Author Archives: Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), an independent journalist who resides in Brewster, Massachusetts, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Rising prescription drug prices: What to know

Madelaine A. Feldman, M.D., F.A.C.R. (Photo courtesy of Paola Rodriguez)

In pharmacies across the country, sticker shock is not uncommon. The high price of prescription drugs is one of the biggest problems facing the nation’s health care system, Joyce Frieden explained on Friday, April 29, during the “Covering the controversy over high prescription drug costs” panel at Health Journalism 2022 in Austin.

Each speaker offered a different perspective as to why prescription medications cost so much. Frieden’s expert panelists included Douglas Holtz-Eakin, Ph.D., the former director of the Congressional Budget Office (CBO) and current president of the American Action Forum, a center-right think tank on fiscal policy; Madelaine A. Feldman, M.D., a clinical assistant professor at the Tulane University School of Medicine, a practicing rheumatologist and president of the Coalition of State Rheumatology Organizations; and Gerard Anderson, Ph.D., a professor of health policy and management and international health at the Johns Hopkins Bloomberg School of Public Health.

“So, what is being done to solve the problem of high prescription drug costs?” asked Frieden, the Washington editor for MedPage Today. “And are there angles to this story that have yet to be fully covered today?”

Distinguishing between brand-name and generic drug prices

Holtz-Eakin began by talking about one of his frustrations with the usual coverage of drug costs. “When we talk about the high cost of prescription drugs, it’s important to be precise about which price we’re talking about,” he said. Too often journalists do not distinguish between the costs of brand-name and generic drugs or between the net price of drugs after rebates and discounts. Also, we often fail to write about the actual cost at the pharmacy counter and what consumers pay out of pocket, he noted. “Being clear about which price you’re trying to keep track of matters a lot,” he said.

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Why limiting insulin out-of-pocket costs solves only part of the problem

Last fall, the U.S. House of Representatives narrowly passed a $2.2 million domestic spending plan called Build Back Better (BBB) that included several health care provisions including one that would limit what patients with diabetes would pay for insulin to $35 per month. One month later, Sen. Joe Manchin (D-West Virginia) effectively killed the legislation when he announced that he could not support the law.

Source: Comparing Insulin Prices in the U.S. to Other Countries, Prepared for the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services by RAND Health Care. September 2020.

Efforts to cap what patients pay for insulin, however, are still under consideration in Congress; some legislation could pass in the coming weeks. If so, health care journalists will need to know how any new law would work. One useful source could be a report last week from the Peterson Center on Healthcare and the Kaiser Family Foundation (KFF), “Out-of-pocket spending on insulin among people with private insurance.”

For health care reporters, there are at least three important concerns to understand about  efforts to limit what patients with diabetes pay for their care.

First, putting a cap on out-of-pocket costs is crucial but amounts to little more than tinkering around the edges of the issue. Patients with diabetes need insulin and supplies to monitor their blood sugar and store and inject insulin. In 2020, researchers for the Commonwealth Fund reported that some 30 million Americans have diabetes, and about 31% of them need insulin to manage the condition. The list prices of many of the newest forms of insulin have risen by 15% to 17% each year since 2012, the report noted.

Second, it’s important to understand that any limit on what patients pay out of pocket for insulin would not address the underlying price of insulin in the U.S., as the Peterson-KFF report explained. What diabetes patients pay for insulin in the U.S. is much higher than it is in other countries, according to a report that the U.S. Department of Health and Human Services (HHS) issued in 2020. For that report, HHS contracted with RAND Health Care to compare what pharmaceutical companies charged for insulin in the U.S. in 2018 against what drug companies charged in 32 other countries that are members of the Organisation for Economic Co-operation and Development (OECD).

The RAND researchers found that the average gross manufacturer price for a standard unit of insulin in 2018 was $98.70 in the U.S., which was more than 10 times higher than the $8.81 price of a standard unit of insulin in 32 other countries.

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5 angles to consider when covering drug-price reform

Want to know why little gets done when the U.S. Congress takes up proposals to control drug prices? One recent headline tells the story in nine words.

On Tuesday, STAT News ran this article, “Three years after the Senate grilled drugmakers … nothing’s changed.” STAT’s Washington correspondent Nicholas Florko reported that the Senate Finance Committee will meet Wednesday (March 16) to discuss what the agenda calls, “Prescription Drug Price Inflation: An Urgent Need to Lower Drug Prices in Medicare.”

Committee Chairman Ron Wyden, D-Oregon, has called the hearing “an opportunity for members to discuss how high drug prices have impacted seniors and families in their states and identify solutions.” But, as Florko noted, lawmakers have had more than a dozen hearings on high drug prices over the past three years and failed to make prescription drugs more affordable.

Florko’s excellent reporting offers four important angles for journalists covering the drug-price-reform issue. The first angle is that prices keep rising and Congress has done little.

In February 2019, for example, the Finance Committee called executives from seven drug companies —AbbVie, AstraZeneca, Bristol Myers Squibb, Johnson & Johnson, Merck, Pfizer and Sanofi — to explain why their drugs were priced so high and why the companies tended to raise prices annually.

But more than three years later, none of those companies has changed its ways, he wrote. What’s more, he added, the list prices for almost all top-selling medications from those companies have increased since the hearing in 2019.

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One reporter follows the money to show why Build Back Better failed

Jessie Hellmann

In December 2021, Jessie Hellmann, a politics reporter, wrote about how the Medicare Advantage program survived cuts that health policy experts were considering to help pay for the cost of adding dental, hearing and vision coverage to the federal Medicare program last summer.

Having Medicare add coverage for these ancillary benefits was among the proposals included in President Joe Biden’s multi-trillion-dollar social spending plan that became part of what was called the Build Back Better legislation, she wrote. To free up the funds to pay for dental, hearing and vision coverage, lawmakers and policy experts suggested cutting federal funding to health insurers that run Medicare Advantage plans.

Based in Washington, D.C., Hellmann has covered the politics of health care and health reform since she joined Modern Healthcare in March 2021. Before working for the Chicago-based weekly news magazine, she covered health care for The Hill.

Her article, “How the insurance lobby got Congress to love Medicare Advantage,” is a guide for any journalist covering efforts in Washington to add benefits to the Medicare program, to reform the health care system or to cut what the government spends on Medicare Advantage (MA).

Almost as soon as the idea was proposed to add dental, hearing and vision and cut funding for Medicare Advantage, “… it was off the table,” wrote Hellmann, an AHCJ member.

“Industry groups aired millions of dollars in television advertisements warning seniors that Washington was ‘messing with’ their health care and urging them to contact members [of Congress] and tell them ‘please don’t cut Medicare Advantage,’” she explained.

For this “How I did it”, we asked Hellmann how she got the idea for her article on the insurance lobby and how she did the reporting.

“For anyone who pays attention to Congress, it was clear what was happening,” she said. “But not everybody pays attention.”

The need for this story became obvious when the insurance industry began running advertisements in the Washington area that were impossible to ignore. “Basically, the ads from the insurance industry were telling lawmakers not to cut Medicare Advantage,” she said. “In the ads, they had seniors who were Medicare Advantage beneficiaries telling other beneficiaries that Congress was considering cutting the Medicare Advantage program.”

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Covering Medicaid expansion: One reporter shows the contrast in bordering states

April Simpson

Dozens of journalists have reported how 38 states and the District of Columbia have increased eligibility in their Medicaid programs under the Affordable Care Act (ACA). Last year, April Simpson, a racial equity reporter for the Center for Public Integrity, showed one of the best ways to cover this story.

In a new tip sheet, Simpson took the unusual step of covering Medicaid expansion by comparing access to health care for residents in states that have expanded Medicaid eligibility versus the lack of access to care for their counterparts in neighboring non-expansion states.

Her work could serve as a model for journalists covering the complex issues in the 12 non-expansion states: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming. Also, Simpson’s articles could serve as a template for journalists in the expansion states adjacent to those that didn’t expand their Medicaid programs.

One of the angles to pursue in covering the Medicaid expansion story is the effect of the American Rescue Plan Act (ARPA), which Congress passed last year, and which included increased funds for the 12 holdout states. An estimated 2.2 million uninsured Americans would benefit from Medicaid expansion in those 12 states: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming, according to research from the Kaiser Family Foundation. By covering almost 75.8 million Americans, Medicaid is the nation’s largest health insurer.

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