JustCare

Category: Drugs and technology

  • Are weight-loss drugs a modern-day miracle?

    Are weight-loss drugs a modern-day miracle?

    Pretty much everywhere I turn, there’s a new story about the benefits of weight-loss drugs beyond helping people lose weight. It’s still early days, and many weight-loss drugs are extremely expensive. But, if you believe the stories, weight-loss drugs can treat heart conditions, can reduce overall health care spending and, can even treat depression and dementia, reports Simar Bajaj for the New Scientist.

    For now, Medicare covers weight-loss drugs mainly for people with diabetes. They are super expensive, driving up insurance premiums considerably, and there’s a lot we still don’t know about them. Still, what’s coming out about their benefits seems nothing short of a miracle.

    Some former alcoholics and drug addicts appear to lose their desire for alcohol and drugs when they take a semaglutide, a weight-loss drug, such as Wegovy and Ozempic. Their depression and anxiety fade away. So, can their addiction.

    Today about six million Americans take a weight-loss drug or GLP-1 medicine. Before long, it is projected that five times that number–30 million–Americans will be on a semaglutide. These drugs enable people to drop between 15 to 20 percent of their body weight.

    Back in February, Epic, which keeps Americans’ medical records, determined that people who took a GLP-1 were considerably less likely to suffer from depression and anxiety than others.  An earlier study arrived at similar findings. 

    Time will tell before we know for sure whether weight-loss drugs deliver all these findings. For now, it seems that the findings make sense. People who are overweight are more prone to depression. If they lose weight after taking a GLP-1, it’s more than likely that it will benefit them mentally as well as physically. For most of us, it feels good to lose weight.

    Some scientists believe there’s more to the story. GLP-1s are produced in the brain as well as the gut. So when you take a GLP-1 drug, you could be benefiting your brain directly, improving cognitive functions and emotional control. Indeed, in a small study of people who did not lose weight from a GLP-1, the researchers still saw improvements to their moods, and they experienced fewer depressive symptoms.

    GLP-1s have been found to increase blood flow in the brain as well as to keep nerve cells from dying as quickly as they otherwise do. They bring more glucose to the brain. As a result, the brain can function better. For these reasons, in small studies, GLP-1s have also been found to be responsible for less brain shrinkage in people with Alzheimer’s and to slow the progression of the disease.

    Again, these are early days. The good news is that these weight-loss drugs seem to have myriad benefits. And, for now, they also appear to come with few risks. But, if we know anything, it’s that what’s good for your health today might be found to come with serious side effects tomorrow.

    Here’s more from Just Care:

  • Republican Congressman accuses drug middlemen execs of perjury

    Republican Congressman accuses drug middlemen execs of perjury

    You might not know what a PBM–Pharmacy Benefit Manager–is, but PBMs are among the biggest companies in American, profiting handsomely from driving up your drug costs. A Republican Congressman, Rep. James Comer, who chairs the House Committee on Oversight and Accountability is going after PBM execs for misleading the Committee with findings that are at odds with the facts, reports Page Minemyer for Fierce Healthcare.

    The three biggest PBMs, which control more than 80 percent of the pharmaceutical market, are Optum Rx, owned by UnitedHealthcare, CVS Caremark, owned by CVS, and ExpressScripts, owned by Cigna. Among other misrepresentations and alleged perjuries, their execs would not concede that their companies steer patients to affiliated pharmacies or pharmacies their companies own.

    Congressman Comer said that the execs could be punished financially and sent to jail for as many as five years for their alleged perjuries. That might be a first. As a general rule, low-income individuals spend more time in jail for petty theft than executives at big companies that gouge Americans financially, harm them physically, and worse.

    But, Congressman Comer lets the PBM execs off if they “correct the record.” Based on Express Scripts’ response to Fierce Healthcare, it sees nothing inaccurate with the representations of its executives. Its spokesperson talks about how Express Scripts reduces the cost of medications, without mentioning that the bulk of those savings go into its pockets and the pockets of insurers. PBMs too often drive up costs for individuals.

    Congressman Comer focuses on the harm these PBMs inflict on local independent pharmacies through their bad acts. And, he appears to want to do something about that. If course, in a world with negotiated drug prices, which is the only way to address outrageous prices and prevent monopoly pricing, these companies would serve no useful purpose. That’s the world that Congressman Comer should be helping to create, not undermining. But, that’s not where Republicans in Congress stand. They uniformly opposed the drug price negotiation provision for Medicare in the Inflation Reduction Act.

    Here’s more from Just Care:
  • FDA won’t approve MDMA for treatment of PTSD

    FDA won’t approve MDMA for treatment of PTSD

    The FDA isn’t approving MDMA (sometimes known as the party-drug ecstasy or molly) for the treatment of post-traumatic stress disorder or PTSD, a mental illness. Some Republican and Democratic members of Congress on the Congressional Psychedelics Advancing Therapies (PATH) Caucus believe the FDA made a mistake. In their view, MDMA could save lives.

    In particular, many think that veterans with PTSD would be well served through MDMA. Other treatments often do not work. Veterans very much supported FDA approval of the psychedelic drug. And, there is mounting support from the public for FDA approval of MDMA. Thirteen million Americans suffer from PTSD.

    The FDA did not rule out future approval of MDMA. Rather, it requested that Lykos Therapeutics, which conducted the clinical trial, conduct a third phase 3 trial to investigate further the safety and efficacy of MDMA. The first two trials suggested MDMA was effective for treating PTSD, but the FDA’s advisory committee claimed that data on adverse events were missing and that the research was biased. A third trial will take several years to complete.

    Olivia Goldhill reports for Stat News that the Institute for Clinical and Economic Review (ICER) determined back in March that evidence supporting MDMA therapy for PTSD was “insufficient.” It posited that there could have been clinical trial misconduct. Trial participants told ICER researchers about “severe negative outcomes.” These outcomes were not reported in the trial data.

    Haleema Shah reports for Vox that MDMA was created decades ago now in a home laboratory, and since then, people have used it illegally. People who use it say that it fills them with love and empathy. Some say that people with PTSD who use it for 18 weeks are relieved of symptoms that other medicines and talk therapy cannot accomplish.

    That said, there is evidence that MDMA can have serious health consequences, including rapid heart rate and other heart conditions.

    Here’s more from Just Care:

  • Aspirin is good at preventing blood clots post-surgery. Why don’t hospitals use it?

    Aspirin is good at preventing blood clots post-surgery. Why don’t hospitals use it?

    A recent study found that patients benefit as much from aspirin post-surgery as they do from costly and painful injectables. Both prevent blood clots in patients who have severely fractured a bone, but most hospitals continue to treat patients with the costly injectables. Researchers make the case that prescribing the injectables has serious health equity consequences in a Stat News op-ed and question provider behavior.

    Patients are burdened with far lower costs for aspirin than the low-molecular weight heparin injectables. And, it’s easier for them to take a pill than to get an injection. However, hospitals and physicians appear not to consider health equity issues or simple cost-effectiveness, for that matter, when they treat patients.

    The goal post bone-fracture surgery is to prevent clots, which keep blood from flowing in the lungs and can cause deadly embolisms. And, again, two aspirins a day work just as well as the painful injections into patients’ stomach wall twice a day for three or four weeks post surgery, even for high-risk patients. Moreover, six days of injections cost at least $70 and as much as $300, while the bottle of aspirin costs a few dollars.

    Health insurers will generally pay for the injectable drug even though the less costly aspirin alternative is just as good. But, the injectable drug drives up  patients’ out-of-pocket costs and members’ premiums. Moreover, people prescribed the injectable after their surgery post bone fracture often don’t take it, making it more likely that they will have a blood clot.

    Physicians do not appear to consider that lower-income people, in particular, often do not have the means–financial or social–to comply with the injectable regimen. Only about 15 percent of physicians prescribe aspirin directly after surgery to treat a bone fracture. Only about half of physicians prescribe aspirin to patients after they are discharged.

    At many hospitals, policies have not changed notwithstanding the results of the clinical study showing aspirin’s efficacy. It appears that the hospitals would benefit financially if they used aspirin and stopped using the injectables.

    The insurers should have a role to play. After all, the insurers claim that they offer “value.” Why aren’t they insisting that aspirin is the most cost-effective treatment and refusing to cover the injectable drug post bone-fracture surgery? Are they somehow benefiting financially from patients taking the injectables?

    Here’s more from Just Care:

  • Medicare Part D drug costs: What to expect in 2025

    Medicare Part D drug costs: What to expect in 2025

    If you have Medicare, you will likely see many changes to your Medicare Part D drug costs in 2025. The Inflation Reduction Act of 2022 should lower your drug costs. Here’s what the Kaiser Family Foundation says to expect.

    Your Medicare Part D premiums probably will increase in 2025. That’s because your total annual out-of-pocket drug costs will be capped at $2,000, far lower than this year. To avoid higher costs and lower profits, Medicare Part D insurers will spread the cost of this cap across everyone who enrolls.

    The Inflation Reduction Act anticipated a Part D premium increase. It includes a provision that does not allow the Part D “base premium” to rise more than six percent from the prior year. What does that mean exactly? Unfortunately, it’s not as simple as a limit on your individual premium increase.

    A new voluntary demonstration, through the Centers for Medicare and Medicaid Services, might also help some people in Traditional Medicare who buy stand-alone drug coverage avoid big premium increases. It lowers the base premium by $15 a month and limits the premium increase from 2024 to 2025 to $35 a month.

    The base premium for Part D will be $36.78 in 2025. That does help reflect what the Part D premiums will be. We will know that in September.

    Here’s what we know now: The standard Part D benefit is changing in significant ways. Enrollees getting the standard benefit will meet their deductible and then pay 25 percent of the cost of their drugs until they reach the $2,000 maximum out-of-pocket cap.

    N.B. This year, if you are willing to give up Traditional Medicare, with access to the physicians and hospitals of your choice anywhere in the US, and subject yourself to huge administrative hurdles when you need complex and costly care, in a Medicare Advantage plan, your Part D premiums are, on average, significantly lower than the Part D premiums for stand-alone plans available to people in Traditional Medicare, $9 v. $43 a month.

    Here’s more from Just Care:
  • Drug prices keep going up, some faster than inflation

    Drug prices keep going up, some faster than inflation

    Until Congress regulates drug prices in the US as every other wealthy country does, prescription drug prices will continue to go up and an increasing number of Americans will suffer or die because they can’t afford their drugs. In the week ending July 5, pharmaceutical companies raised prices for 195 drugs, reports MM+M. Price increases were greater than the rate of inflation for more than half of these drugs.

    Eli Lilly, BMS, Pfizer, AbbVie, Novartis and GSK raised prescription drug prices of certain drugs around seven percent, more than twice the rate of inflation, which was three percent. Prices rose $620, on average. Many of these drugs were cancer drugs or drugs for people with autoimmune conditions.

    The price of Revlimid, a Celgene/Bristol Myers Squibb drug, which treats myelodysplastic syndrome, multiple myeloma and mantle cell lymphoma increased seven percent. The drug price jumped from $83,322 to $89,155.

    Some drug prices rose only a small amount. But, we know that even a very small out-of-pocket cost increase for a drug means that some people will stop taking their drugs. These price hikes will not stop until Congress regulates drug prices.

    Medicare has begun negotiating the prices of ten high-priced drugs. We will know very shortly how the negotiated prices compare to what people pay in other wealthy countries for the same drugs. For reasons I cannot explain, people with Medicare will not benefit from these new prices until January 2026.

    Here’s more from Just Care:

  • Bipartisan agreement on how to keep drug middlemen from ripping people off

    Bipartisan agreement on how to keep drug middlemen from ripping people off

    A new bill in Congress would end some of the most egregious practices of Pharmacy Benefit Managers (PBMs), reports Annika Kim Constantino for CNBC. PBMs are the drug middlemen who negotiate lower drug prices from manufacturers and then tend to pocket the savings for themselves or the health insurers who own them. The bill sounds appealing, but the only way to ensure fair drug prices for Americans is to remove the PBMs from the mix and have the government negotiate drug prices directly with the pharmaceutical manufacturers, as every other wealthy country does.

    Right now, the PBMs are driving up drug costs and forcing millions of Americans to forgo or delay filling their prescriptions. The PBMs are also driving community pharmacies out of business by underpaying them for their services or steering customers to pharmacies that promote the PBMs’ financial interests. The Congressional bill would make it easier for people to use community pharmacies, help ensure the PBMs pay these pharmacies appropriately, and lower people’s drug costs.

    This bill is not the only bill attempting to address high drug costs and abuses by the PBMs. And, though it’s bipartisan, it’s not at all clear that it will become law. Because the insurers and PBMs are so powerful, Congress is often hamstrung in its efforts to address their bad acts. Three PBMs–Optum Rx, Express Scripts and CVS Caremark–control about 85 percent of the prescription drug market and are owned by big insurers.

    Fortunately, the FTC is also working to address PBM abusive and unfair practices harming consumers. It plans to sue the three largest PBMs, which control about 80 percent of the market.

    If passed, the bill in Congress would create a new model for paying pharmacies. For reasons I can’t explain, today, PBMs can reimburse pharmacies less than what the pharmacies pay for drugs. The bill also would require PBMs to pass along to patients 80 percent of the savings they negotiate. And, it would forbid PBMs from steering patients to brand-name drugs when lower-cost generics are available.

    Here’s more from Just Care:

  • FTC criticizes Rx middlemen in new report

    FTC criticizes Rx middlemen in new report

    In a health care world filled with insane prices and complexities, the prescription drug middlemen, sometimes called Pharmacy Benefit Managers or PBMs, are at the top of the “is this even possible” list. The Federal Trade Commission or FTC criticizes PBMs sharply in a new 71-page report, reports Reed Abelson and Rebecca Robbins for The New York Times. Only when the government negotiates prescription drugs prices will we see fair prices for prescription drugs; PBMs would cease to exist.

    So that we’re all on the same page: In a better world, PBMs would negotiate lower drug prices from pharmaceutical companies so that health insurance companies could pass on those savings to their members. In our world, the big health insurance companies own the PBMs and pocket all or most of the savings for themselves. Insured Americans end up paying more for their drugs in many cases than people without insurance. Sometimes, their insurers direct them to use higher cost brand-name drugs (because the pharmaceutical manufacturers pay the PBMs a fair bit to steer people to those drugs); people’s insurers might not even offer the generic substitute or do so at a higher copay.

    PBMs keep drugs prices so high that, in many instances, even with a Medicare Part D prescription drug benefit, you will pay less for the full cost of your prescription from Costco or using GoodRx than the Part D copay. PBMs also sometimes overcharge people for the cost of drugs.

    What the FTC says: “[T]hese powerful middlemen may be profiting by inflating drug costs and squeezing Main Street pharmacies.” They “wield enormous power and influence” and their practices “can have dire consequences for Americans.” The only quibble I have with that statement is the “may be;” PBMs profit substantially from these tactics.

    The FTC has not sued a PBM yet. But, the PBMs and the big insurers who own them have taken notice and now worry that they will be sued for anticompetitive conduct. Until there’s a Democratic majority in both houses of Congress and a Democratic president, it seems unlikely that our federal government will block their bad behavior. The Republicans appear to have no interest in reducing drug prices.

    Who owns the three biggest PBMs? CVS Health owns Caremark, UnitedHealth Group owns Optum Rx and Cigna owns Express Scripts. These three PBMs control about 80 percent of the prescription drug market in the US.

    It seems to me that the only way to stop the PBMs from driving up drug costs is to put them out of business. In an ideal world, the US would negotiate drug prices as every other wealthy nation does. PBMs would lose their value. Americans would not be victims of PBM abuse.

    As you might expect, the PBMs disagree strongly with the FTC’s report. They are huge corporations, and they will fight back as hard as they can. They correctly claim that they have enormous leverage to bring down drug prices. But they fail to acknowledge that once they negotiate lower prices, they pocket most, if not all of the savings, and/or pass the savings on to the health insurers who own them.

    The evidence speaks volumes: The PBMs have pharmacies that send mail-order drugs to patients. The FTC found that PBMs paid their pharmacies a lot more for two generic cancer drugs than it would cost to buy these drugs directly from a wholesaler. As a result, in less than three years, they made $1.6 billion in revenue from these two drugs.

    Here’s more from Just Care:

  • What’s more dangerous than dozens of insurers offering Medicare Advantage? UnitedHealth for All

    What’s more dangerous than dozens of insurers offering Medicare Advantage? UnitedHealth for All

    Hayden Rooke-Ley et al. write in the The New England Journal of Medicine about the dangers of a corporate health insurer takeover of Medicare. Medicare Advantage, which is administered by corporate health insurers, is growing like wildflowers. Unless the government ends overpayments to Medicare Advantage plans, a future of UnitedHealth for everyone with Medicare is not unlikely–undermining competition, driving up costs, and putting patient health at risk.

    UnitedHealth is the largest health insurer in the US. In part thanks to the billions of dollars of fixed upfront (capitated) payments it receives from the government to offer Medicare Advantage plans, UnitedHealth is acquiring physician practices and clinics. Indeed, UnitedHealth is the largest employer of physicians in the nation. It also owns the third largest Pharmacy Benefit Manager, OptumRx. And it even owns an enormous provider payment system.

    The government’s payment system for Medicare Advantage, through upfront capitated payments to insurers who bear the full risk of providing Medicare benefits, creates powerful financial disincentives for corporate insurers to withhold patient care and reimbursements to providers every way they can. In sharp contrast, Traditional Medicare, which is administered directly by the government, has a fee-for-service payment system that incentivizes providers to deliver health care.

    Recently, UnitedHealth’s payment system, Change Healthcare, was hacked. As a result, UnitedHealth held up reimbursements to hospitals, physicians and pharmacies. In turn, many of these providers were unable to meet payroll and to deliver care as needed.

    Corporate control of health care is a threat to our health care system. Change Healthcare processes payments in Traditional Medicare as well as in Medicare Advantage. After the Change hack, while UnitedHealth left providers in Medicare Advantage with long waits for reimbursements, the Centers for Medicare and Medicaid Services stepped in on behalf of providers in Traditional Medicare to ensure they were paid. Unlike UnitedHealth, the federal government was most concerned about ensuring providers were paid.

    Humana and CVS are not as large as UnitedHealth, but they too are building enormous positions in senior care, post-acute care, and in-home services. Cigna, Centene and Elevance are also buying up health care businesses.

    This vertical integration in the corporate health insurance sector comes with serious risks. It undermines competition and drives up costs. It can also bankrupt physicians and hospitals and endanger patient care.

    Some argue that corporate control and consolidation in the health care sector delivers efficiencies that can save money and improve care. For example, insurers have an incentive to keep people from going to the ER because they are paid a fixed amount and can pocket what they don’t spend on care. They also have an incentive to keep members healthy so they spend less on their care.

    But, insurers have a financial incentive to keep people from going to the ER and getting other costly care when they need it. The Office of the Inspector General has found that they engage in widespread inappropriate delays and denials of care. So, whatever the benefits of consolidation, the risks are costly and dangerous.

    Insurers also game the Medicare payment system to reap billions of dollars in additional revenue. Last year, they received $83 billion in overpayments, according to the Medicare Payment Advisory Commission.

    The notion that insurers’ employment of physicians eases physicians’ administrative burden is misplaced. Insurers control staffing and scheduling, burdening physicians with a large caseload. In fact, insurers can keep physicians from putting the health of their patients first. Insurers can call the shots regarding the number of patients each clinician sees. And, insurers can incentivize providers to withhold care.

    Insurers like UnitedHealth and CVS have so much money and power at this point that the Department of Justice and Federal Trade Commission have not been successful at blocking monopolistic acquisitions such as United’s purchase of Change Healthcare. UnitedHealth prevailed in court.

    Theoretically, Congress could put an end to vertical consolidation by passing legislation that would prevent insurers from employing physicians and controlling our care-delivery system. Those reforms appear to be a pipe dream, given the gridlock in Congress.

    For sure, Congress should eliminate insurer overpayments. That would cripple the insurers quickly. But, that’s equally unlikely, given the politics.

    At the very least, Congress and the Administration should warn people with Medicare of the dangers they face in Medicare Advantage, instead of misleading them to think they will get the same benefits as in Traditional Medicare. While that might be the case in theory, Medicare Advantage enrollees do not get the same benefits as people in Traditional Medicare in practice. Medicare Advantage plans limit enrollees’ access to doctors and hospitals, impose administrative obstacles to care, and second-guess treating physicians, often inappropriately denying critical care.

    Here’s more from Just Care:

  • How to avoid overpaying for your prescription drugs

    How to avoid overpaying for your prescription drugs

    In a piece for the New York Times, Rebecca Robbins and Reed Abelson advise readers on how to avoid overpaying for prescription drugs. Most importantly, you should not assume that your insurer is saving you money on your drugs. Too often you will pay more for your drugs with insurance than you would if you paid for your drugs in full, without insurance.

    How is it possible you would pay more for your drugs with employer coverage or Medicare Part D coverage than without it? Three words: Pharmacy benefit managers or “PBMs.” These entities—prescription drug middlemen who work for health insurers and are often owned by them—are responsible for negotiating with pharmaceutical companies for lower-priced drugs. But, they can and do pocket a lot of the savings. They then determine which drugs your insurer will cover and your copay for each drug, your “formulary.”

    Three big corporations own the three biggest PBMs. UnitedHealth owns Optum Rx, CVS owns Caremark and Cigna owns ExpressScripts. These insurance corporations put their shareholders’ interests ahead of their customers’. What’s worse is that our government allows them to upcharge their customers.

    Robbins and Abelson suggest that you might want to know which PBM controls your formulary, but I’m not sure why. Caremark, ExpressScripts and Optum control 80 percent of the prescriptions filled in the US. And, there’s no evidence that any of them offer better prescription drug coverage than any other.

    How do PBMs game the system? In addition to being able to pocket and not pass along to you the discounts they secure from drug manufacturers, they can force you to take a brand-name drug when a lower-cost generic is available. They take money from the brand-name manufacturer to steer you to its drug and away from the generic; they might not include the generic on their formulary.

    Sometimes, PBMs include generic drugs on their formularies, but they charge copays for these drugs that are higher than the full cost of the drugs without insurance.

    What can you do? Always check to see whether you can get your prescription drugs at a lower price from Costco or GoodRx or Mark Cuban’s Cost Plus Drugs or from abroad. You often can. A colleague of mine was told the Medicare Part D copay for his drug was over $300.  When he asked the cost with GoodRx, he was told it was $30!

    Here’s more from Just Care: