The Trump Administration has proposed using its demonstration authority under section 1115A of the Social Security Act to test a method of reimbursement for physician-administered drugs based on prices in 14 countries. The proposal is controversial, raising constitutional questions about the agency’s authority to modify Medicare reimbursement absent congressional action, as well as objections to the use of international reference pricing. A recent paper from the Foundation for Research on Equal Opportunity (FREOPP) makes a useful contribution to this debate. The FREOPP paper recommends that the administration construct a market-based international index (MBII) that would exclude “industrialized countries with little room for market-based pricing.” This report examines the drug pricing and reimbursement policies in MBII countries and finds that these policies are generally not market-based. Secondly, it presents data showing that many drugs introduced between 2011 and 2018 are not available to consumers in MBII countries. Under the proposal advanced by the administration and that suggested by FREOPP, Medicare reimbursement for physician-administered drugs would largely be based on international reference prices in which the regulatory agency of one government sets drug prices based at least in part on those set by regulatory agencies in other countries. Importing these mutually reinforcing, centralized decisions into Medicare may reduce reimbursement for physician-administered drugs, but the new reimbursement system cannot be said to be based on market prices.

Finland’s coalition government resigned on Friday a month ahead of a general election, saying it could not deliver on a healthcare reform package that is widely seen as crucial to securing long-term government finances.

Healthcare systems across much of the developed world have come under increasing stress in recent years as treatment costs soar and people live longer, meaning fewer workers are supporting more pensioners.

Three years ago this month, as alarms were sounding across the country about the over-prescription of opioid painkillers, the federal government issued course-correcting guidelines for primary care doctors. But in a letter sent to the Centers for Disease Control and Prevention on Wednesday, more than 300 medical experts, including three former White House drug czars, contend that the guidelines are harming one group of vulnerable patients: those with severe chronic pain who may have been taking opioids for years, without becoming addicted, so they can function in daily life and work. The leaders say the guidelines are being used as cover by insurers to deny reimbursement and by doctors to turn patients away.  

The sudden resignation of Scott Gottlieb, the commissioner of the Food and Drug Administration, leaves a giant hole atop an agency that oversees a quarter of the U.S. economy. Which, of course, leads to an equally big question: Who will replace him? Top contenders include Amy Abernethy, formerly the chief medical officer at health data firm Flatiron Health, who became Gottlieb’s principal deputy commissioner early this year. Another contender is Ned Sharpless, director of the National Cancer Institute since October 2017, who would bring a deep knowledge of biotech to an FDA stint. And another is Brett Giroir, the current HHS assistant secretary for health, with experience in government, academia, and industry.

As centrist Republicans contemplated an Obamacare repeal-and-replace plan, the CBO warned that doing so would boost the number of uninsured by 22 million. That scared enough Republicans away to kill the bill. The intrepid Philip Klein at the Washington Examiner noticed that, buried in a footnote, was a stunning rebuke of those CBO forecasts. Turns out, the CBO’s forecasts off by a factor of six. The report says that the mandate repeal will result in only 1.5 million dropping out of the individual insurance market, and 1 million from employer plans, with Medicaid enrollment unaffected. These forecasting errors don’t even rise to the “good enough for government work” level. But they were good enough to get Obamacare on the books, and then keep it there.

Today, Type 1 diabetes patients pay twice as much for insulin as they did in 2012. This is outrageous — but drug companies aren’t to blame. The problem is a dysfunctional supply chain that benefits everyone except patients.

In today’s system, insurers hire third-party firms, known as pharmacy benefit managers, to manage drug plans. These PBMs negotiate with drugmakers and have the power to decide which drugs are covered by each plan. Each year, manufacturers dole out  $150 billion in rebates and discounts as a result of these negotiations. But patients rarely see these savings at the pharmacy counter.

A new report from government actuaries has revealed that the Congressional Budget Office was scandalously off in its estimates of the impact of Obamacare’s individual mandate, a miscalculation that has had significant ramifications for healthcare and tax policy over the past decade.

Expert witness Grace-Marie Turner of the Galen Institute said policies like the new Section 1332 guidelines aren’t meant to drive a stake into the Affordable Care Act, but rather give more discretion to states to tailor health care needs specifically for their own citizens. “Cost relief” is the driving force behind state discretion, Turner said. 

GOP lawmakers balk at the rising costs of Obamacare premiums for constituents who fall into middle-range tax brackets. And putting healthy people in the pool with the chronically ill, some say, just adds to the premium hike. 

Democrats and Republicans on the House Energy and Commerce Committee on Wednesday signaled they could band together to slap clear consumer warnings on short-term limited-duration health plans.

Rep. Morgan Griffith (R-Va.) and Grace-Marie Turner, president of the conservative Galen Institute who defended the Trump administration’s expansion of short-term plans as a needed low-cost alternative to ACA coverage, agreed the limited coverage of short-term plans warranted advisories.

We examined trends in per capita spending for Medicare beneficiaries ages sixty-five and older in the United States in the period 1999–2012 to determine why spending growth has been declining since around 2005. Decomposing spending by condition, we found that half of the spending slowdown was attributable to slower growth in spending for cardiovascular diseases. Spending growth also slowed for dementia, renal and genitourinary diseases, and aftercare for people with acute illnesses. Using estimates from the medical literature of the impact of pharmaceuticals on acute disease, we found that roughly half of the reduction in major cardiovascular events was attributable to medications controlling cardiovascular risk factors. Despite this substantial cost-saving improvement in cardiovascular health, additional opportunities remain to lower spending through disease prevention and control.