Hot Topics From Around the World

Surprise Federal Drug Rule Directs Insurers to Reveal What They Pay for Prescription Drugs

(Kaiser Health News)

Under an unexpected new Trump administration rule, insurers will have to give their customers estimated out-of-pocket costs for prescription drugs and disclose to the public the negotiated prices they pay for drugs. The rule is part of a broader rule issued in October that forces health plans to disclose costs and payments for most healthcare services. The drug price rule, which was promoted as a way to encourage competition and empower consumers to make better medical decisions, does not apply to Medicare or Medicaid.

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Indication-Based Pricing Sparks Interest in the United Kingdom

(Pink Sheet)

A cross-sector experts panel recommends tying benefits of a drug to the benefits that it delivers, as well as setting different prices for different indications treated by a drug. The panel aims to improve patient access to innovative new cancer indications.

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Estimation of Differential Occupational Risk of COVID-19 by Comparing Risk Factors With Case Data by Occupational Group

(American Journal of Industrial Medicine)

In a study published in the November 18 issue of the American Journal of Industrial Medicine, Dr Michael Zhang looked at a way to assess the differential risk of various professions of developing COVID-19. By using predictors from the Occupational Information Network (O*NET) database and correlating them with case counts published by the Washington State Department of Health, Zhang found 2 variables that correlate with case prevalence: disease exposure (r = .66; p = .001) and physical proximity (r = .64; p = .002), and predict 47.5% of prevalence variance (p = .003) on multiple linear regression analysis.

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IQVIA Joins FDA to Advance COVID-19 Understanding at Community Level Through COVID Active Research Experience (CARE) Project


To understand the impact of COVID-19 on people–what symptoms individuals experience, the length and severity, and whether any medications or vitamin supplements they are taking affect the severity of their coronavirus symptoms–IQVIA and the US Food and Drug Administration (FDA) have started a joint program that will use data from IQVIA’s CARE Project registry. The registry was started in April and is open to US-based residents who think they may have been exposed to the coronavirus, regardless of whether they have been diagnosed with COVID-19, including people who have continued with everyday life and may have been exposed. Working with the FDA, IQVIA’s scientific team will use the ongoing CARE Project to provide rapid insights into important COVID-19 questions that have yet to be explored or answered well via other available real-time data.

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Syneos Health on Digital Therapeutics and Payers

(Syneos Health)

Looking back at this panel from June, Syneos Health presents research that shows how payers are concerned with the real-world utility of digital therapeutics, a market that has grown more than 50% in the past 3 years. The panel also covered existing pricing and payment models and existing case studies.

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Vertex Pharma’s Vision for Reimbursement Innovation


Pharmaphorum’s Paul Tunnah talks with Simon Lem, regional vice president for Northern Europe and Australia for Vertex. Lem, who had led the digital launch of Vertex’s novel cystic fibrosis drug, Kaftrio (ivacaftor/tezacaftor/elexacaftor), describes how Vertex tried to meet the needs of the cystic fibrosis patient population (that tends to be young and tech-savvy) and his hopes that the speedy nature of the Kaftrio approval by the National Health Service is a good signal for the future of reimbursement.

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A Leading Artificial Intelligence Researcher Calls for Standards to Ensure Equity and Fairness

(STAT News)

The old computing adage regarding programming and the quality of results was GIGO, or “garbage in, garbage out.” When it comes to programming artificial intelligence (AI) engines to review health information, that acronym could be updated to RIRO, or “racism in, racism out.” Regina Barzilay, a top AI researcher at the Massachusetts Institute of Technology, warns that AI systems developed for medicine must become more transparent and judged against a set of common standards to ensure equity and fairness. These engines must be trained on diverse populations to be able to provide more equitable care, she says.

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ICER Provides Second Update to Pricing Models for Remdesivir as a Treatment for COVID-19


The Institute for Clinical and Economic Review (ICER) in November issued a second update to its pricing model for the drug. The group stated that an analysis of 4 studies shows that the evidence no longer supports an assumption of survival benefit from remdesivir. With the new analysis, ICER suggests a health-benefit price benchmark of $2470 for hospitalized patients with moderate-to-severe disease, and $70 for patients hospitalized with milder disease.

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To Maintain Opioid Sales, Purdue Was Advised to Pay Rebates to Health Insurers for Each Overdose


 In perhaps not the best look for the company, consultants, or for health insurers, court documents showed that Purdue Pharma was advised by McKinsey to pay a rebate of up to $14,000 to its 7 top health insurers for each patient that overdosed on OxyContin. It is not clear that Purdue ever implemented the move, which was suggested to maintain “crucial business relationships” as the company faced serious challenges to OxyContin sales. It had projected that it could cost the company $3 million to $15 million a year. The disclosure came in the wake of a decision by a US bankruptcy court judge who approved an $8.3 billion settlement between Purdue and the Justice Department.

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How Professionals Are Working to Address Healthcare Disparities in Northeast Ohio


The Center for Community Solutions studied Ohio neighborhoods and found a disparity of 23 years between the highest life expectancy neighborhood and the lowest life expectancy neighborhood. Additionally, systemic racism is fact beyond socioeconomic status, with Blacks having higher education and incomes still experiencing health disparities. In response, Cleveland Clinic set up programs to help educate and then hire future nurses as well as other critical positions.

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“All-Hands-on-Deck” Approach Needed on Social Determinants of Health
(American Medical Association)

An AMA Council on Medical Services report has found that social determinants of health need to be addressed not in the traditional ways by stakeholders in the healthcare system. Health plans, for example, should design benefits and coverage to cover the nonmedical but critical things patients need. And public and private health plans should examine implicit bias and the role of racism and social determinants of health, including through such mechanisms as professional development and other training.

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You Can Influence ICER Recommendations, You Just Need the Right Evidence


According to Matt Sussman at the healthcare analytics company Panalgo, it is possible to influence ICER recommendations if a pharmaceutical manufacturer can provide cost-effectiveness models developed by outside groups. The reason is that the results of these budget impact analyses are often more favorable than the “base” ICER ones.




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