First Edition: March 9, 2016

Kaiser Health News: Medicare To Test New Payment Approaches For Some Prescription Medications
Currently, Medicare Part B pays the average sales price of the drug, plus 6 percent. Under the proposal that would start later this year, doctors and hospital outpatient centers would get the average price plus 2.5 percent, along with a flat fee of $16.80 per drug per day. (Appleby, 3/9)

Kaiser Health News: Using Data To Help Home Health Workers Manage Patients’ Conditions
There is little in Ruby’s life that is easy. Nearly blind and unable to walk more than a step or two, the 39-year-old struggles to raise three sons while dealing with a daunting array of health conditions, from diabetes that recently landed her in the hospital to pain from bulging spinal disks. Without support, odds are she’ll end up back in a hospital. But Ruby, who asked that her last name not be used to protect her family’s privacy, is part of a growing effort to reduce those odds by arming home care aides and other non-medical workers with the power of data. (Appleby, 3/9)

Kaiser Health News: Housing Project Takes On Seniors' Health
Hui-Zhen Li doesn't speak English, but here she can speak freely. She's standing amid more than 150 Chinese seniors, all perched on metal folding chairs or slouching in wheelchairs, packed wall to wall in the main lobby of the Hotel Oakland. ... The gathering at this low-income housing project in downtown Oakland, California, is called Neighbors Helping Neighbors. It's part of an ambitious plan to help elderly residents, many of them Asian immigrants, take control of their health — in part by joining at least one of 14 groups intended to enhance their physical and mental well-being. This particular meeting focuses on improving memory and warding off dementia. Other groups range from healthy eating to karaoke singing. (Gorn, 3/9)

The New York Times: U.S. To Test Ways To Cut Drug Prices In Medicare
The Obama administration said on Tuesday that it would test new ways to pay for prescription drugs in an effort to slow the growth of Medicare spending on medicines while encouraging doctors to choose the most effective treatments for their patients. The announcement comes as presidential candidates including Hillary Clinton, Senator Bernie Sanders and Donald J. Trump are calling for government action to protect consumers against high drug prices. Federal officials said the government spent $20 billion last year under Part B of Medicare for prescription drugs administered in doctors’ offices and hospital outpatient departments. (Pear, 3/8)

The Wall Street Journal: U.S. Officials Propose Test Program Aimed At Lowering Medicare Drug Costs
The development could lead to an overhaul of reimbursements under Medicare Part B, a program that pays about $19 billion a year to providers—and is outlined in a proposed rule issued Tuesday by the Centers for Medicare and Medicaid Services, which runs the program. The initiative is part of a strategy by the Obama administration and Congressional lawmakers to tackle health-care spending that is driven in part by rising prescription-drug prices, an issue that has loomed in the presidential race and ranks high among public concerns in polls. The administration has sought information on pricing from pharmaceutical companies and has been probing ways to help consumers keep their drug costs in check. (Armour, 3/8)

The Washington Post: Medicare Considers Overhaul Of Doctors’ Payments For Drugs
Patrick Conway, chief medical officer for CMS, said in a telebriefing that the plan isn’t designed to save money. But he left little doubt that the ultimate aim is to eliminate incentives that may encourage doctors to select higher-priced medications that benefit their bottom lines but not their patients. Conway called the current system — in which doctors are paid the average sales price plus 6 percent for handling and administration costs — a “perverse incentive structure that doesn’t benefit patients or the system.” He said oncologists have told CMS they sometimes feel pressure from their health-care systems to pick more expensive drugs to bolster profits. (McGinley, 3/8)

The Associated Press: Medicare To Test New Payment Model For Some Outpatient Drugs
Under the elaborate experiment being proposed by Medicare, parts of the country would operate under different payment rules for physician-administered medications. The results would then be compared, and if new approaches can maintain or improve quality while showing potential to curb costs, permanent changes could follow across the whole country. ... It's unclear how doctors and hospitals will respond. In the past, smaller oncology clinics have complained that Medicare cuts have a disproportionate impact on them. (Alonso-Zaldivar, 3/8)

Los Angeles Times: Obama Administration Proposes New Effort To Combat High Drug Prices
Facing skyrocketing drug prices, the Obama administration is proposing potentially major changes in how Medicare pays for some medications, including high-priced specialty drugs used to treat cancer and other costly diseases. The proposed regulations, unveiled Tuesday, would initially affect a relatively small share of the nation’s nearly $500-billion drug tab. But if widely implemented, they could overhaul the way Medicare, America’s largest insurer, pays for drugs, by linking payments to the effectiveness of medications, not just their prices. (Levey, 3/8)

The Wall Street Journal: U.S. Prescription Drug Spending Is On The Rise
Prescription drug spending in the U.S. is rising and is projected to continue to climb faster than overall health spending, federal officials said Tuesday. Drug spending rose an estimated sharp 12.6% in 2014 after years of unusually slow growth—it rose about 2% a year between 2008 and 2012. The increase is largely due to higher-priced specialty medications and the fact that millions of people have gained insurance coverage through the Affordable Care Act, according to a report released Tuesday by the Department of Health and Human Services. (Armour, 3/8)

Reuters: U.S. Health Agency Estimates 2015 Prescription Drug Spend Rose To $457 Billion
Spending on prescription drugs is projected to have risen to $457 billion in 2015 and will likely continue to grow as a percentage of overall healthcare spending, a U.S. government health agency said on Tuesday. ... The agency forecast that total drug spending will grow to $535 billion in 2018 and represent about 16.8 percent of all healthcare spending. The figures are based in part on National Health Expenditure Accounts estimates from the Centers for Medicaid and Medicare Services. (Humer, 3/8)

USA Today: Feds Call Prescription Drug Price 2014 Increase 'Remarkable'
Fast-rising drug prices coupled with the use of costlier specialty drugs were the main reasons for a nearly 13% uptick in prescription drug spending in 2014, federal health officials said Tuesday. The Department of Health and Human Services called drug growth in 2013 “subdued,” but said 2014’s increase was “remarkable” and that it remained elevated during 2015 based on preliminary estimates. (O'Donnell, 3/8)

The Wall Street Journal: Repayment Of Health-Insurance Tax Credits Threatens Refunds
Most people who got tax credits to buy insurance under the federal health law will be repaying part of them for the second year in a row, according to a leading tax preparer. H&R Block Inc. executives said Tuesday that, to date, 60% of 2015 tax filers with the credit have found that they owe the government money because they had been credited too much. That is up from 52% last year, the first year in which filers had to reckon with reporting the credit and figuring out if their income projections had been accurate. (Radnofsky, 3/8)

The Associated Press: Health Law Fines Double For Many Uninsured At Tax Time
Many people who went without health insurance last year are now seeing fines more than double under President Barack Obama's health care law, tax preparation company H&R Block said Tuesday. Among its customers who owe a penalty for the 2015 tax year, the average fine is $383, compared with $172 for 2014, the company said. Separately, among those who complied with the law and took advantage of its taxpayer-subsidized private health insurance, 6 in 10 are now having to pay back to the IRS some portion of their financial assistance. (Alonso-Zaldivar, 3/8)

NPR: Medical Bills Still Take A Big Toll, Even With Insurance
For Barbara Radley, there is "before" and "after." Before was when she could work — moving furniture, and driving a long-haul truck. "It was nothing for me to throw a couch on my back and carry it up a flight of stairs," says the 58-year-old from Oshkosh, Wis. Then there's after. After she herniated five disks in her back. And after, she says, her blood pressure medicine destroyed her pancreas. Now Radley is disabled, suffering from diabetes, liver failure and scleroderma. And she is bankrupt. (Kodjak, 3/8)

The New York Times: F.D.A. Deal Allows Amarin To Promote Drug For Off-Label Use
In a deal that could change the way some companies market their drugs, the Food and Drug Administration has agreed to allow a pharmaceutical company to promote a drug for a use that the agency has not approved, the company said on Tuesday. The agreement settles a legal case between the agency and the company, Amarin, a small drug maker that sued the F.D.A. last year for the right to promote its only product, Vascepa, to a broader range of patients. In August, a federal district judge in Manhattan ruled that the F.D.A. could not prohibit Amarin from using truthful information to promote its drug, even for unapproved uses, because doing so would violate the company’s right to free speech. (Thomas, 3/8)

The Wall Street Journal: Valeant In Talks To Add New Board Members
Valeant Pharmaceuticals International Inc. is in discussions to add as many as three new directors to its board as the drugmaker seeks to reassure investors, according to people familiar with the matter. Three candidates the Canadian drugmaker is considering, the people said, are Fred Eshelman, a veteran pharmaceutical executive; Stephen Fraidin, a senior executive at William Ackman’s Pershing Square Capital Management LP, a major Valeant shareholder; and Thomas Ross, former president of the University of North Carolina system. (Hoffman and McNish, 3/8)

NPR: Medicaid Rules Can Thwart Immigrants Who Need Dialysis
Carla can't afford private health insurance. And like the estimated 5,500 immigrants in the U.S. illegally who need dialysis, the only publicly funded insurance she's eligible for is a government program called Emergency Medicaid. But in most states, including Indiana, hospitals can't bill Emergency Medicaid until they know for sure they're dealing with an emergency. So for kidney disease, doctors will often wait until there are dangerous levels of potassium in the blood or fluid in the lungs — levels they deem urgent enough to merit hospitalization. (Harper, 3/8)

Reuters: Valeant To Appoint Three New Directors As Soon As Wednesday: Sources
Embattled drug company Valeant Pharmaceuticals International Inc, whose stock price has tumbled 38 percent this year, will appoint three new board members as soon as Wednesday, people familiar with the matter said on Tuesday. The drug maker will award one of the seats to Pershing Square Capital Management, one of its biggest investors, two people familiar with the matter said. (Herbst-Bayliss and O'Donnell, 3/8)

USA Today/The Indianapolis Star: E-Cig Makers Face Increased Regulation In Indiana
Much of the controversy over electronic smoking focuses on whether health risks are associated with it. But in Indiana much more esoteric concerns could significantly narrow the number of vape shops open in the Hoosier state. This week the Indiana General Assembly adopted a measure that would increase regulations on manufacturers of e-liquids, the inhaled substance inside the cigarette or vaporizer. In addition to requiring that mixing be done in a clean room and that business owners undergo background checks, the measure also stipulates that manufacturers adhere to rigorous security requirements that some in the industry fear could wind up putting many out of business. (Rudavsky, 3/8)

USA Today/The Tennessean: Why More Than Half Of Hospital Bills Don’t Get Paid
Hospitals and medical practices share a growing problem with those they treat: Patients aren’t paying their bills. Working people are on the hook for an increasingly large portion of the cost of their care, as insurance policies pay for less. It’s a trend that is not reversing — and it’s causing financial distress for families and CEOs alike. (Fletcher, 3/8)