The nonpartisan Congressional Budget Office (CBO) will release an analysis next week detailing the effects of ending key ObamaCare insurer payments.
The CBO announced Friday the score would be released next week.
President Trump has threatened to cancel the payments, known as cost-sharing reductions, which reimburse insurers for giving discounted deductibles and copays to low-income people.
The administration has made the payments on a month-to-month basis but insurers have pleaded for long-term certainty.
The reimbursements total $7 billion for fiscal 2017, and regardless of whether the administration pays them, insurers would still be on the hook to offer these discounts to enrollees — they just wouldn’t be reimbursed for doing so.
Uncertainty over the future of the payments has contributed to insurers exiting the healthcare exchanges and proposed premium increases for 2018. More insurers might leave or increase premiums if the payments aren’t continued.
The Senate Health Committee will hold bipartisan hearings in September on ways to stabilize and strengthen the individual market.
The goal is to craft a bipartisan, short-term proposal by mid-September, which could include funding the payments.
Congress is on vacation, but state insurance commissioners have no time off. They have spent the past three days debating what to do if President Trump stops subsidies paid to insurance companies on behalf of millions of low-income people.
For administration officials and many in Congress, the subsidies are a political and legal issue in a fight over the future of the Affordable Care Act. But for state officials, gathered here at the summer meeting of the National Association of Insurance Commissioners, the subsidies are a more immediate, practical concern.
The insurance commissioners are frustrated with the gridlock in Washington, which they say threatens coverage for consumers and the solvency of some insurers. Without the payments, they say, consumers will face higher premiums in 2018, and more insurers will pull back from the individual insurance market.
Mr. Trump has repeatedly threatened to cut off the payments, which reimburse insurers for reducing the deductibles, co-payments and other out-of-pocket costs for low-income people.
If the government continues providing funds for the subsidies, insurers will have “a small profit,” said Craig Wright, the chief actuary at the Florida Office of Insurance Regulation. “If the subsidies are not funded, carriers would face the prospect of large financial losses, which could increase the risk to their solvency.”
“It could be very damaging,” Mr. Wright said. “Our market wouldn’t recover.”
With no guidance or clarity from the Trump administration, state officials are agonizing over what to do. Many expressed a sense of urgency, saying they needed to make decisions soon on rates to be charged in 2018.
Trump administration officials were invited to speak to state insurance regulators and were listed in the program for at least one public session, but they did not show up at that event to provide the promised update on federal policy.
“Most of us are hoping and praying that this gets resolved,” said David Shea, a health actuary at the Virginia Bureau of Insurance. “But that’s not the case right now.”
Without the federal subsidies, insurers would need to get the money — estimated at $7 billion to $10 billion next year — from another source. And that means higher premiums, state officials said.
The officials here are wrestling with several questions: How much should premiums be increased? Who should pay the higher premiums? Is there any way to minimize the effect on low-income people? Is it better to assume that the cost-sharing subsidy payments will or will not be made in 2018? What happens if state officials guess wrong?
State officials said they would allow insurers to impose a surcharge on premiums if the federal government cuts off funds for the cost-sharing subsidies.
Paul Lombardo, a health actuary at the Connecticut Insurance Department, said officials there might direct insurers to spread the cost across all of their health plans, both on and off the insurance exchange created under the Affordable Care Act.
By contrast, Florida has asked insurers to load all of the extra cost into the prices charged for midlevel “silver plans” sold on the exchange. The federal government would then absorb almost all of the cost through another subsidy program, which provides tax credits to help low-income people pay premiums, Mr. Wright said. The tax credits generally increase when premiums rise.
J. P. Wieske, the deputy insurance commissioner in Wisconsin, said that two companies, Anthem and Molina Healthcare, were leaving the state’s marketplace in 2018 and that two others, Humana and UnitedHealth, exited in previous years. As a result, he said, more people will be enrolled in smaller local health plans that could be more affected by a termination of federal subsidy payments.
“Carriers left in the Wisconsin market are smaller, local plans,” Mr. Wieske said. “Particular carriers could have huge surges in population, going from 7 or 8 percent of their business in the individual market to 30 or 40 percent. If that’s the case, if it’s 30 or 40 percent of their business in the individual market, that’s obviously a gargantuan risk.”
The risks for consumers are also high, Mr. Wieske said. “Consumers,” he said, “could be stuck in a zombie plan, an insurer that is essentially no longer able to do business in the worst-case scenario, or consumers may have to move to another insurer with different health care providers.”
Officials in many states must decide this month on insurance rates for next year.
“We are holding off making those decisions until the very last possible minute,” said Julie Mix McPeak, the Tennessee insurance commissioner. “In doing so, we are really making it difficult for consumers who need information about open enrollment — who’s participating in the market and what the rates might be. We don’t know the answers to any of those questions.”
The uncertainty stems not only from the White House and Congress, but also from federal courts.
House Republicans challenged the cost-sharing payments in a lawsuit in 2014. A federal judge ruled last year that the Obama administration had been illegally making the payments, in the absence of a law explicitly providing money for the purpose. The case is pending before the United States Court of Appeals for the District of Columbia Circuit, which has held it “in abeyance” at the request of House Republicans and the Trump administration.
The administration has been providing funds for cost-sharing subsidies month to month, with no commitment to pay for the remainder of this year, much less for 2018.
“I am very fearful that we’ll have insurers make a decision to leave markets as a result of the uncertainty,” said Ms. McPeak, who is the president-elect of the National Association of Insurance Commissioners. “It’s somewhat inequitable to ask insurers to sign a contract that binds them but may not bind the federal government.”
The Affordable Care Act requires an annual review of health insurance rate increases, and states are taking different approaches.
Nebraska initially told insurers to file 2018 rates on the assumption that the cost-sharing subsidies would continue. But “because of the confusion in Washington,” said Martin W. Swanson of the Nebraska Insurance Department, the state later told insurers to assume that they would not receive the subsidy payments.
Mike Chaney, the Mississippi insurance commissioner, and Allen W. Kerr, the Arkansas insurance commissioner, said they had instructed companies to assume that they would receive the cost-sharing subsidies next year. Michigan has told insurers to submit two sets of rates, one with the subsidies and one without.
Michael F. Consedine, the chief executive of the National Association of Insurance Commissioners, said that without a firm commitment of federal funds for the cost-sharing subsidies, “we have grave concerns about the long-term viability of the individual health insurance market in a number of states.”
“We need some step right away,” Mr. Consedine said, “either by action of Congress or by direction of the administration, to ensure that Americans continue to have access to coverage.”
As Republican senators work to fix their troubled health care bill, there is one giant health insurance subsidy no one is talking about.
It is bigger than any offered under the Affordable Care Act — subsidies some Republicans loathe as handouts — and costs the federal government $250 billion in lost tax revenue every year.
The beneficiaries: everyone who gets health insurance through a job, including members of Congress.
Much of the bitter debate over how to repeal and replace the law known as Obamacare has focused on cutting Medicaid and subsidies that help low-income people buy insurance.
But economists on the left and the right argue that to really rein in health costs, Congress should scale back or eliminate the tax exclusion on what employers pay toward employees’ health insurance premiums. Under current law, those premiums are not subject to the payroll or income taxes that are taken out of employees’ wages, an arrangement that vastly benefits middle- and upper-income people.
That one policy tweak could reduce health care spending, stabilize the health insurance market and, according to Congressional Budget Office estimates, shrink the federal budget deficit by between $174 billion and $429 billion over a six-year period
Lawmakers briefly pondered the idea this year but quickly abandoned it, recognizing how politically explosive it would be. Still, as Congress seeks to push ahead with major changes to the health system and the tax code, there has been a growing awareness of how long-established tax subsidies — like the mortgage deduction for homeowners — have contributed to economic inequality in the United States.
Republicans who have been fighting for seven years to repeal the Affordable Care Act argue that the Medicaid expansion has cost too much, that the subsidies for lower-income insurance customers are in some cases handouts. Senator Orrin G. Hatch of Utah, the chairman of the Finance Committee, likened the expenditures recently to “the dole.”
“The public wants every dime they can be given,” he told reporters in May as he left a health care meeting to explain the difficulty in cutting those programs. “Let’s face it, once you get them on the dole, they’ll take every dime they can.”
The tax exclusion, though, is also a subsidy, one that disproportionately helps the affluent, who are more likely to receive generous health benefits from an employer and who fall into higher tax brackets, making the tax break worth more.
A 2008 study by the Joint Committee on Taxation found that not paying taxes on these benefits saved people with incomes less than $30,000 about $1,650. For people with incomes above $200,000, the average tax savings was $4,580.
The Affordable Care Act required companies to start reporting the value of employer-sponsored health benefits on W-2 forms (Box 12; Code DD). But most people don’t even realize they get a subsidy typically worth thousands of dollars a year.
For the federal government, the health benefits exclusion is the single largest tax expenditure, accumulating over the next decade to about 1.5 percent of the nation’s gross domestic product. (Economists say it is effectively the federal government’s third-largest health care expenditure, after Medicare, which cost about $581 billion last year, and Medicaid, at $349 billion.)
It costs five times as much as the subsidies the Affordable Care Act set up to help people buy health insurance, which are estimated to total $49 billion this year. And it is far more than the $70 billion the federal government is spending to expand Medicaid under Obamacare this year.
But few lawmakers, Republican or Democrat, have ever argued to change the exclusion. The closest Congress came to making the system more progressive — that is, to make it scale up according to income — was the so-called Cadillac tax included in the Affordable Care Act.
That was supposed to tax the most generous employer benefits to help pay the subsidies in the law, but its effective date got pushed back to 2020. Both the Republican House and Senate health bills shove it back further, so long — a decade in the Senate bill — that many analysts say it is unlikely to ever take effect.
What Different Health Policies Cost
“This seems like a natural place to look for revenue to expand coverage,” said Stephen Zuckerman, a senior fellow and co-director of the health policy center at the left-leaning Urban Institute. But, he said, “It becomes a political problem.”
Business groups, which tend to back Republicans, argue that a cut in the tax exclusion is a tax increase; labor unions, which tend to support Democrats, say it will lead them to lose benefits at the same time their wages have stagnated.
“We don’t think it does the things economists say it’s going to do,” said James Gelfand, senior vice president for health policy for the Erisa Industry Committee, which lobbies for large employers. “Ultimately these proposals are designed to end the employer-sponsored system,” he said. “They’re not indexed to reality.”
The benefit began with the wage controls of World War II. Employers got around those limits by offering more generous health benefits, and the Internal Revenue Service and later Congress said those benefits did not have to be taxed.
Employer-based health insurance now covers more than half the non-elderly population in the United States. The average premium in 2016, according to the Kaiser Family Foundation, was $6,435 for an individual and $18,142 for a family, and the tax exclusion reduced the cost of insurance by about 30 percent.
Even economists who dislike the exclusion recognize its benefit: It pools risk, the way some countries have done with national health insurance, and reduces adverse selection by encouraging the healthy to buy insurance.
But economists also argue that the exclusion creates perverse incentives that drive up the cost of coverage. Studies have found it encourages workers to buy more expensive insurance and to use more medical services than they need.
“Because we have invented a system where most people have extremely generous coverage, no one asks about the price, and no one tells them what the price is,” said Joseph Antos, an economist and scholar in health care policy at the American Enterprise Institute, a conservative think tank.
Every year the Congressional Budget Office analyzes options for reducing the deficit, including reductions in the tax exclusions for employer-provided health insurance.
In its 2016 analysis, the C.B.O. found that imposing income and payroll taxes on premiums higher than the 50th percentile beginning in 2020 — this would be contributions above $7,700 a year for individuals and $19,080 for families — would cut the federal deficit by $429 billion by 2026, more than either the House or Senate health bills would achieve, according to C.B.O. analyses.
It would also cause four million fewer people to have employer-based health insurance, the analysis found. Half of those people would go to health insurance exchanges set up by the Affordable Care Act, fewer than 500,000 would enroll in Medicaid, and one million would remain uninsured.
Subjecting premiums at the 75th percentile or higher to payroll and income taxes beginning in 2020 — premiums higher than $9,520 for an individual and $23,860 for a family — would reduce the deficit by $174 billion by 2026, the C.B.O. found.
Economists bet that employers would pay less for health insurance and pass on that savings in the form of higher wages. But business groups and business owners say that is unlikely.
Particularly in high-cost states, employers say offering a less attractive package of health benefits hurts their ability to hire.
“Good employees are the most important resource companies have, and this is part of the landscape that folks expect,” said William McDevitt, a shareholder with Wilkin & Guttenplan, an accounting and consulting firm in New York and New Jersey. “Messing with that matrix to generate revenue, I just see it as anarchy, politically.”
Even if companies did increase wages, employees would have to pay higher taxes, leaving them with less money to buy health insurance.
“You’re going to tell every employee they’re going to pay 20 percent more in federal taxes? Is that going to change what they need and their behavior?” asked Bill Grant, the chief financial officer of Cummings Properties in Massachusetts, a real estate firm that spends about $2 million a year to pay about 70 percent of the health insurance premiums for its 350 full-time employees. “And if part of that premise is that they are using more than they need, is paying more to Uncle Sam going to change that lifestyle? I don’t think so.”
The shrinking unemployment rate has been a healthy turn for people with job-based benefits.
Eager to attract help in a tight labor market and unsure of Obamacare’s future, large employers are newly committed to maintaining coverage for workers and often their families, according to new research and interviews with analysts.
Two surveys of large employers — one released Aug. 2 by consultancy Willis Towers Watson and the other out Tuesday from the National Business Group on Health, show companies continue to try to control costs while backing away from shrinking or dropping health benefits. NBGH is a coalition of large employers.
“The extent of uncertainty in Washington has made people reluctant to make changes to their benefit programs without knowing what’s happening,” said Julie Stone, a senior benefits consultant with Willis Towers Watson. “They’re taking a wait-and-see attitude.”
That’s a marked change from three years ago, when many big employers — those with 1,000 employees or more — contemplated ending medical benefits and shifting workers to the Affordable Care Act’s marketplaces.
In 2014, only 25 percent of big companies were “very confident” they would have a job-based health plan for employees in 10 years, according to the Willis Towers Watson survey.
This year, 65 percent expected to offer health benefits in a decade. And 92 percent said they were very confident a company-based health plan would exist in five years.
Many managers once eyed Obamacare marketplaces as workable coverage alternatives despite the law’s requirement that employers offer health insurance, analysts said.
But problems with marketplace plans, including fewer offerings, rising premiums and shrinking medical networks, have made employers think twice, they said.
Another big reason to maintain rich coverage is “the strength of the economy,” said Paul Fronstin, director of health research at the Employee Benefit Research Institute, an industry group. “Employers are doing what they have to do to get the right workers.”
Unemployment has fallen from 9.9 percent when Obamacare became law in 2010 to 4.3 percent last month, which equaled a 16-year low reached in May.
With such a steep decline, he added, “employers are thinking, ‘We need to offer this benefit for recruitment and retention.’”
Second Thoughts On High-Deductible Plans
Companies are even rethinking the long-standing expedient of shifting a portion of rising medical costs to employees through high-deductible plans and a greater share of the premium bill, other research shows.
“Employers are beginning to recognize that cost sharing has its limits,” said a June report from PwC, a multinational professional services network. Low unemployment and competition for workers mean “employers have less appetite for scaling back benefits and continuing with a plan design that has proven largely unpopular.”
At Fidelity Investments, a Boston-based financial firm with more than 45,000 employees, worker contributions have grown to about 30 percent of total health costs.
Jennifer Hanson, the company’s benefits chief who sits on NBGH’s board, doesn’t see that continuing.
As costs grow, “if you continue to shift more of a bigger number to employees, health care becomes unaffordable,” she said in an interview. “As employers, we really do need to pay attention less to who’s paying for what and more to how much everything costs.”
More than half of Americans with job-based insurance face deductibles — out-of-pocket costs for most care before insurance kicks in — of more than $1,000 for single-person coverage. Family deductibles can be much higher.
High On The To-Do List: Controlling Drug Costs
Big employers’ planned changes for next year focus on controlling drug costs and improving health results through telemedicine and steering patients to efficient, high-quality hospitals, noted the Willis Towers Watson report and the NBGH survey.
Employer health costs continue to rise, but not at the double-digit clip seen for many plans sold to individuals and families through the ACA marketplaces.
Employers expect health costs to increase 5.5 percent next year, up from 4.6 percent in 2017, according to the Willis Towers Watson report.
Companies in the NBGH survey predicted health costs will rise 5 percent next year, up from an average 4.1 percent increase for 2016.
That’s still far faster than inflation, which is less than 3 percent, and overall wage growth.
By many accounts, soaring costs for specialty pharmaceuticals used to treat cancer, rheumatoid arthritis, hemophilia and other complex conditions are the biggest factor.
“These are very expensive drugs,” said Brian Marcotte, NBGH’s CEO. “They cost thousands or tens of thousands per treatment.”
Often these drugs require infusion into the blood in a clinical setting, which can drive up their price tag.
For instance, hospital-based infusions have been found to cost as much as seven times more than those performed in, say, a doctor’s office.
Employers are working hard to steer patients to the least expensive, appropriate site, Marcotte said.
Big employers are also offering more on-site nurses and doctors; setting up accountable care organizations with incentives for doctors and hospitals to control costs; and striking deals with particular hospitals for high-cost operations such as transplants and joint replacements, the NBGH survey found.
Job-based insurance covers some 160 million people younger than 65, according to Census and Labor Department data, far more than the 10 million or so insured by plans sold through Obamacare marketplaces.
Government employers and companies with at least 500 workers, which historically have been more likely to offer health benefits than smaller employers, cover more than 90 million employees and dependents.
Willis Towers surveyed 555 large employers with about 12 million workers and dependents. NBGH surveyed 148 large companies with more than 15 million employees and dependents.
A new study published in JAMA Psychiatry this month finds that the rate of alcohol use disorder, or what’s colloquially known as “alcoholism,” rose by a shocking 49 percent in the first decade of the 2000s. One in eight American adults, or 12.7 percent of the U.S. population, now meets diagnostic criteria for alcohol use disorder, according to the study.
The study’s authors characterize the findings as a serious and overlooked public health crisis, noting that alcoholism is a significant driver of mortality from a cornucopia of ailments: “fetal alcohol spectrum disorders, hypertension, cardiovascular diseases, stroke, liver cirrhosis, several types of cancer and infections, pancreatitis, type 2 diabetes, and various injuries.”
Indeed, the study’s findings are bolstered by the fact that deaths from a number of these conditions, particularly alcohol-related cirrhosis and hypertension, have risen concurrently over the study period. The Centers for Disease Control and Prevention estimates that 88,000 people a year die of alcohol-related causes, more than twice the annual death toll of opiate overdose.
How did the study’s authors judge who counts as “an alcoholic”?
The study’s data comes from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey administered by the National Institutes of Health. Survey respondents were considered to have alcohol use disorder if they met widely used diagnostic criteria for either alcohol abuse or dependence.
For a diagnosis of alcohol abuse, an individual must have exhibited at least one of the following characteristics in the past year (bulleted text is quoted directly from the National Institutes of Health):
Recurrent use of alcohol resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to alcohol use; alcohol-related absences, suspensions, or expulsions from school; neglect of children or household).
Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use).
Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication).
“Facing Addiction,” a report, pulls together the latest information on the health impacts of drug and alcohol misuse, as well as on the issues surrounding treatment and prevention. (Department of Health and Human Services)
For a diagnosis of alcohol dependence, an individual must experience at least three of the following seven symptoms (again, bulleted text is quoted directly from the National Institutes of Health):
Need for markedly increased amounts of alcohol to achieve intoxication or desired effect; or markedly diminished effect with continued use of the same amount of alcohol.
The characteristic withdrawal syndrome for alcohol; or drinking (or using a closely related substance) to relieve or avoid withdrawal symptoms.
Drinking in larger amounts or over a longer period than intended.
Persistent desire or one or more unsuccessful efforts to cut down or control drinking.
Important social, occupational, or recreational activities given up or reduced because of drinking.
A great deal of time spent in activities necessary to obtain, to use, or to recover from the effects of drinking.
Continued drinking despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by drinking.
Meeting either of those criteria — abuse or dependence — would lead to an individual being characterized as having an alcohol use disorder (alcoholism).
The study found that rates of alcoholism were higher among men (16.7 percent), Native Americans (16.6 percent), people below the poverty threshold (14.3 percent), and people living in the Midwest (14.8 percent). Stunningly, nearly 1 in 4 adults under age 30 (23.4 percent) met the diagnostic criteria for alcoholism.
Some caveats
While the study’s findings are alarming, a different federal survey, the National Survey on Drug Use and Health (NSDUH), has shown that alcohol use disorder rates are lower and falling, rather than rising, since 2002. Grant says she’s not sure what’s behind the discrepancies between the two federal surveys, but it’s difficult to square the declining NSDUH numbers with the rising mortality rates seen in alcohol-driven conditions like cirrhosis and hypertension.
A separate study looking at differences between the two federal surveys found that the disparities are probably caused by how each survey asks about alcohol disorders: It found that the NESARC questionnaire used in the current study is a “more sensitive instrument” that leads to a “more thorough probing” of the criteria for alcohol use disorder.
If the more sensitive data used in the current study is indeed more accurate, there’s one final caveat to note: The study’s data go only through 2013. If the observed trend continues, the true rate of alcoholism today would be even higher.
What do the researchers think is driving the increase?
“I think the increases are due to stress and despair and the use of alcohol as a coping mechanism,” said the study’s lead author, Bridget Grant, a researcher at the National Institutes of Health. The study notes that the increases in alcohol use disorder were “much greater among minorities than among white individuals,” likely reflecting widening social inequalities after the 2008 recession.
“If we ignore these problems, they will come back to us at much higher costs through emergency department visits, impaired children who are likely to need care for many years for preventable problems, and higher costs for jails and prisons that are the last resort for help for many,” University of California at San Diego psychiatrist Marc Schuckit said in an editorial accompanying the study.
Even before media reports and a congressional hearing vilified Valeant Pharmaceuticals International for raising prices on a pair of lifesaving heart drugs, Dr. Umesh Khot knew something was very wrong.
Khot is a cardiologist at the Cleveland Clinic, which prides itself on its outstanding heart care. The health system’s internal monitoring system had alerted doctors about the skyrocketing cost of the drugs, nitroprusside and isoproterenol. But these two older drugs, frequently used in emergency and intensive care situations, have no direct alternatives.
“If we are having concerns, what is happening nationally?” Khot wondered.
As it turned out, a lot was happening.
Following major price increases, use of the two cardiac medicines has dramatically decreased at 47 hospitals, according to a research letter Khot and two others published Wednesday in the New England Journal of Medicine.
The number of patients in these hospitals getting nitroprusside, which is given intravenously when a patient’s blood pressure is dangerously high, decreased 53 percent from 2012 to 2015, the researchers found. At the same time, the drug’s price per 50 milligrams jumped more than 30-fold — from $27.46 in 2012 to $880.88 in 2015.
The use of isoproterenol, key to monitoring and treating heart-rhythm problems during surgery, decreased 35 percent as the price per milligram rose from $26.20 to $1,790.11.
The two drugs, which are off patent, have long been go-to medicines for doctors.
“This isn’t like a cholesterol medicine; these are really, very specialized drugs,” says Khot, who is lead author on the peer-reviewed research letter. When patients get the drugs, he says, “they are either sick beyond sick in intensive care or they’re under anesthesia [during] a procedure.”
Valeant bought the drugs in early 2015 from Marathon Pharmaceuticals.Last year, Valeant announced a rebate program to lower the price hospitals paid for the drugs.
And Valeant’s Lainie Keller, a vice president of communications, says the company is committed to limiting price increases.
“The current management team is committed to ensuring that past decisions with respect to product pricing are not repeated,” Keller says.
Pharmacist Erin Fox, the director of drug information at University of Utah Health Care, said the findings by Khot and his colleagues reveal “exactly what a lot of pharmacists have been talking about. When prices are unsustainable, you have to stop using the drug whenever you can. You just can’t afford it.”
Fox says her Utah health system has removed isoproterenol from its bright-red crash carts, which are stocked for emergencies like heart attacks. But Nitroprusside is more difficult to replace.
“If you need it, you need it,” Fox says. “That’s exactly why the usage has not gone down to zero, even with the huge price increases.”
Cleveland Clinic leaders spent months investigating each drug’s use and potential alternatives, Khot says.
“We’re not going to ration or restrict this drug in any way that would negatively impact these patients,” Khot says, adding that he hopes to do more research on how the decreased use of both drugs has affected patients.
Dr. Richard Fogel is a cardiologist and electrophysiologist at St. Vincent, an Indiana hospital that’s part of Ascension, a large nonprofit chain with facilities in 22 states and the District of Columbia. He told a Senate committee last year that the cost of the two drugs alone drove a nearly $12 million increase in Ascension’s spending over one year.
“While we understand a steady, rational increase in prices, it is the sudden, unfounded price explosions in select older drugs that hinder us in caring for patients,” Fogel told the committee.
The NEJM letter also analyzed the use of two drugs that remained stable in price over that time period, as a control group — nitroglycerin and dobutamine. The number of patients treated with nitroglycerin, a drug used for chest pain and heart failure, increased by 89 percent. Khot warns that the drugs can’t always be used as substitutes.
HENRY KOTULA 