up the bulk of the tab. Medicare prohibits copay coupons, essentially calling them kickbacks. The groups are suing to change that interpretation. Yes, but: "We're talking about pharmaceutical manufacturers ... seeking to circumvent cost-sharing mechanisms that have some ability to constrain pharmaceutical prices and direct utilization to more cost-effective care," Leemore Dafny, a health economist at Harvard, told Axios. Read the rest.     2. What's killing Americans? Data: National Center for Health Statistics; Chart: Erin Davis/Axios Visuals Life expectancy at birth in the U.S. declined nearly a year from 2020 to 2021, according to new provisional data from the CDC. Why it matters: It's the latest evidence of the toll the COVID pandemic took on Americans' health and takes the U.S. life expectancy at birth to its lowest level — 76.1 years — since 1996. Together with recent data showing life expectancy fell 1.8 years between 2019 and 2020, that means life expectancy at birth fell by 2.7 years over two years — the largest two-year decline since 1921–1923. Be smart: COVID-19 was the biggest driver, followed by unintentional injuries and heart disease. The losses were offset in part by decreases in deaths attributed to the flu and pneumonia, which is likely tied to COVID mitigation measures such as masking and social distancing.     3. Early arbitration issues between insurers, providers A lot of hay has been made out of the process insurers and providers use to settle billing disputes under the surprise billing law — and it turns out that process is already causing some ... friction, Modern Healthcare reports. Why it matters: As we've told you before, billions of dollars are at stake — either for providers or for insurers and employers. And it's the predicted fallout now that patients are protected from facing unexpected charges from doctors who are not in their insurance networks. What's happening: Insurers have accused providers of submitting every possible claim for mediation to settle billing disputes, even ones that aren't eligible, while providers say it's the insurers who are holding up the process, Modern Healthcare reports. "I'm a generally optimistic person. But I'm not so optimistic," said Lisa Maurer, a physician at Emergency Medicine Specialists in Milwaukee, per Modern Healthcare. Our thought bubble: Is anyone really surprised?     A message from Humana Older Americans are choosing Medicare Advantage     Medicare Advantage can help provide better health outcomes and lower costs. With Medicare Advantage, members see a 43% drop in avoidable hospitalizations and save nearly $2,000 a year compared to those who choose fee-for-service Medicare. Learn more.     4. Pic du jour Photo: Asif Hassan/AFP via Getty Images   A doctor examines a 4-month-old at a free medical camp run by Al-Khidmat Foundation for flood victims on the outskirts of Sukkur, Pakistan on Tuesday. Tens of millions of people have been affected by relentless monsoon rains that have submerged a third of the country and claimed more than 1,100 lives.     5. Catch up quick 💧 The flooding crisis in Jackson, Mississippi, is causing schools and local governments to shift their weekly plans as residents remain unable to drink fresh water. (Axios) 👉 Texas health officials on Tuesday confirmed the death of a person diagnosed with monkeypox, which, if confirmed as the cause, would be the first known death from the virus in the U.S. (Axios)     A message from Humana Medicare Advantage: Better care, better savings     Eligible members don't have to choose between better health outcomes and savings. Here's why: Medicare Advantage members benefit from 43% lower avoidable hospitalizations and save nearly $2,000 every year compared to those who choose fee-for-service Medicare. Learn more.   Editors note: The second item in the Aug. 26 Vitals incorrectly stated drugmakers are required to report quality problems with products through FDA field alert reports. 1,143 manufacturing sites are eligible, but not required, to submit the reports. 49.1% of them didn't over a four-year period the FDA reviewed. Why stop here? Let's go Pro. Join the thousands of professionals reading Axios Pro: Health Tech Deals to better understand the forces shaping their industry.   Axios thanks our partners for supporting our newsletters. If you're interested in advertising, learn more here. Sponsorship has no influence on editorial content. Axios, 3100 Clarendon B‌lvd, Arlington VA 22201   You received this email because you signed up for newsletters from Axios. Change your preferences or unsubscribe here.   Was this email forwarded to you? Sign up now to get Axios in your inbox.   Follow Axios on social media: