The Rundown | Week of 9.24.2018

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Opioid Act Passes Senate with Near-Unanimous Vote

The Senate approved the Opioid Crisis Response Act of 2018 by a 99–1 vote. The bipartisan measure aims to obstruct the traffic of illegal opioids while supporting local prevention, treatment, and recovery programs. The bill provided $8 billion to the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), and state governments. The bill proposes several population health technology initiatives such as developing non-addictive painkillers, incentivizing behavioral health providers to adopt electronic health records to “prominently [display] substance use treatment information,” and requiring CMS to adopt an online portal to foster better communication, and implementing “evidence-based prevention strategies,” that “[encourage] data sharing between states.”
>>Read More: Senate passes $8 billion opioid bill to stop the flow of illegal drugs and for treatment efforts

Population Health Correlated with Reduced Medicare Spending

New research correlates population health with lower healthcare costs per Medicare fee-for-service beneficiary. The cross-sectional study analyzed data from 2,998 U.S. counties and discovered that Medicare spent $992 less per beneficiary in counties in the top 20 percent of overall well-being — measured in terms of physical, mental, and social health — when compared to counties in the bottom 20 percent. Researchers accounted for factors such as median household income, healthcare system capacity, and “urbancity,” which is the degree to which a region is urban or rural. Researchers suggested that, in addition to managing care for high-risk populations, a “complementary strategy … could be targeting areas that might more broadly affect population health and spending.”
>>Read More: Does investing in pop health and social determinants work? New study finds link to lower Medicare spending

DOJ Pauses CVS Health-Aetna Merger

The Department of Justice (DOJ) will not approve CVS Health and Aetna’s proposed merger until the entities have shed Medicare Part D assets. The $69 billion merger was halted when an insurance commissioner raised antitrust concerns over Aetna’s 9 percent market share of Part D plans and CVS Health’s 24 percent share. One potential buyer for the plans is WellCare Health Plans, the Wall Street Journal reported. If approved, the merger would afford Aetna with a pharmacy benefit manager (PBM), which currently provides its own PBM and clinical program management. This merger follows the DOJ’s clearance of Express Scripts’ acquisition by Cigna, a $67 billion transaction.
>>Read More: DOJ wants Aetna, CVS Health to divest Part D plans before merger approval

Employer-Sponsored Healthcare Spending on the Rise

Researchers from the Health Care Cost Institute (HCCI) determined that healthcare spending through employer-sponsored insurance programs increased 44 percent since 2007 (from $3,752 to $5,394 per person). Contributing factors include brand-name prescriptions, emergency department visits, and outpatient surgery, which combined accounted for 48 percent of the per capita increase. Out-of-pocket costs increased at a nearly identical rate of 43 percent, with significant costs from emergency department balanced by a reduction in spending on brand-name and generic drugs. The HCCI study complements a recent Mercer survey, which attributed the slowed rates of insurance cost with the Affordable Care Act’s tax on high-cost plans, healthcare consumerism, and other factors. High utilization and an aging population are expected to drive the future costs of employer-sponsored health plans.
>>Read More: Prescriptions, ED visits, outpatient services drive healthcare spending growth

Majority of Consumers Would Purchase Prescriptions from Amazon

A survey from Deutsche Bank analysts indicates that 85 percent of insured Amazon Prime members would feel comfortable purchasing prescription drugs from the digital retail giant. In June, Amazon announced plans to buy PillPack — an online pharmacy that delivers prescriptions throughout the continental U.S. — for $1 billion. While the merger has not been approved, researchers estimate the deal could enable Amazon to capture a 30 percent share of the mail-order pharmacy market worth $3 billion as well as $55 billion in front-office sales through the company’s Whole Foods stores. In related news, Amazon’s still-unnamed health venture with JPMorgan Chase and Berkshire Hathaway announced work with Monitor Group, a Deloitte subsidiary, to develop strategies for treating chronic diseases.
>>Read More: ‘When, not if’: Amazon is moving closer to selling Rx drugs—and 85% of Prime members say they’d buy

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