Medicare weighs whether to pay for acupuncture

Seeking ways to address chronic pain without narcotics, Medicare is exploring whether to pay for acupuncture, a move that would thrust the government health insurance program into the long-standing controversy over whether the therapy is any better than placebo.

Coverage would be for chronic low-back pain only, a malady that afflicts millions of people. Low-back pain, acute and chronic, ranks as the third-greatest cause of poor health or mortality in the United States, behind only heart disease and chronic obstructive pulmonary disease, according to the National Institutes of Health.

In its request for comments on acupuncture, the Department of Health and Human Services said that “in response to the U.S. opioid crisis, HHS is focused on preventing opioid use disorder and providing more evidence-based non-pharmacologic treatment options for chronic pain.”

The agency said it hopes “to determine if acupuncture for [chronic low-back pain] is reasonable and necessary under the Medicare program.” A proposal is due by July 15, with a final decision by Oct. 13.

Chronic pain — generally defined as pain that lasts 12 weeks or more — is a complex disorder with numerous causes and many possible treatments. But there is widespread agreement that health-care providers have overused powerful opioid painkillers to address it, with little research to support that approach.

Currently, Medicare covers injections, braces, implanted neurostimulators and chiropractic care as well as drugs for chronic low-back pain, under certain conditions set by the program.

Acupuncture continues to gain legitimacy for pain relief in the United States. A 2014 review reported that more than 10 million acupuncture treatments are administered each year. Some insurance companies cover the practice, respected medical institutions offer it, and schools of acupuncture produce new practitioners. The Department of Veterans Affairs has trained 2,400 providers to offer “battlefield acupuncture,” five tiny needles inserted at points in each ear, for pain relief.

Medicare coverage “is long overdue,” said Tony Y. Chon, director of integrative medicine and health at the Mayo Clinic in Minnesota. “The opioid epidemic is going to be the momentum that’s really needed to push not just acupuncture but other kinds of non-pharmacological interventions to the forefront.”

Some proponents also note that acupuncture is one of the safest interventions available for pain — though some accidents have been reported. Even if it works only for some people, they argue, there is little harm in trying it when other options are not effective.

Taken overall, however, research shows that acupuncture is little more effective than placebo in many cases. When the government’s Agency for Healthcare Research and Quality reviewed research on a wide range of therapies for chronic pain in 2018, it found the “strength of evidence” that acupuncture works for chronic low-back pain is “low.”

The National Center for Complementary and Integrative Health, part of NIH, says “research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain.”

For low-back pain, the institute cites a study that found it “more helpful than either no acupuncture or simulated acupuncture.” But another found “strong evidence that there is no difference between the effects of actual and simulated acupuncture,” according to its website.

Critics go further, noting that hundreds of years of anatomical studies have not found evidence of the points in the body linked to the “energy channels” that acupuncture claims to be stimulating to provide pain relief. They contend that acupuncture shows all the signs of the placebo effect, with providers and recipients who believe it works and the elaborate ritual of placing the needles in specially selected spots.

“The whole thing is a big scam,” said Steven Novella, an assistant professor of neurology at the Yale School of Medicine and editor of the “Science-Based Medicine” website. “The only honest interpretation of the data is that acupuncture is a theatrical placebo.”

In part, the controversy has lingered because acupuncture is difficult to study. The practice involves inserting tiny needles into the skin, so patients who do not receive that treatment provide a poor comparison, or “control” group. Researchers have turned to “sham acupuncture,” using needles that appear to pierce the skin but retract like stage daggers. In that way, neither the practitioner nor the patient knows whether acupuncture is being administered, eliminating some of the bias that confounds studies.

A 2018 review of 39 studies involving nearly 21,000 patients has buoyed acupuncture proponents. It concluded that “acupuncture was superior to sham as well as no acupuncture control for each pain condition.”

“With this kind of research evidence behind it, why hasn’t acupuncture been accepted?” asked Vitaly Napadow, a neuroscientist and practicing acupuncturist at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital. “And the reason, in my opinion, is that acupuncture is being held back by philosophy.” Specifically, he said, Western medicine is slow to change despite acceptance of acupuncture by patients because the concepts come from Eastern medicine.

“Not everybody is going to want to try it,” said Lisa Conboy, director of research at the New England School of Acupuncture, part of the Massachusetts College of Pharmacy and Health Sciences. “It’s a different way of looking at the world. I think it makes some people nervous to have a whole other set of medical professionals.”

But Alan Levinovitz, an associate professor of religion at James Madison University, who has studied Chinese thought and medicine, said acupuncture represents the blurring of the lines between ritual and medicine. To the extent that rituals alleviate pain, that is a good thing — but not a reason to cover them with taxpayer-funded insurance, he said.

“One concern would be that we would cover acupuncture as if it were a physiological treatment, when in fact it is a psychological treatment,” he said.

Novella said that the efficacy attributed to acupuncture in the 2018 review could easily be explained by various research biases and that no drug would be allowed on the market based on that level of proof.

“We never get that threshold of evidence that you need in medicine, where you get that persistent effect, and it’s replicable” across numerous studies, he said.

https://www.washingtonpost.com/health/medicare-weighs-whether-to-cover-acupuncture/2019/07/02/0e7ad7c2-9c14-11e9-b27f-ed2942f73d70_story.html

Cal. widens probe of docs issuing questionable vaccine exemptions

The Medical Board of California’s investigations are unfolding amid the nation’s worst measles outbreak in more than a quarter-century.

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KEY TAKEAWAYS

The crackdown comes as California lawmakers consider legislation to tighten the requirements for exempting children from the vaccinations required to attend schools and day care.

The CDC says vaccine exemptions for medical reasons should be rare, and typically reserved for children with severely compromised immune systems.

The California agency that regulates doctors is investigating at least four physicians for issuing questionable medical exemptions to children whose parents did not  want them immunized.

The Medical Board of California’s investigations are unfolding amid the nation’s worst measles outbreak in more than a quarter-century, as California lawmakers consider controversial legislation to tighten the requirements for exempting children from the vaccinations required to attend schools and day care centers.

Last month, the Department of Consumer Affairs, which oversees the medical board, sued in state court to obtain medical records for patients of Sacramento-area pediatricians Dr. Kelly Sutton and Dr. Michael Fielding Allen.

In the past nine months, the board also has sought patients’ records in connection with two Santa Rosa physicians under investigation for writing allegedly inappropriate exemptions.

The state acted on the Sutton and Allen cases following complaints to the medical board from Dr. Wendy Cerny, assistant chief of pediatrics at a Kaiser Permanente clinic in Roseville, court documents show. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanante.) Cerny contacted the board about Sutton in February 2017 and followed up with an email about Allen 15 months later, according to the documents.

Cerny became concerned after seeing permanent medical exemptions for Kaiser Permanente pediatric patients written by Sutton and Allen that cited reasons including “a personal history of genetic defect,” food and environmental allergies, “neurological vulnerability” and a family history of mental health disorders, according to the legal documents.

The doctors under investigation are not Kaiser Permanente doctors, but parents went to them for vaccination exemptions. In one case, Sutton issued a “lifelong medical exemption from all vaccines” to a boy before his family joined Kaiser Permanente, according to Cerny’s complaint. When one of Cerny’s colleagues refused to write similar exemptions for the boy’s two younger siblings, the mother said she would go back to Sutton to get them, the complaint says.

“We feel this doctor and perhaps her colleagues … are making easy money on these exemptions that are not based on true medical need and are actually putting children and other people in the community at risk for contracting and spreading serious infectious diseases,” Cerny wrote in her complaint about Sutton.

A physician appointed by the medical board to review exemptions issued by Sutton and Allen described them as “either of questionable validity or patently without medical basis.”

Vaccine exemptions for medical reasons should be rare, according to the Centers for Disease Control and Prevention. They are typically reserved for children with severely compromised immune systems, like those being treated for cancer or those who are allergic to a vaccine component or have previously had a severe reaction to a vaccine.

A spokesman for the medical board declined to comment on the cases. The agency generally does not acknowledge investigations publicly unless a formal accusation is filed against a physician.

But the board’s legal efforts to obtain patient records sheds rare light on how the agency handles such complaints.

It “tells me that there are doctors who are giving problematic exemptions and the Medical Board of California is taking this issue very seriously,” said Dorit Reiss, a professor at University of California-Hastings College of the Law in San Francisco who researches vaccine law.

Sutton and Allen did not respond to phone calls and emails seeking comment.

Sutton, based in Fair Oaks, is known as a go-to doctor for medical vaccine exemptions. She offers a $97 “program” that purports to “help protect your child from the ‘One Size Fits All’ California vaccine mandate.”

Cerny submitted copies of exemption letters by Sutton and Allen in the complaints she filed with the medical board, but the names of the patients were blacked out. The board wants the names of those children and their parents, and it asked the court to compel the Permanente Medical Group, a subsidiary of Kaiser Permanente, to hand over unredacted versions of the letters.

The board also wants Kaiser Permanente to hand over the patients’ medical charts, which it believes will help determine whether the exemptions written by Sutton and Allen were indeed unmerited.

In June, Superior Court Judge Ethan Schulman ordered the Permanente Medical Group to disclose the names of the patients known to have received medical exemptions from Allen, as well as the names and addresses of their parents. He has not yet issued a ruling in the Sutton case.

Kaiser Permanente said it would comply with court orders.

“We take the health and safety of our members, patients and communities very seriously,” said Dr. Stephen Parodi, associate executive director of the Permanente Medical Group, via email.

In a case similar to Sutton’s and Allen’s, a judge ordered the Permanente Medical Group in November to provide the names of patients and parents subpoenaed in a medical board investigation of Dr. Kenneth Stoller, a Santa Rosa physician who gave vaccine exemptions to children who were Kaiser Permanente patients, as well as to others in the Mammoth Unified School District.

Stoller, who is not affiliated with Kaiser Permanente, is also being investigated by the city attorney of San Francisco, where he used to practice. He didn’t respond to a request for comment.

In April, Judge Schulman granted a petition from the state ordering Dr. Ron Kennedy to hand over the medical records of children to whom he had issued vaccination exemptions. Kennedy, a psychiatrist who runs an anti-aging clinic in Santa Rosa, has written numerous exemptions for kids, according to court records.

Kennedy’s lawyer, Michael Machat, said his client has handed over the records as ordered.

“The medical board has adopted the practice of thinking it can invade people’s privacy and search children’s private medical records to see whether or not the doctors are following the law,” Machat said. “Where does this stop?”

To date, the only doctor sanctioned for inappropriate medical vaccine exemptions is Southern California pediatrician Robert Sears, the well-known author of “The Vaccine Book.”

In 2015, California banned all philosophical and religious exemptions for immunizations in the wake of a large measles outbreak that originated at Disneyland. It is one of four states to have done so, and its vaccination rate rose sharply for three years after the law was tightened. But vaccination rates have declined in the past two years, in part because many parents opposed to vaccines have found doctors willing to write questionable medical exemptions — sometimes for a fee.

California’s vaccination policies are once again drawing national attention in the wake of the nation’s recent measles outbreak, which totaled 1,095 cases as of June 27. In California, 55 cases were reported as of June 26.

A bill pending in the California legislature, SB-276, would impose more oversight on vaccine exemptions written by doctors. After it passed the state Senate in May, it was softened to appease Gov. Gavin Newsom but would still allow the state Department of Public Health to review some exemptions. It also would prevent doctors who are under investigation for writing unwarranted exemptions from issuing new ones.

Newsom has said he will sign the legislation if it lands on his desk.

https://www.healthleadersmedia.com/clinical-care/california-broadens-investigation-doctors-issuing-questionable-vaccination-exemptions

Primary care positions filled by 4th-year med students lowest on record

According to the Match, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty.

Only 41.5% were filled by seniors pursuing their MDs from U.S. medical schools. Similar trends were seen this year in family medicine and pediatrics.

Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields.

A record-high number of primary care positions was offered in the 2019 National Resident Matching Program — known to doctors as “the Match.” It determines where a medical student will study in their chosen specialty after graduation. But this year, the percentage of primary care positions filled by fourth-year medical students was the lowest on record.

“I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said.

The three key primary care fields are internal medicine, family medicine and pediatrics. According to the 2019 Match report, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty, but only 41.5% were filled by seniors pursuing their M.D.s from U.S. medical schools. Similar trends were seen this year in family medicine and pediatrics.

In their final year of medical school, students apply and interview for residency programs in their chosen specialty. The Match, a nonprofit group, then assigns them a residency program based on how the applicant and the program ranked each other.

Since 2011, the percentage of U.S.-trained allopathic, or M.D., physicians who have matched into primary care positions has been on the decline, according to an analysis of historical Match data by Kaiser Health News.

But, over the same period, the percentage of U.S.-trained osteopathic and foreign-trained physicians matching into primary care roles has increased. 2019 marks the first year in which the percentage of osteopathic and foreign-trained doctors surpassed the percentage of U.S. trained medical doctors matching into primary care positions.

Medical colleges granting M.D. degrees graduate nearly three-quarters of U.S. students moving on to become doctors. The rest graduate from osteopathic schools, granting D.O. degrees. The five medical schools with the highest percentage of graduates who chose primary care are all osteopathic institutions, according to the latest U.S. News & World Report survey.

Beyond the standard medical curriculum, osteopathic students receive training in manipulative medicine, a hands-on technique focused on muscles and joints that can be used to diagnose and treat conditions. They are licensed by states and work side by side with M.D.s in physician practices and health systems.

Although the osteopathic graduates have been able to join the main residency match or go through a separate osteopathic match through this year, in 2020 the two matches will be combined.

Physicians who are trained at foreign medical schools, including both U.S. and non-U.S. citizens, also take unfilled primary care residency positions. In the 2019 match, 68.9% of foreign-trained physicians went into internal medicine, family medicine and pediatrics.

But, despite osteopathic graduates and foreign-trained medical doctors taking up these primary care spots, a looming primary care physician shortage is still expected.

The Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032. More doctors will be needed in the coming years to care for aging baby boomers, many of whom have multiple chronic conditions. The obesity rate is alsoincreasing, which portends more people with chronic health problems.

Studies have shown that states with a higher ratio of primary care physicians have better health and lower rates of mortality. Patients who regularly see a primary care physician also have lower health costs than those without one.

But choosing a specialty other than primary care often means a higher paycheck.

According to a recently published survey of physicians conducted by Medscape, internal medicine doctors’ salaries average $243,000 annually. That’s a little over half of what the highest earners, orthopedic physicians, make with an average annual salary of $482,000. Family medicine and pediatrics earn even less than internal medicine, at $231,000 and $225,000 per year, respectively.

Dr. Eric Hsieh, the internal medicine residency program director at the University of Southern California’s Keck School of Medicine, said another deterrent is the amount of time primary care doctors spend filling out patients’ electronic medical records.

“I don’t think people realize how involved electronic medical records are,” said Hsieh. “You have to synthesize everything and coordinate all of the care. And something that I see with the residents in our program is that the time spent on electronic medical records rather than caring for patients frustrates them.”

The Medscape survey confirms this. Internists appear to be more burdened with paperwork than other specialties, and 80% of internists report spending 10 or more hours a week on administrative tasks.

The result: Only 62% of internal medicine doctors said they would choose to go into their specialty again — the lowest percentage on record for all physician specialties surveyed.

Elsa Pearson, a health policy analyst at Boston University, said one way to keep and attract primary care doctors might be to shift some tasks to health care providers who aren’t doctors, such as nurse practitioners or physician assistants.

“The primary care that they provide compared to a physician is just as effective,” said Pearson. They wouldn’t replace physicians but could help lift the burden and free up doctors for more complicated care issues.

Pearson said more medical scribes, individuals who take notes for doctors while they are seeing patients, could also help to ease the doctors’ burden of electronic health record documentation.

Another solution is spreading the word about the loan forgiveness programs available to those who choose to pursue primary care, usually in an underserved area of the country, said Dr. Tyree Winters, the associate director of the pediatric residency program at Goryeb Children’s Hospital in New Jersey.

“The trend has been more so thinking about the amount of debt that a student has, compared to potential income in primary care,” said Winters. “But that’s not considering things like medical debt forgiveness through state or federal programs, which really can help individuals who want to choose primary care.”

https://www.healthleadersmedia.com/clinical-care/american-medical-students-less-likely-choose-become-primary-care-doctors

AstraZeneca appeals NICE rejection of Tagrisso lung cancer med

AstraZeneca is appealing against NICE’s decision not to recommend funding for its lung cancer drug Tagrisso (osimertinib) in untreated patients with epidermal growth factor receptor (EGFR) mutations.

In final draft guidance, NICE said it had rejected regular NHS funding for Tagrisso, because the survival benefits compared with standard treatment such as AZ’s older drug Iressa (gefitinib) are unclear in first-line non-small cell lung cancer.

Tagrisso has been the driving force behind AZ’s sales recovery after a steep patent cliff – it generated $630 million in Q1 alone and is the company’s top selling drug after first approval in 2015 in a more advanced form of the disease.

NICE had been considering results from the FLAURA trial, comparing Tagrisso with Roche’s Tarceva (erlotinib) and AZ’s Iressa (gefitinib) in untreated patients.

Patients in the trial had either exon 19 deletion (del19) or exon 21 (L858R) mutations, accounting for around 90% of EGFR mutations.

NICE said it noted progression-free survival was 18.9 months on Tagrisso compared with 10.2 months on standard care.

Overall survival data is not mature but data gathered so far show that Tagrisso will likely extend this too.

However NICE is concerned that data so far do not show the size of treatment benefits, and that AZ’s economic model does not fully capture the benefits of subsequent treatments.

As a result Tagrisso’s cost per quality-adjusted life year (QALY) is greater than the £30,000 threshold that NICE usually applies.

However NICE also ruled that Tagrisso does not qualify for End of Life consideration, which gives extra financial leeway for drugs where patients typically have less than two years to live.

AZ said that analyses submitted to NICE show that it would be considered cost-effective if EoL status was granted.

AZ’s CEO Pascal Soriot said: “We are very disappointed with this decision and will appeal. The UK has the second worst lung cancer survival outcomes in Europe and patients need new innovative treatments.

“NHS data show that patients in England who would be eligible for our medicine have very low survival rates and therefore Tagrisso should qualify for End of Life consideration to evaluate cost-effectiveness.”

Dr Carles Escriu, medical oncology consultant at The Clatterbridge Cancer Centre and Honorary Research Fellow at the University of Liverpool, said: “I am surprised at this negative decision. While I understand the methodological challenge for NICE, the fact is that NHS data show that patients with this type of lung cancer survive for 17 months, which is within the 24-month short life expectancy threshold for End of Life consideration.”

AZ appeals against NICE rejection of Tagrisso in untreated lung cancer

Pfizer’s lung cancer drug Vizimpro cleared for NHS front-line use

Pfizer has stolen a march on rival AstraZeneca in the first-line non-small cell lung cancer category, after NICE backed the use of its EGFR inhibitor Vizimpro for NHS use.

The once-daily pill will now be routinely available for adults with locally advanced or metastatic non-small cell lung cancer (NSCLC), who have tested positive for the epidermal growth factor receptor (EGFR) mutation. Earlier, NICE rejected the drug on the grounds that it wasn’t a cost-effective use of NHS resources.

AZ has not been so lucky, with the cost-effectiveness agency turning down its EGFR inhibitor Tagrisso (osimertinib) for the same indication, although the company has said it intends to appeal the decision.

Pfizer has offered a discount on Vizimpro (dacomitinib), which was approved by the EMA in April and in the US last September. Its list price in the UK is £2,703 for a 30-day pack of capsules, but the agreed reduction is confidential.

In a statement, NICE said Pfizer’s “responsible pricing” had allowed its appraisal committee to reconsider its initial decision.

Both Vizimpro and Tagrisso were turned down by the agency in April after an initial assessment, with the committee deciding neither drug offered enough extra benefit to patients when compared with existing treatments to be value for money.

“Our committee acknowledged that dacomitinib had the potential to extend life for people with this type of lung cancer more than existing treatments currently available on the NHS,” said Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE.

Company estimates are that around 1,477 people in England will be eligible for treatment with Vizimpro every year, according to the agency.

Health services in Wales and Northern Ireland usually follow NICE recommendations too, so the drug will likely be available there as well, according to Cancer Research UK.

The charity welcomed the green light for Vizimpro but said the Tagrisso decision was “disappointing”, particularly as AZ’s drug seems to offer some efficacy advantages and fewer side effects.

For now, the decision puts Pfizer UK in the driving seat for first-line EGFR-positive NSCLC therapy in England.

The company’s oncology director, Olivia Ashman, said: “Lung cancer remains a challenging condition to treat and we are pleased that clinicians managing patients with EGFR-mutated NSCLC will now have access to this important medicine.”

NICE has already recommended three other EGFR inhibitors for previously-untreated EGFR-positive NSCLC, including AZ’s Iressa, Boehringer Ingelheim’s Giotrif and Roche’s Tarceva, although these are considered less effective than the newer agents.

The agency’s guidance says people who took Vizimpro had longer overall survival rates than those who took Iressa – 34.1 months compared with 26.8 months – and Pfizer’s drug also increased the length of time before the disease worsened by around five months.

Vizimpro had a higher incidence of side effects than Iressa, however, so a lower dose may be needed, according to NICE.

NICE clears front-line NHS use for Pfizer’s lung cancer drug Vizimpro

Economic cost of cancer in U.S. tops $94 billion annually: study

State-by-state variations in cancer deaths suggest effective cancer prevention and treatment could yield economic benefits.

A new study published in JAMA Oncology estimates individuals between the ages of 16 and 84 who died of cancer in the United States in 2015 alone account for over $94 billion in lost earnings. This type of information offers policymakers another way of quantifying the burden of cancer, according to the study’s senior author, Robin Yabroff, Ph.D., senior scientific director of health services research with the American Cancer Society.

“Looking at the number of years that are lost due to premature cancer death gives you a different type of information than just looking at newly diagnosed patients—you’re really getting a sense of what would have happened in the absence of those deaths,” she told FierceHealthcare.

The study also took a more granular look at the data than most previous approaches, allowing researchers to estimate lost earnings both by type of cancer and at a state-by-state level. Lung cancer accounted for the highest number of lost wages at $21.3 billion, or 22.5% of all cases. Among the states, Utah’s $19.6 million in lost wages was the lowest in the country, while Kentucky had the highest losses of $35.3 million.

The differences in lost wages from state to state surprised Yabroff. “I had known that there are differences in mortality rates by state—you do see higher cancer mortality rates in many southern states than you do in other states—but I really thought the magnitude of the differences between states, for example Utah to Kentucky or Missisippi had really big differences in lost earnings.”

A variety of factors likely accounts for the difference in the economic impact of early cancer deaths from state to state, but that doesn’t mean states lack effective means to address the problem. In fact, many of the state-level policies that Yabroff recommends to address cancer risk factors, such as reducing smoking and countering obesity, offer additional benefits as they relate to population health beyond cancer treatment.

Connecting cancer to its economic consequences could also help policymakers better understand the relevance of existing policies that have demonstrated positive results. “There are a number of studies that we’ve conducted evaluating the effects of Medicaid expansion where we’ve found higher prevalence of screening, earlier diagnosis, and reductions in disparities in health insurance coverage,” Yabroff said.

Using the current study’s data as a benchmark could also help to guide future policy decisions. However, Yabroff warns that there could be a gap between the implementation of new policies and a reduction in state-by-state disparities in economic impact because prevention, screening and treatment can take place long before a patient succumbs to cancer prematurely. In essence, that could mean the current disparities have yet to fully reflect state-level policies related to access to care and improved screening. For example, most of the states that have adopted Medicaid expansion did so in 2014 and 2015, so any potential improvement caused by cancer screening would likely show up in future studies.

And while Utah may have the lowest loss of wages relative to other states, Yabroff said it still has opportunities to reduce cancer risk factors by improving screening, access to care and treatment.

“We don’t know how to prevent all cancers, but there are some where we have a sense of what to do, like reducing smoking, improving physical activity and reducing obesity. Those things are definitely associated with increased risk of cancer,” she said.

https://www.fiercehealthcare.com/hospitals-health-systems/study-cancer-prevention-could-produce-financial-benefits

How Team Trump is keeping drug prices down

At some point, almost all Americans have been stuck with massive, unexpected medical bills or forced to make health decisions without real information or anyone to guide them. We have worked at the highest levels of US health care for years, yet it has happened to both of us.

It’s one reason why President Trump signed an executive order last week to help you easily find the typical price — and what you would actually owe — for major health services before you have to purchase them.

This step is part of a number of efforts underway, across the administration, to fix the problems in American health care, while preserving what works and what Americans like about the system. Most Americans, especially the 240 million on Medicare or employer insurance, like what they have but are concerned about the flaws in the system. Too many fear that they are one bit of bad luck away from crippling medical bills.

The president understands this, which is why he vowed to build on what works and continue fighting to deliver the affordability you need, the options and control you want and the quality you deserve.

What does following through look like? First, the president has been clear: Americans need affordable health care. Patients deserve a backstop against high medical costs, and the government takeover of individual insurance over the past decade has failed to deliver that peace of mind.

The Trump administration has opened new insurance options for American small employers and workers both inside and outside of the individual insurance market, and we continue to protect Americans with preexisting conditions.

Last week, we finalized a new way for Americans to use tax-free contributions from their employer to purchase insurance of their choosing. The president’s executive order will also open up new access to health-savings accounts, which can protect Americans from high medical bills.

We also need to address unaffordable prices in health care. There is already evidence that significant savings can be generated just by giving patients the tools to know prices and shop among providers, which is what the president’s executive order will deliver. Americans should also be allowed to receive more services from lower-priced providers, such as nurse practitioners and physician’s assistants.

The cost of prescription drugs also must keep coming down. The Trump administration has set ­records for approvals of low-cost generic drugs, saving patients $26 billion in just the first year and a half of the president’s term. We have also proposed that backdoor rebates in Medicare Part D, which amounted to $29 billion last year, be delivered directly as discounts to patients at the pharmacy counter — as soon as Jan. 1, 2020.

Second, American patients deserve to be in control, not left at the mercy of a shadowy system. That is the goal of the president’s new executive order: to bring you the pricing information you need to find the right options for you. The president has already ensured you have a right to find out the best possible price for medications from your pharmacist and required drug companies to put their prices in TV ads.

We are also working to give ­patients control over their own health information, allowing them seamless access to their health data through private-sector apps.

Third, we are going to deliver the quality patients deserve. High-quality care means not just cutting-edge treatments but also care that keeps you healthy, rather than only helping when you’re sick.

We launched a major initiative that could connect 10 million or more Medicare beneficiaries to a primary-care provider who will be accountable to them — and paid more when patients stay healthy. The president’s executive order aims to simplify health care quality measures collected by the federal government, so your doctor can focus on keeping you healthy, rather than filling out paperwork.

Putting you in control and providing you with real certainty is a stark contrast to recent proposals for a government takeover of our entire health care system. That leap would leave behind what so many Americans know and like about our system.

President Trump has promised a better vision: a health care system that treats you like a person, not a number. He wants to hold providers and Big Pharma accountable to transparency and reasonable prices. We are working every day to protect American patients and deliver on the president’s vision.

Alex Azar II is the US secretary of health and human services. Joe Grogan is director of the Domestic Policy Council at the White House.

https://nypost.com/2019/07/01/how-team-trump-is-keeping-drug-prices-down/