HealthCare Roundtable e-News – June 17, 2020

Latest AHIP Study Estimates COVID-19 Testing and Diagnostics Could Cost Up to $25 Billion a Year

A recent study analyzing health insurance costs resulting from the coronavirus pandemic estimates that COVID-19 diagnostic testing is likely to cost between $6 billion and $25 billion a year, and antibody testing costing between $5 billion and $19 billion, according to America’s Health Insurance Plans (AHIP). The study, which was commissioned by Wakely Consulting, will inform lawmakers’ strategies for determining the potential costs of testing and what types of investments are needed.

The study itself does not go into detail to distinguish between medically necessary testing for patient treatment and testing designed for public health or occupational health purposes. Wakeley stresses there is a large amount of uncertainty over the scale and cost of the testing, but concludes that “(a)t the upper end of estimates, the total annual costs of testing could have a material impact on overall costs to insurers…While it is possible that state or federal governments may expand funding to support public health and return to work testing capacity, all testing costs are included since the level of actual government investment is unknown.” (InsideHealthPolicy)

According to Inside Health Policy, the National Association of Insurance Commissioners recently asked CMS to provide guidance on which tests must be covered and how they should be financed.

26 Pharmaceutical Companies Sued by State Attorneys General for Drug Price Fixing Scheme

Attorneys general from forty-six states, four territories, and the District of Columbia filed a lawsuit on Wednesday (June 10) against twenty-six pharmaceutical companies on charges of conspiring to rig the drug market. The lawsuit targets drug manufacturers, including Pfizer, Sandoz, Taro, Novartis, and Mylan, for prioritizing profits by driving up generic drug prices and constraining competition for dermatologic treatments between 2009 and 2016.

The plaintiffs, led by Connecticut Attorney General William Tong, claim the drug makers “perpetrated a multibillion-dollar fraud on the American public so systemic that it has touched nearly every single consumer of topical products.” The filing against the drug makers claims that the conspiracy took aim at more than 80 drugs, including glaucoma drug Xalatan, acne drug Differin, anti-seizure medicine Dilantin, anti-fungal medicine Lotrimin AF Cream, and Ritalin for attention deficit disorder.

The lawsuit is the third from an anti-trust investigation. The first complaint was filed in 2016 and is still pending in the U.S. District Court of the Eastern District of Pennsylvania. The second was filed in 2019 against Teva and 91 other drug makers and is also pending in the same Pennsylvania court. (InsideHealthPolicy)

House Democrats Look to Vote on ACA Enhancements Week of July 4

House Democrats are setting sights on the week of July 4 to bring a legislative package with adjustments to the Affordable Care Act to the floor for a vote. House Majority Leader Steny Hoyer (D-Md.) didn’t offer specific details about the package but claimed the adjustments would strengthen the ACA and will help lower premiums and co-pays.

“We’re going to meet on the Affordable Care Act, trying to bring the costs of premiums and co-pays and deductibles in the Affordable Care Act down to a place where people can in fact afford them,” Hoyer said during a webinar hosted by the law firm Baker Hostetler. House Democrats had originally planned on unveiling improvements to ACA back in March to coincide with the 10th anniversary of the law’s passage. Concerns around the rapidly evolving coronavirus pandemic ultimately delayed the unveiling. House Democrats had also passed a major bill to lower drug prices last year, which also lost its momentum in the midst of the crisis.

Bipartisan Senators Probe HHS Officials on Testing, PPE Supply Nation Braces for Next COVID-19 Wave

As a second wave of COVID-19 seems likely and southern states continue to see spikes in cases, Senate lawmakers are pressing HHS to share details on how the administration is preparing. Of particular interest is how many diagnostic tests and how much personal protective equipment is available in the U.S. stockpile.

HHS Assistant Secretary for Health Brett Giroir said the administration’s current efforts are making it easier for states to make available drive-through and community testing sites. Others have confirmed that we still don’t know the country’s testing capacity, which is essential to determine how widespread the virus is. At a Homeland Security and Governmental Affairs hearing last week, Chair Ron Johnson (R-Wis.) said, “it is evident that our preparedness enterprise, resources, and supply chains were stressed past the capacity required to meet a nationwide pandemic.” (InsideHealthPolicy)

Giroir told Sen. Gary Peters (D-Mich.) the administration is focusing on testing more people in underserved, minority communities with higher rates of COVID-19, but HHS does not have enough information yet. Giroir confirmed the administration is expecting to have data on minority community infection rates in the coming weeks.

FEMA confirmed that the administration has coordinated the delivery of 149.2 million surgical masks, 14.3 million face shields, 44.6 million surgical gowns, and over 1 billion gloves. Administrator Peter Gaynor told Sen. Maggie Hassan (D-N.H.) that the agency would soon release internal documents that detail the administration’s estimated supply and demand for personal protective gear as that information becomes available. (InsideHealthPolicy)

Fauci Dismisses Questions on Drug Price Controls, Advises Government to Work with Drug Makers

Dr. Anthony Fauci, Director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), spoke on Tuesday (June 9) on the topic of forcing price controls on COVID-19 drugs and vaccines, suggesting that forcing controls on pharmaceutical companies that are in the process of developing COVID-19 products could drive them away.

“Often … many of these outbreaks disproportionately affect regions of the world that cannot afford a very expensive intervention. So that’s the reason why we’ve got to work with each other in good faith,” he said. “I’ve never seen a successful attempt at doing controls.”

The NIAID is a government research organization that is not involved in drug pricing policies. Fauci’s advice on the matter is for the government to instead work with companies on coming to an understanding on pricing. Fauci noted that some level of profit has to be considered as long as drug makers don’t go overboard in a way that makes products unattainable for people who need them.