From The Washington Post

‘There’s a Lot of Screaming Into the Void’: Toddler’s Parents Battle for Coverage of $2.1 Million Gene Therapy

July 10, 2019

When a $2.1 million gene therapy offering the chance of a cure for her daughter’s rare disease won government approval in May, Lauren Sullivan was struck by a sense of “dangerous hope.’’

But after UnitedHealthcare said it would not cover the treatment, Sullivan’s hope has given way to an anxious race against the calendar.

When a $2.1 million gene therapy offering the chance of a cure for her daughter’s rare disease won government approval in May, Lauren Sullivan was struck by a sense of “dangerous hope.’’

But after UnitedHealthcare said it would not cover the treatment, Sullivan’s hope has given way to an anxious race against the calendar.

The Food and Drug Administration said the new drug, which works by replacing the defective gene that causes Daryn’s spinal muscular atrophy with a good one, must be administered by age 2. Daryn’s second birthday arrives in early October.

With time running out, the family is caught in a battle over who gets treated with a cutting-edge drug that is also extraordinarily expensive.

Read the full The Washington Post article

Would Medicare for All Mean Hospitals for None?

July 3, 2019

“If you go to every hospital in this country and you ask them one question, which is, ‘How would it have been for you last year if every one of your bills were paid at the Medicare rate?’ Every single hospital administrator said they would close. And the Medicare-for-all bill requires payments to stay at current Medicare rates. So to some extent, we’re supporting a bill that will have every hospital closing.”

“If you go to every hospital in this country and you ask them one question, which is, ‘How would it have been for you last year if every one of your bills were paid at the Medicare rate?’ Every single hospital administrator said they would close. And the Medicare-for-all bill requires payments to stay at current Medicare rates. So to some extent, we’re supporting a bill that will have every hospital closing.”

— Former congressman John Delaney, at a Democratic presidential candidate debate, Miami, June 26, 2019

In a crowded stage featuring many candidates who support Medicare-for-all, Delaney stood out with a doomsday prediction that it would force all hospitals to close.

Shifting the U.S. health-care industry to a single-payer system such as Medicare-for-all would be a huge endeavor, and it’s impossible to foresee every potential consequence. But we couldn’t find any expert or research study supporting the former Maryland congressman’s claim that Medicare-for-all would cause widespread hospital closures….

Read the full The Washington Post article

Appellate Court Raises Potential New Threat to ACA

June 26, 2019

A federal appeals court on Wednesday questioned whether more than a dozen Democratic states and the U.S. House of Representatives have the right to appeal a lower-court decision that struck down the entirety of the Affordable Care Act, throwing the law’s future into question.

The U.S. Court of Appeals for the 5th Circuit, which is scheduled to begin hearing oral arguments about the constitutionality of the law on July 9, said it needed more information as to whether the House and Democratic states had standing to intervene in the lawsuit and whether their interventions were timely. Some legal experts said the request did not bode well for the future of President Barack Obama’s signature domestic policy achievement.

A federal appeals court on Wednesday questioned whether more than a dozen Democratic states and the U.S. House of Representatives have the right to appeal a lower-court decision that struck down the entirety of the Affordable Care Act, throwing the law’s future into question.

The U.S. Court of Appeals for the 5th Circuit, which is scheduled to begin hearing oral arguments about the constitutionality of the law on July 9, said it needed more information as to whether the House and Democratic states had standing to intervene in the lawsuit and whether their interventions were timely. Some legal experts said the request did not bode well for the future of President Barack Obama’s signature domestic policy achievement.

“More generally, this order suggests that the Fifth Circuit panel may be hostile to the ACA and inclined to support the red states,” Nicholas Bagley, a University of Michigan law professor, wrote on Twitter. “The odds that the Fifth Circuit does something nasty to the health-reform law have gone up….”

Read the full The Washington Post article

Low Prices of Some Lifesaving Drugs Make Them Impossible to Get

June 18, 2019

When Andrew Archuleta’s bladder cancer returned two years ago, his doctor prescribed periodic treatments of a powerful immunotherapy designed to stave off another recurrence. But the latest round, scheduled for May, was abruptly canceled because of a severe shortage of the drug.

“I keep calling the clinic and saying, ‘Is my treatment still canceled?’ and they say, ‘Yes,’ ” said the 65-year-old Colorado resident. Now he fears the cancer might come back in an even more aggressive form, endangering his bladder — or even his life, if the disease were to spread. With his anxiety and blood pressure rising, he temporarily took Prozac.

When Andrew Archuleta’s bladder cancer returned two years ago, his doctor prescribed periodic treatments of a powerful immunotherapy designed to stave off another recurrence. But the latest round, scheduled for May, was abruptly canceled because of a severe shortage of the drug.

“I keep calling the clinic and saying, ‘Is my treatment still canceled?’ and they say, ‘Yes,’ ” said the 65-year-old Colorado resident. Now he fears the cancer might come back in an even more aggressive form, endangering his bladder — or even his life, if the disease were to spread. With his anxiety and blood pressure rising, he temporarily took Prozac.

“My doctor says he feels really bad about it, but I keep wondering: How could this happen in this day and age?” he said.

Archuleta is one of tens of thousands of people across the country affected by a shortage of the gold-standard treatment, called BCG, for early-stage bladder cancer, with potentially life-changing consequences….

Read the full The Washington Post article

Maker of Addictive Fentanyl Spray Agrees to Pay $225 Million for Prescriptions-For-Cash Scheme

June 6, 2019

The opioid manufacturer Insys Therapeutics has agreed to pay some $225 million to end criminal and civil investigations into allegations that it used a system of bribes to get doctors to illegally prescribe its highly addictive product, federal officials announced Wednesday.

As part of the resolution, the company will plead guilty to five counts of mail fraud, admitting that a speaker program it used to increase its brand awareness was actually a “vehicle to pay bribes and kickbacks to targeted practitioners,” who were willing to increase prescriptions for Subsys, the company’s powerful fentanyl spray, according to a news release from the Justice Department.

The opioid manufacturer Insys Therapeutics has agreed to pay some $225 million to end criminal and civil investigations into allegations that it used a system of bribes to get doctors to illegally prescribe its highly addictive product, federal officials announced Wednesday.

As part of the resolution, the company will plead guilty to five counts of mail fraud, admitting that a speaker program it used to increase its brand awareness was actually a “vehicle to pay bribes and kickbacks to targeted practitioners,” who were willing to increase prescriptions for Subsys, the company’s powerful fentanyl spray, according to a news release from the Justice Department.

The spray had been approved by the Food and Drug Administration for treating the severe pain of terminal cancer patients. But the company came up with ways to get doctors to write prescriptions for patients who didn’t need the drug, prosecutors have charged….

Read the full The Washington Post article