Health News This Week: June 27, 2022
Just the stories I'm paying attention to. My completely subjective opinions on the healthcare news that matters. I could be wrong. Both in opinion and whether it matters.
In Case You Didn't Hear... The Supreme Court's decision to overturn Roe v. Wade continues to dominate the headlines, with no end in sight. This is clearly a healthcare matter. Wherever the individual states go, there are clear and obvious scenarios of immediate medical necessity. These at a minimum must be protected , and any reasonable person would agree to that. Some states are already acting. Unfortunately, not the states that need to. On that note, why is Alabama always in the mix on every contentious social issue?
As with nearly all legal, political, medical, scientific, and other highly technical matters, very few people have actually read the source material. Very few people know the name of the case that was before the court. I have not found a single media outlet linking to the SCOTUS website and the opinion released by the court (admittedly, there must be one somewhere, but not in my feeds anyway). Very few people have read the Roe decision. Yet we have a lot of "experts" pushing their opinions around who are understandably and justifiably upset, yet cannot begin to explain the legal arguments at play. That type of reporting doesn't feed the mob (either mob, on either side). You can read the actual case here: Dobbs v. Jackson Women's Health Organization. I suspect few people will. It's far more nuanced than the mainstream media cares to report.
That's not to say I like the outcome--I don't. But thanks to the actual opinion and a little Schoolhouse Rock episode called "Three Ring Government," (accurate analogy) I can understand how the decision was made and the limitations of the court in interpreting (not creating) law.
Supreme Court Sides with Doctors on Opioids
I guess we're not done with the Supreme Court. In a story likely to get very little attention, the court sided with the medical community in Xiulu Ruan v. United States and simultaneously in Shakeel Kahn v. United States, in a 9-0 decision no less. Gosh it's nice when people agree on things. As always, I'll say what I always say: READ THE ACTUAL SOURCE MATERIAL if you want to better understand the matter. This one is only 33 pages, so not a tough read unlike the Dobbs opinion linked above, which is 213 pages long.
At issue here is whether each of the 2 physicians violated the controlled substances act by prescribing scheduled drugs without medical necessity. The court ruled that under the law, the government had to "prove beyond a reasonable doubt that the defendant knew that he or she was acting in an unauthorized manner, or intended to do so." Each physician was sentenced to over 20 years in prison and millions in restitution, despite the fact that they were found, even by the lower courts, to have acted in accordance with usual standards of practice.
This aligns with my many rantings that the government has over-corrected in response to the opioid crisis, and is going after the wrong people. From the mid '90's to the late 2000's, we were systematically duped by the pharmaceutical industry with bad research that said pain was undertreated and opioids weren't addictive. There was a very successful narrative about pain as the "5th vital sign" that helped sell a lot of Oxycontin. Physicians, pharmacists and others go with the prevailing research, and at the time it had become nearly consensus medical opinion and practice to use opioids more liberally. We know better now.
The villains here are the big pharma corporations like Purdue, Teva, and J&J. While they are now paying out settlements too, for awhile it felt like only the wholesalers, chain pharmacies, and a few physicians were going to be made examples of. I wonder if Walgreens, CVS, and the big 3 wholesalers are reconsidering their voluntary settlements in light of this SCOTUS decision. From my standpoint, many providers, pharmacies and wholesalers have been judged by a standard that didn't exist at the time.
Mark Cuban Drug Co. Headlines Have Staying Power
I really didn't think we'd be still talking about this, but celebrity influence certainly seems to have helped MCCPDC stay at the forefront. I don't know who does their marketing, but they're good. Really good. I'm shocked to still see headlines about this, I thought it was going to capture our attention for about as long as the Will Smith Oscar's slap. That's not a knock on the business strategy--I think this is great, and we need more of it. It's just that the public normally loses interest pretty quickly on this stuff. To be fair, there were other pharmacies doing this first, but I'm not sure they've had the funding or sophistication to attempt doing it at scale. And while I like the strategy, I'm concerned about good pharmaceutical care--patients benefit from a personal relationship with their local pharmacist--see this excellent content from Benjamin Jolley on that point.
The latest headline here is that Medicare could have saved billions buying from MCCPDC. This is somewhat misleading as there's no way MCCPDC can service all of those patients, at least not yet. And the idea doesn't really jive with how the Med D program is structured. But the point is the same, we spend way too much on prescription drugs via Med D because the government can't negotiate prices collectively, and also because PBMs are taking a fat cut of the dollars. We're about 15 years into the Med D program, and there's a lot to be desired. It's absurd that a startup pharmacy, no matter how well funded, can buy drugs cheaper than Medicare. If Med D is going to continue to be barred from directly negotiating prices, maybe there's a way to integrate this strategy.
Political Sausage Making at its' Finest
Somehow, buried on page 55 of the Senate gun bill, is an extension of the PBM rebate exemption from anti-kickback rules.
What this has to do with the gun bill, nobody knows. But the fact that the practice of pharmaceutical rebates extracted by PBMs must be exempted from a fairly straightforward anti-corruption law in order to NOT be illegal is statement enough.
As always, I say READ THE SOURCE MATERIAL if you want to understand the issue. In doing so, you'll find at least one other interesting nugget. Just after the gift to PBMs, you'll see that the Medicare Improvement Fund got a pay raise. $5M in funding last year becomes $7.5 Billion in fiscal year 2022. I'm no accountant, but a 150,000% increase seems like something worth a discussion.