California’s Exchange Will Be First To Cap Patient Costs For Pricey Medications

Los Angeles Times: Obamacare: California Exchange Caps Specialty Drug Costs For Patients
Tackling the high price of specialty drugs, California's Obamacare exchange capped what consumers will have to pay for expensive medications each month. The new limits, set to go into effect in January, mark a first for state exchanges nationwide, according to Covered California. The exchange's four-member board approved the changes unanimously Thursday. (Terhune, 5/22)

Sacramento Bee: Covered California To Cap Patient Costs For High-Priced Specialty Drugs
Covered California board members voted Thursday to become the first state health care exchange in the nation to impose price caps on high-cost specialty drugs to treat conditions such as hepatitis C and HIV. The four board members unanimously agreed to impose $250 monthly limits on out-of-pocket prescription costs for most patients, creating a precedent that other government health exchanges could follow. (Sangree, 5/21)

NPR/KQED: Covered California Votes To Cap What Patients Pay For Pricey Drugs
In recent years, expensive specialty medicines used to treat cancer and chronic illnesses have forced some very ill Americans to choose between getting proper treatment and paying their rent. To ease the financial burden, the California agency that governs the state's Obamacare plans issued landmark rules Thursday that will put a lid on the amount anyone enrolled in one of those plans can be charged each month for high-end medicine. (Dembosky, 5/22)

The Hill: Calif. ObamaCare Exchange Caps Patient Drug Costs
California’s ObamaCare exchange is announcing a cap on patients’ costs for high-priced specialty drugs, the first state in the country to do so. The announcement, which comes after a unanimous vote by the exchange’s board Thursday, would cap the cost for most enrollees on the insurance exchange at $250 per prescription per month. (Sullivan, 5/22)

A new multiple sclerosis drug -- which can cost $66,000 a year -- is one of the expensive, next-generation medications that is proving unaffordable for some patients -

NPR: Multiple Sclerosis Patients Stressed Out By Soaring Drug Costs
American medicine is heading into new terrain, a place where a year's supply of drugs can come with a price tag that exceeds what an average family earns. Pharmacy benefit manager Express Scripts says last year more than half a million Americans racked up prescription drug bills exceeding $50,000. Barbara Haedtke of Portland, Ore., knows this all too well. When she was diagnosed with multiple sclerosis in 2001 at the age of 35, she was prescribed Avonex, at a cost of around $10,000 a year. ... She's now taking a new drug, Tecfidera, that's priced even higher — $66,000 a year, according to her pharmacy receipt. (Harris, 5/25)

Critics of the  "21st Century Cures" bill, set for a House vote next month, are voicing concerns about drug and device safety testing and the cost of the measure -

The Wall Street Journal: Proposed Medical-Research Law Raises Safety Concerns
Legislation aimed at boosting U.S. medical research funding and revamping some rules over drug and medical-device safety is headed toward a vote in the full House of Representatives, likely in June. But while the bill, known as the 21st Century Cures Act, passed the House Energy & Commerce Committee unanimously last week and opposition has been muted, some critics are beginning to question whether it would open the way for companies to sell drugs and devices that aren’t fully tested. (Burton, 5/25)

In other pharmaceutical news, a court tells Actavis it can't pull its top-selling Alzheimer's drug in favor of a new, pricier one. Meanwhile, two innovative cholesterol drugs may soon come to market that are similar in make up but differ in dosage. And cancer patients in Charlotte, N.C. who want some say in where they are treated form an advocacy network -

Reuters: Actavis Cannot Drop Old Version Of Alzheimer's Drug-Appeals Court
Actavis Plc cannot pull its top-selling Alzheimer's drug from the market in favor of a pricier extended-release version, a federal appeals court in New York ruled on Friday. The decision from the 2nd U.S. Circuit Court of Appeals is a win for New York State Attorney General Eric Schneiderman, who sued to block the switch, arguing that Actavis was trying to stifle competition from generic drugmakers. A three-judge panel upheld an order by U.S. District Judge Robert Sweet in December requiring Actavis to keep the older drug, Namenda IR, on the market. (Ax and Pierson, 5/22)

Related KHN Coverage: Battle Over Dementia Drug Swap Has Big Stakes For Drugmakers, Consumers (Appleby, 3/19)

Reuters: Fight Over Hot New Cholesterol Drugs May Be Won In Milligrams
Two powerful and innovative cholesterol drugs likely to be approved this summer both target the same protein and have been shown to sharply lower LDL in high-risk patients. But there is at least one significant difference between the two offerings: the dosages in which they will be sold. Assuming approval from the U.S. Food and Drug Administration, Amgen Inc. will offer its drug, Repatha, as a biweekly 140 mg injection or a monthly injection of 420 mg, while Praluent, from Regeneron Pharmaceuticals Inc and Sanofi, will be offered in biweekly injections of 75 mg or 150 mg. The difference in dosages is likely to lead to very different sales strategies for the two drugs, in what could be a fierce competition for market share. (Beasley, 5/26)

The Charlotte Observer: Cancer Patients Form Advocacy Group For Doctor Pay
Many cancer patients get their chemotherapy in the offices of oncologists who own their practices, unaffiliated with large hospital systems. Oncology Specialists of Charlotte is one of those clinics, and earlier this month, it hosted a meeting for patients and health care professionals who want to ensure that cancer specialists who want to remain independent can do so. One of the issues of concern is reimbursement. Doctors employed by hospitals, even if they work in clinics separate from those hospitals, get paid more for providing chemotherapy than independent doctors. The lower rate is set by Medicare, the government’s health program for seniors, and most private insurance plans follow suit. Nationally, chemotherapy costs 24 percent more in hospital-based outpatient clinics than in private doctor’s offices, according to a study by Avalere Health. Hospital officials say their charges are justifiably higher because they must cover the cost of non-paying patients and maintain around-the-clock emergency care. (Garloch, 5/25)