What is “it,” you ask? Spark Therapeutics’ new gene therapy Luxturna which can cure blindness in a single treatment. The condition causing the blindness only affects a few thousand people, so the FDA has designated it as an orphan drug. The single dose and orphan drug aspects of this gene therapy combine for a rather expensive R&D bill, and translate into a bit of sticker shock at the selling price: $425,000 per eye. Spark is trying out some interesting commercialization practices to get the drug to patients, like giving rebates to patients whose eyes don’t see better over time. They’re also considering selling the therapy directly to insurance companies so that health care providers don’t have to pay and store the treatment without a guarantee it’ll ever be used.
CVS Health is going to need a few more dimes than the guys in Blazing Saddles. Why? Because CVS agreed to buy Aetna insurance for $77B. Apparently CVS wants to win the contest for the longest press release title ever: “CVS Health to Acquire Aetna; Combination to Provide Consumers with a Better Experience, Reduced Costs and Improved Access to Health Care Experts in Homes and Communities Across the Country.” Why the merger? According to a Reuters article, “Expanding the (CVS) clinics could eventually save the combined company more than $1B annually by substituting low-cost treatments in CVS stores for more expensive hospital visits.” While the impact on patients is unknown, remember CVS stopped selling tobacco products in 2014, so we’re saying there’s a chance this is a good thing.
It’s one thing to make a profit but it’s another to excessively charge uninsured patients nearly double the amount for the same diagnostic tests that insured patients receive. Two separate lawsuits filed in New Jersey and North Carolina allege that diagnostics firms, LabCorp and Quest Diagnostics purposefully made their billing forms difficult to interpret and routinely overcharged uninsured patients at rates far above the market price. Ouch. Plaintiffs are seeking reimbursement of fees and damages. Both lab companies maintain they haven’t engaged in any shenanigans. Is this where we begin to analyze the difference between what’s “legal,” “immoral,” and “amoral?”
The Justice Department filed a lawsuit to block two big insurance mergers, citing that reduced competition would be bad for consumers. In one deal, Aetna would buy Humana for $34 billion. In the other, Anthem would buy Cigna for $48 billion. These mergers would make a dent, reducing the number of mega insurance providers in the US from 5 to just 3. And even worse than a new insurance card, Justice is afraid your coverage could get a *lot* more expensive. Meanwhile, United, the only top 5 insurance company not invited to the party, is just chillin’, wondering who called the cops.