Pharmaceutical & Life Sciences News

Capsule: Cost-Conscious Patients, Diabetics, & Drugmakers

Dec. 14, 2018, 11:45 AM

Welcome to Capsule—your weekly dose of health-care news, where we give you a recap of this week’s highs and lows for key players in the health-care industry. You can expect us every Friday morning as a bookend for your week.

Michael Cohen is going to prison. What does that mean for the health-care space? Mostly nothing, except it gives me an opportunity to share this interesting Bloomberg News piece about a loan to merge prison and jail health-care providers. Speaking of health care, lets dive into this week’s highs and lows.

Here’s who ended the week on a high note:

Cost-Conscious Patients

  • The fight against surprise hospital billing is gaining steam. You’ve probably gotten a surprise bill yourself (I know I have). They’re usually a result of physicians not being in your health-care network even if a hospital is, or a result of so-called hospital facility fees you weren’t expecting.
  • Health insurers, employers, and consumer groups are now calling for federal protections to prevent patients from receiving unexpected bills from hospitals when they are treated by medical providers who aren’t covered by their health insurance network, Alex Ruoff and Sara Hansard report.
  • Patients should also be informed about whether facilities or providers aren’t participating in their insurance company’s network, they said. Patients should be given an opportunity to seek in-network care and an estimate of the costs of out-of-network care.
  • Lawmakers appear eager to take on this issue, Ruoff and Hansard write. Sen. Maggie Hassan (D-N.H.) introduced a bill (S.3592) on the issue in October. A separate bipartisan group of senators unveiled a bill in September to ensure that Americans only pay the cost-sharing amount defined by their health plan and prohibiting hospitals from charging beyond that amount for emergency services.

Planned Parenthood

  • Planned Parenthood still has a fighting chance in the states that are trying to cut some of its funding, Mary Anne Pazanowski and Kimberly Strawbridge Robinson report. The U.S. Supreme Court said it won’t consider whether states can block Planned Parenthood from receiving Medicaid money.
  • Justice Brett Kavanaugh cast the pivotal vote. “One of the biggest concerns of those who opposed Justice Kavanaugh’s nomination was that he would” not only vote to hear these cases, but that he’d vote against Planned Parenthood, health law scholar Timothy S. Jost, of Washington & Lee University School of Law, told Bloomberg Law.
  • But Planned Parenthood still needs to duke it out in the states trying to cut its funding. It’s also opposing a separate issue in Ohio—bills that would ban abortions as early as six weeks into pregnancy, Alex Ebert writes. Ohio’s Republican-controlled House of Representatives and Senate are expected to send two abortion restriction bills to Gov. John Kasich (R), each of which would tee up abortion-rights litigation if enacted.


  • The long-held promise of a cheaper, generic insulin is starting to come to fruition, which would provide significant relief for diabetics struggling to afford their medication. Countless testimonies describe patients dying because they rationed their insulin due to its cost, Jacquie Lee writes.
  • Starting in March 2020, insulin will fall under a narrower definition, namely “biologic,” making it easier to create a substitutable generic and drive down insulin costs, FDA leader Scott Gottlieb said this week. Gottlieb called it a “watershed moment” for insulin products.
  • The definition shift is meant to make it easier to create cheaper copies of insulin, called biosimilars. Although Gottlieb and drug price control advocates are expecting the price of insulin to drop after 2020, there are still plenty of barriers for insulin biosimilars like market and formulary access, intellectual property lawsuits, and running afoul of other patents.

It was a bleak week for others. Here’s whose Thursday closed on a downswing:

Drugmaker Influence

  • House Democrats are standing firm against giving the pharmaceutical industry as much as $4 billion in drug discount relief this year, a sign that one of Washington’s most powerful lobbies will be at odds with the new Democratic majority ahead, Alex Ruoff reports.
  • House Minority Leader Nancy Pelosi (D-Calif.) doesn’t want to roll back a change to the Medicare “doughnut hole” set to cost the industry a reported $11 billion over the next decade as part of a year-end spending bill, according to an aide.
  • Meanwhile, the House passed a measure to punish drugmakers trying to game Medicaid’s rebate system to garner bigger profits, a move designed to save the programs $52 million over the next decade, Ruoff writes.
  • Drugmakers can also expect more pushback from Republicans, Jeannie Baumann writes. Drug and device industry payments to doctors likely will face more scrutiny from the Senate Finance Committee once Sen. Chuck Grassley (R-Iowa) resumes its chairmanship.

Medical Device Developers

  • Device makers could face approval lags under a new European Union rule, Dana Elfin writes.
  • Medical device industry giants like Medtronic Inc., Fresenius Medical Care, and Stryker Inc. are facing a deadline of May 26, 2020, to get their products recertified as compliant with the EU’s new Medical Device Regulation (MDR). It replaces a decades-old regulatory framework in the EU and would create a logjam of applicants.
  • Back in the U.S., the medical device industry is still trying to chip away at a pending deadline that would mean a tax on sales of its goods, Ayanna Alexander reports. A Republican-backed repeal (H.R. 184) of the tax passed the House in July but has since been stalled in the Senate.
  • Its fate will fall into the hands of the incoming Democrat-run House next year, unless it’s approved or extended before then. However, Democrats generally oppose a repeal because there’s nothing to offset the cost.

Patient Data Push

  • Democrats and Republicans were equally upset over the delay in a government proposal to free up the electronic exchange of health-care data, James Swann reports.
  • Hospitals sometimes block other health institutions from accessing electronic patient data, and the proposed rule is expected to flesh out what types of data are unlawful to block and describe the limited occasions when such blocking is allowed. It would allow the HHS Office of Inspector General to investigate hospitals and hit them with penalties of up to $1 million per case.
  • Lawmakers have been wanting to know about the proposed rule’s release for the past year, and it looks like they’ll have to keep waiting, Swann writes.

Thanks for joining us this week and have a great weekend. I’m all ears when it comes to your two cents, tips, critiques, or coordinating exclusive interviews. Send them my way at jlee1@bloomberglaw.com.

To contact the reporter on this story: Jacquie Lee in Washington at jlee1@bloomberglaw.com

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