New Bill to Increase IVIG Access
Congress is seeking to expand access to intravenous immunoglobulin by allowing higher reimbursement through Medicare. The Medicare Patient IVIG Access Act (H.R. 2002) directs the Health and Human Services secretary to review pricing data from hospitals and physicians and to determine within 7 months whether an add-on payment is necessary. Current law requires Medicare to pay for all Part B drugs, including IVIG, using the average sales price methodology. However, outpatient facilities pay higher prices because they don't have access to the group discounts that are received by large hospital systems. As a result, physicians are sending patients to the hospital for IVIG treatment, because they cannot purchase IVIG at prices below Medicare payment amounts, according to the bill sponsors, Rep. Steve Israel (D-N.Y.), Rep. Kevin Brady (R-Tex.), and Rep. Allyson Schwartz (D-Pa.). Similar legislation was introduced in the Senate earlier this year (S. 701).
Funds for Rheumatic Research
The Obama administration's fiscal year 2010 budget request includes $531 million for the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about $6 million more than Congress budgeted this year. The FY 2010 funds would be used to continue the agency's support for pain research related to arthritis and rheumatic diseases. NIAMS will also be part of the administration's push to accelerate cancer research by doubling NIH-wide cancer research spending by 2017. NIAMS plans to support investigator-initiated research that focuses on the effects of anticancer therapies on bone quality and muscle strength, as well as the cellular mechanisms associated with autoimmune diseases and cancer.
Sharp Increase in Drug Spending
Spending on rheumatologic drugs rose more than 17% between 2007 and 2008, driven by increases in utilization and higher unit costs, according to Medco Health Solutions Inc. Their report tracks year-over-year increases in prescription spending among its clients. For example, use of adalimumab (Humira) was up following its approval for chronic plaque psoriasis and juvenile idiopathic arthritis in 2008 and for Crohn's disease in 2007. Use of etanercept (Enbrel) also increased in 2008, according to the report. However, overall drug spending growth was only 3.3% in 2008, kept low by the increased use of generic drugs. Generic drugs accounted for about 64% of all prescriptions dispensed by Medco clients in 2008, according to the report.
Imaging Penalties Proposed
In the first of a series of reports on potential health reform options issued by the Senate Finance Committee, the panel said it was proposing a “lower payment for ordering physicians who were determined to be outliers for inappropriate ordering” of imaging. According to the proposal, the Department of Health and Human Services would work with national groups to create appropriateness criteria for imaging services. The Senate committee also envisioned a monitoring system that would report how imaging is being used. Among many other options is the use of radiology benefit managers. In a written statement, the Access to Medical Imaging Coalition said that it endorsed the committee's plan to create and promote appropriateness criteria and a proposal to establish a network to give physicians access to patients' previous imaging studies. But the coalition said it “remains very concerned” about radiology benefit managers.
Part A to Go Broke in 2017
The Medicare Hospital Insurance Trust Fund will run out of money in 2017—2 years earlier than predicted last year—in part because it is collecting fewer payroll taxes during the recession, trustees of the fund announced in their annual report. In 2017, the Part A Hospital Insurance Trust Fund could pay only 81% of anticipated benefits, and that would decline to about 50% in 2035 and 30% in 2080, the trustees said. Premiums for Medicare Parts B and D are predicted to continue to rise much faster than inflation, and the separate Medicare Supplemental Insurance Trust Fund that in part finances those benefits will require additional money from the general treasury. Health and Human Services Secretary Kathleen Sebelius said in a statement that the report should spur action on the part of lawmakers who are considering overall health care reform. “This isn't just another government report,” Ms. Sebelius said. “It's a wake-up call for everyone who is concerned about Medicare and the health of our economy. And it's yet another sign that we can't wait for real, comprehensive health reform.”
Promo Items Influence Students
Subtle exposures to small promotional items, such as notepaper with printed logos, influences medical students' attitudes toward pharmaceutical brands, a study in the Archives of Internal Medicine showed. However, medical school policies on pharmaceutical advertising might also affect students' attitudes toward drug brands, the researchers noted. At one institution with a strong policy on pharmaceutical marketing, the students increased their negative reactions to a brand-name drug after exposure to small promotional items. At another institution without such a policy, students had more positive reactions to the same product after the same exposure.