Health Policy News and Views
Compiled by Benita M. Dodd
The law and unintended consequences
One of the pieces of legislation that passed in the Georgia General Assembly is known as the Honorable Jimmy Carter Cancer Treatment Access Act. It’s prefaced with the statement that, “on December 6, President Carter revealed that his physicians said that all signs of cancer were gone.”
The former president, you may recall, was diagnosed with melanoma, the deadliest form of skin cancer, and it had spread to his brain and liver. He was 91 years old at diagnosis. He continues to undergo treatment; he says his doctors found no trace of the lesions.
The legislation, HB 965, mandates:
No health benefit plan issued, delivered, or renewed in this state that, as a provision of hospital, medical, or surgical services, directly or indirectly covers the treatment of stage four advanced, metastatic cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of such drug or drugs; provided, however, that the use of such drug or drugs is consistent with best practices for the treatment of stage four advanced, metastatic cancer and is supported by peer reviewed medical literature.”
It concerns me that legislators are playing doctor
Carter was given an immunotherapy drug, pembrolizumab, sold under the brand name Keytruda in the United States. Instead of killing cancer cells, like chemotherapy and radiation, this amazing new drug is injected into the system and boosts the immune system to do the job. Carter’s treatment was a combination of surgery, radiotherapy and the drug.
In trials of the drug, just under 70 percent of 411 patients with stage four melanoma were still alive one year after starting the treatment, the Guardian of Britain reported. After 18 months, 62 percent were still alive and undergoing treatment. One-year survival rates for similar patients are just 10 percent for men and 35 percent for women without treatment.
Merck & Co.’s Keytruda was fast-tracked for approval by the Food and Drug Administration in September 2014 and is expected to be No. 14 on the list of 50 top-selling products in the United States by 2020.
The problem? Based on data collected by EvaluatePharma in 2013, Keytruda’s price would make it the sixth most expensive drug on the market. The treatment costs about $150,000 per year in the United States; in New Zealand, the government medication purchaser Pharmac rejected the treatment in November because of its $136,000 per patient price tag (U.S. dollars).
New Zealand also rejected the drug because of “a lack of long-term data.”
It’s all very noble of legislators to mandate that insurers provide to everyone in President Carter’s condition the same treatment he is receiving. Sadly, not only can this offer false hope, it could also impact the cost of insurance. What happens when everyone demands that their insurance cover it, without going through the established, existing protocol? The American Cancer Society estimates 16,840 Georgians will die of cancer in 2016. Hold onto your wallets.
For more, read:
The 2015-16 Legislative session
Protectionist and indefensible: One of the egregious acts by the Georgia Legislature was a bill that raced through both chambers and was aimed at ousting an innovative, affordable online vision care service already operating in Georgia. The vote made Georgia the first state in the nation to ban Opternative from operating. A sad day for millennials; a sad day for millions of low-income Georgians who could have benefited from this service. It offered online refraction exams for $40 for an eyeglass prescription for individuals 18-40 who are asymptomatic (no diabetes, glaucoma, etc.) This shortsighted legislation has attracted national attention, including this op-ed by Newt Gingrich in the Washington Times.
Good health care news: Legislation sponsored by Democratic Senator Michael Rhett of Cobb County provides for the creation of a Senate study committee to examine a health care premium assistance program for Georgians with an income too high to qualify for Medicaid but too low to qualify for federal subsidies. Right to try legislation passed.
Bad health care news: Efforts to expand the scope of practice for dental hygienists died, as did a bill that would ensure nurse anesthetists could practice without a physician present. Also dead for the session was direct care legislation – basically a membership health plan with a physician that is cheaper than insurance and should not count as insurance. As I said last month, it’s disappointing that Georgians will miss out on this affordable, effective health care option. Read the Foundation’s recent commentary here; read the Heritage Foundation study on direct care here.
Amaze(eye)balls: Two scientific teams have used adult stem cells to regenerate parts of the eye and restore sight to the blind. A joint British-Japanese team grew a variety of cells, using one particular type to cure induced blindness in lab rabbits. A U.S.-Chinese team generated human lens cells, using them to restore sight to human infants with congenital cataracts. Both studies were published this month in the journal Nature.
Allergy season: Spring is predicted to produce a longer, heavier pollen season than usual, thanks to warm, wet weather. Judging from the runoff, the forecast is on target. Today’s count is a record for 2016. Find the pollen count here; with the wet weather forecast for the end of the week, allergy sufferers can expect a sneezy weekend!
Home, James: Giving birth outside of a hospital has become more common in the United States, especially for white women, with almost 60,000 out-of-hospital births in 2014, according to a new study. The percentage is still small – 1.5 percent of births – but it’s a 72 percent increase since 2004, according to researchers. As a product of a midwife delivery at home, I’m not surprised that more mothers-to-be with low-risk pregnancies prefer the germs they know.
Handwashing: Here’s some “germ-ane” advice. If you’re taking a gift to a hospitalized patient, don’t make it flowers or fruit. Definitely don’t take a stuffed toy and, if you take books and magazines, be sure to toss them when the patient leaves the hospital. In fact, the best gift you can take is hand sanitizer. Why? It seems it’s not just doctors and nurses who need to wash their hands to hinder the spread of germs. Patients should also wash their hands, according to new research. Researchers focused on inner-city Detroit and examined patients who went from hospitals to post-acute care facilities – rehabilitation centers or hospices, for example. They found that almost one in four adults who left the hospital had on their hands a superbug: a virus, bacteria or another kind of microbe that resists multiple kinds of medicine. While in post-acute care, about 10 percent of patients picked up another superbug. Of those who had superbugs, 67 percent still had them upon being discharged, even if they hadn’t gotten sick. If you’re visiting, I don’t have to remind you to wash your hands when you leave, do I? Source: Kaiser Health News
ObamaCare turned 6: I wrote this commentary for ZPolitics to mark the Affordable Health Care’s sixth anniversary.
Quotes of Note
“Lest anyone doubt that the discounts are substantial, allow me to report freely that the average net prices paid last year by Lilly’s customers in the U.S. ranged from a high of 67 percent of list prices paid by commercial health plans to a low of 19 percent paid by government purchasers including Medicaid. That’s right: The average discount off list price was more than 80 percent for government payers.” – John C. Lechleiter, chairman, president and CEO of Eli Lilly and Co.
I wanted to publicly say how much I appreciate Georgia Public Policy Foundation. For those of you that will be entering the Legislature or are relatively new you may not quite yet appreciate how much we rely on Georgia Public Policy Foundation’s research and work. As you know we’re a citizen’s legislature. We have very little staff. They have been an invaluable, invaluable resource to us. To put this [Forum] on and the regular programs that they do throughout the year make us better at what we do. (At the 2012 Georgia Legislative Policy Forum.)