Summary of Trump’s Drug Pricing Plan

American Patients First. Catchy title. Unless you’ve been under a rock, you’ve likely heard of President Trump’s “sweeping” drug pricing proposals. While it’s way too complicated a topic to cover in our typical article length, we’re going to provide some of the better summaries. First is a nice summary about how this could impact the drug distribution system. Second is about how PhRMA increased its lobbying by 30% in 2017. Third is how Wall St. reacted in a positive manner on Friday, signaling Wall St. isn’t scared of the Trump plan for drug makers. Our last point is how Health & Human Services (HHS) Secretary Alex Azar said pharmacy benefit managers (PBMs) are a prime target in the effort. There will be lots more to digest in the future as the plan is unraveled. As the Brits say, keep calm and carry on.

“It’s the prices, stupid”

That’s really the name of a 2003 paper that explains health care spending is so high in the US because the prices for health care are so high, stupid. 14 years later the story still rings true—the per unit cost of health services hasn’t shifted much. Vox, in an effort to get a scope of these prices across the nation, is asking readers to send in their emergency facility fee (think: what the hospital charges to keep their lights on waiting for you to break your toe) to crowdsource the cost of that specific unit price. It’s an interesting idea since hospitals don’t advertise their ED admission fees. Telling patients they have to pay at least $500 beforehand typically isn’t the best look after all.

Oral anticoagulants…who needs ‘em?

Patients with atrial fibrillation do! According to a new study, hundreds of thousands of patients aren’t receiving them each year. Folks with AFib are at a very high risk for stroke, and guess what? Oral anticoagulants—a.k.a. blood thinners—can reduce the risk by two-thirds and direct oral anticoagulants (DOACs) are proven to be just as effective, if not more so. No, this isn’t a groundbreaking new therapy. Quite the opposite. DOACs have been available since 2010. 655,000 patients were evaluated in the study and the data show that over a seven-year period, only 6 out of 10 patients with high stroke risk were prescribed these potentially life-saving meds. This guy sums it up best.

Ever wonder what your guts look like?

If you have an upcoming surgery, you might just get a sneak peek at your innards. Surgery performed on awake patients is on the upswing. InsightCity staff are split on whether this trend is terrifying or awesome (tell us your thoughts in this week’s FastPoll™). This technique is being used primarily in orthopedics but other specialties are moving in this direction. Benefits include reduced cost (no anesthesiologist necessary), faster recovery, patient feeling increased control, and curiosity satisfaction. I mean, who doesn’t want to see their colon up close and personal? Surgeons are going to have to work on their (operating) table manners… cursing when something goes awry or re-hashing last night’s partying will no longer be kosher. InsightCity assumes patients would rather not think of their surgeon binge-drinking like she’s on Grey’s Anatomy.

2. I’d like one surgical procedure with a side of pain meds, please

Doctor: Unfortunately, you’ve been diagnosed with [insert scary disease here]. Call this number to schedule your procedure. See you in a month.

Patient: Huh? (shuffles out, looking bewildered)

New research is telling us that the above doctor-patient interaction is not what’s best for patients. Wuuuuuuut? No way. We’ll wait while you pick your jaws up from the floor… Data show that the more involved patients are in their health care decisions, the better. Presenting clear options, simplifying information, and making EMR data available to patients are ways physicians can involve patients in treatment decisions. Sounds to InsightCity like that leaves the ball mostly in the doctors’ court. Here’s hoping a little doctor-patient teamwork will leave patients feeling less like this.

2. The war on drug stores heats up

Recent power plays in the prescription drug industry make J.R. Ewing’s actions seem like child’s play. If you don’t track the specialty pharmacy market, you should. This is a $100B industry that is growing rapidly. Think high-priced drugs used to treat Hep C and Cystic Fibrosis. According to the New York Times, large PBMs might be trying to force out independent specialty pharmacies. In Alabama, BCBS recently told patients that they cannot have their prescriptions filled at CVS. This is a big deal. It means patients have to sever long-standing relationships with pharmacists, especially difficult with specialty indications. This is all part of an emerging trend to narrow networks. Look it up. You will be glad you did and you’ll be smarter.

2. Rocket Fuel Shortage in Cancer Moonshot

With so many Americans terrified of shots, the National Cancer Moonshot initiative may have trouble getting off the ground. A new study reveals only 40% of Americans hold a positive view of clinical trials, and just 4% of cancer patients enroll in a clinical trial annually. Yet, “when it comes to advancing cancer care, clinical research is the rocket fuel for better treatments, more accurate diagnoses and, ultimately, cures,” Dr. Jose Baselga, physician-in-chief and chief medical officer at Memorial Sloan Kettering Cancer Institute said. Concerns about side-effects, safety and out-of-pocket costs combined with the fear of receiving a placebo instead of an active treatment mean the cancer community needs to do some myth busting about clinical trials before advancing towards a cure.