Author: Peter

As lawmakers began a detailed review of the state mental health budgets on Friday, speakers asked them not to cut services to the mentally ill, but rather to reinvest the money where critical needs continue to exist...a Joint Senate Finance and Assembly Ways and Means subcommittee took a look at the funding proposals for mental health services, which are proposed to see some state general fund spending reductions in the coming two years...Southern Nevada Adult Mental Health Services, state general fund support would decrease from $93 million in the current budget to $83 million in the new spending plan, with the loss of 38 staff...Northern Nevada Adult Mental Health Services, the general fund budget reduction is from $32 million to $26 million with the loss of 56 positions...Officials with the Division of Public and Behavioral Health told lawmakers that funding for mental health programs is increasing, but services being provided from the state general fund are being shifted to the Medicaid program with an expansion under the Affordable Care Act. Medicaid costs are shared by the state and federal governments...Private sector psychiatric hospitals are also being built to provide treatment to the mentally ill because many are now Medicaid eligible and do not have to be treated in state-funded hospitals...

Nicole Crisano, PTNN. This weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal...Pusey’s contracts with drug-benefit managers at his Medicap Pharmacy in Olyphant, Pennsylvania, bar him from volunteering the fact that for many cheap, generic medicines, co-pays sometimes are more expensive than if patients simply pay out of pocket and bypass insurance. The extra money -- what the industry calls a clawback -- ends up with the benefit companies…Clawbacks, which can be as little as $2 a prescription or as much as $30, may boost profits by hundreds of millions for benefit managers and have prompted at least 16 lawsuits since October. The legal cases as well dozens of receipts obtained by Bloomberg and interviews with more than a dozen pharmacists and industry consultants show the growing importance of the clawbacks.

Drug pricing in the U.S. is in need of a fix. Mired in layers of complexity and controversy, experts insist that pharmaceutical manufacturers can take basic steps to navigate the process more smoothly through improved transparency, better communication about products’ clinical value, and tighter internal organization that focuses on the drug’s full revenue life-cycle...many factors should be considered when pricing drugs and biologics, including the clinical value of the drug compared to its competitors, the increased survival and quality of life with the drug, patient affordability, competitors’ prices and the effect of various discount programs…

• ‘Thinking in bits and pieces’...some companies ahead of the curve are managing price, adding analytics and tracking patients’ journeys with the assistance of electronic health records and other technologies...
• Understanding risk and reward...The stakes are high for pharma manufacturers, and they "have to understand what their risk and reward is with pricing," and follow up with analytics to determine the best ways to move forward...what we’re really trying to do [is improve] communicating and understanding the value of these drugs,"...

The pharmaceutical industry’s growing interest in orphan disease shows no sign of diminishing, and for good reason. The increased R&D investment in these indications in recent years has translated into a growing share of overall pharmaceutical sales...The drivers of this change include the favourable regulatory treatment of orphans, as well as market exclusivity and pricing advantages that make such drugs much more profitable than non-orphans. It is notable that the top 25 non-oncology orphan drugs in 2022 are expected to show a compounded growth of 18% over the next six years, almost three times the wider market average...Orphans...remain one of the brightest spots of pharmaceutical development, and the legislation framing them is widely claimed to have been a great success in public policy terms. However, there is a risk that before long orphans could face the same sort of pricing pressure as is common in non-orphan indications...

Spending on prescription drugs for health plans created under the Affordable Care Act increased last year at a rate more than three times that of other commercial plans and most government-run plans managed by Express Scripts Holding Co...year-over-year spending per person for individual insurance plans sold on the Obamacare exchanges where it manages the pharmacy benefit rose 14 percent in 2016, driven by higher drug prices and utilization...Express Scripts said per-capita spending for other commercial plans it manages, mostly for employers, rose just 3.8 percent last year, despite an 11 percent increase in list prices for brand-name drugs...Drug spending for plans the company manages under Medicare...increased 4.1 percent last year while the rise for Medicaid...was 5.5 percent.

Middlemen who manage drug benefits for employers and insurers should be under greater government oversight of their pricing and billing practices to make health care cheaper, an independent pharmacists’ group said (National Community Pharmacists Association)...plans to lower prescription drug costs will only succeed if greater transparency is imposed on pharmacy benefit managers...Benefit managers engage in price negotiations that are often kept secret for competitive reasons, with manufacturers on one end and pharmacies on the other. Pharmacists have criticized these discussions, as well as so-called clawbacks -- extra profit for the PBM after co-pays for cheap, generic medicines exceed the price of the drug itself...PBMs...continue to operate in a virtual black box...As the outcry over drug pricing intensifies, the middlemen have gained more attention...

Laura Joszt, assistant managing editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

The World Health Organization warned on Monday that a dozen antibiotic-resistant “superbugs” pose an enormous threat to human health, and urged hospital infection-control experts and pharmaceutical researchers to focus on fighting the most dangerous pathogens first...Many consider the new strains just as dangerous as emerging viruses like Zika or Ebola...the...European Center for Disease Prevention and Control estimated that superbugs kill 25,000 Europeans each year; the C.D.C. has estimated that they kill at least 23,000 Americans a year...New antibiotic candidates are in short supply...because 70 years of research have made it harder to find new ones, and because they are not very profitable for pharmaceutical companies...In the United States, although constant vigilance is crucial, the problem has actually declined in the last decade...

Pfizer Inc. said that it received two subpoenas from the U.S. Attorney’s office in Massachusetts related to charities that help Medicare patients afford co-payments for drugs, the latest company to disclose involvement in the probe...The...subpoenas...requesting documents related to the Patient Access Network Foundation and other organizations that provide financial assistance to Medicare patients. Pfizer donated more than $10 million to the PAN Foundation in 2016...including for funds related to kidney cancer and...acromegaly...A long list of drugmakers have now received subpoenas about their relationships with patient assistance charities, some related to how they help people in the Medicare drug program for the elderly afford the co-payments for drugs...As drug prices have surged, pharmaceutical companies’ large contributions to charities have given them a public-relations foil against backlash and helped keep patients from seeking lower-priced medicines. The seven biggest co-pay charities, which cover scores of diseases, reported combined contributions of $1.1 billion in 2014...