HealthCare Roundtable e-News – October 16, 2018

Trump Administration Proposal to Require Drugmakers to Advertise Drug Prices

The Trump administration will require drug companies to post their list prices in consumer ads under a proposal announced yesterday. Drugmakers have opposed the idea.

The proposal, released late in the day, would require pharmaceutical companies to include in its television advertising the price of any drug that cost more than $35 a month. The price should be listed at the end of the advertisement in “a legible manner,” the rule states. It goes on to explain that the price should be presented against a contrasting background in a way that is easy to read.

Policy experts are warning that the impact of the proposal could be relatively insignificant and potentially confusing to patients. Dale Cooke, a consultant who specializes in drug advertisements and has been a vocal critic of the government’s plan, cautioned that an ad containing a high list price could scare away patients who will assume they can’t afford the cost of the drug, even if their health insurance would pick up most of the cost.

President Trump and HHS Secretary Alex Azar have championed the proposal as a simple approach for addressing high drug prices and encouraging cost transparency in the industry. Azar called the move an “important part of fair balance,” on POLITICO’s “Pulse Check” podcast earlier this year.

The proposal from HHS has been under review by the White House since August and is expected to be published in the Federal Register this month. The rule would be issued through CMS and the agency’s regulatory authority under the Social Security Act.

More information can be found HERE.

Leapfrog Group Grades 5,600 Surgery Centers Based on Safety & Quality

The Leapfrog Group, a national health care nonprofit driven by employers and other purchasers of health care, announced today the expansion of its public reporting to outpatient settings. For the first time, Leapfrog will collect safety data on ambulatory surgery centers (ASCs) through a new voluntary survey. In addition, hospital outpatient surgery departments will report similar data through a new section of the Leapfrog Hospital Survey, the organization’s first rating system that has been gathering information about the quality and safety of inpatient care for almost 20 years. Both surveys will open in April 2019 according to a Leapfrog press release.

The group now issues hospitals an overall letter grade and evaluates how hospitals handle myriad problems, from infections to collapsed lungs to dangerous blood clots – helping patients decide where to seek care, according to Kaiser Health News.

The new surgery center effort will focus on staffing, surgical outcomes and patient experience in facilities that are performing increasingly complex procedures and seeing more aging patients. The grades will also cover surgery centers’ closest competitor, hospital outpatient departments.

A recent Kaiser Health News/USA Today Network investigation highlighted the need for independent information about surgery centers. The investigation found that since 2013, more than 260 patients died after care at centers that lacked appropriate lifesaving equipment, operated on very fragile patients or sent people home before they fully recovered.

“The vast majority of surgeries in the U.S. are performed in outpatient or ambulatory settings, but there are almost no independent data about the safety and quality of this care. This leaves patients at risk without the information they need to select the best place for their care,” said Leah Binder, president and CEO of The Leapfrog Group. “We’re confident that, given the opportunity, hospitals and ASCs will be transparent in voluntarily reporting their performance, just like the nearly 2,000 hospitals that report on their inpatient quality today.”

Open Enrollment Begins in California for 2019

Open enrollment for 2019 starts today in California, the nation’s first marketplace to open to consumers, POLITICO’s Victoria Colliver reports from Sacramento. In comparison, opens two weeks later and ends a full month earlier.

Covered California plans to commit about $100 million in marketing – or roughly 10 times what the federal government plans to spend on the 34 states that rely on the federal platform. But that marketing push won’t start in earnest until after the mid-term elections, Politico indicates.

2019 is the first year that consumers can opt to not have insurance, and not have to pay a tax penalty. This is because Congress passed legislation in late 2017 that eliminated the tax penalty for not having insurance, also known as the individual mandate under the Affordable Care Act.

Covered California officials say the change will contribute to a 12 percent drop-off in enrollment. Premiums will rise nearly 9 percent on average for consumers renewing their same plan (San Francisco Chronicle).

“We urge Californians to sign up for coverage, and then fight like hell to maintain the benefits,” Anthony Wright, executive director of Health Access California, told reporters in a briefing on Friday. Health Access released new data on premium increases by California congressional district and what’s at stake for residents with pre-existing conditions under current federal proposals, according to Politico.