The Daily Rise: Thursday, May 12

Know Your Jargon: PBM

As part of this week’s “Know Your Jargon” entry, we’re tackling PBMs, or pharmacy benefit managers.

What They Are: Insurance companies and big companies outsource the administration of drug benefits to PBMs, which frequently save money by limiting patients’ access to life-saving treatments. Think of them as the middleman that does the dirty work encouraging patients to fail first.

Why They’re Bad for Patients: PBMs operate entirely in secret. Even PBM clients can’t access information. Susan Hayes, who works as an auditor of PBM contracts, told USA Today in February, that “auditors aren’t allowed to copy or take pictures of documents when they audit a PBM’s rebate contracts… In recent proposals from Caremark that she reviewed for clients, Caremark provided a flat amount for a rebate and not 100% of rebate savings.”

In the News Today: The U.S. Department of Justice is taking notice of the secrecy and questionable practices surrounding pharmacy benefit managers, and has launched federal investigations of PBM contracts, according to BioPharmaDive.com.

Crowdsourcing to the Moon

The Cancer Moonshot is crowdsourcing its way to a cure.

This week, Vice-President Biden announced that the much ballyhooed “cancer moonshot” initiative will share patient stories and cancer research on the blog platform Medium.com, USA Today reports.

Only $1 billion has been set aside for the cancer moonshot initiative, which is a drop in the bucket when it comes to overall medical research. Nevertheless, we’re pleased to see the broader benefits that the initiative is generating, such as this blog.

“Key achievements are within our reach, if we can identify the areas that are most ripe for progress, and put a marketplace of ideas, energies, and talents behind them,” Douglas Lowy, acting director of the National Cancer Institute, writes in an inaugural Medium post.

“Part of accelerating progress against cancer at the speed envisioned under the Moonshot Initiative requires casting a wide net for ideas on how to achieve this goal.”

Get Ready for Large Increases

Get ready for double-digit increases in health care exchange insurance premiums says Morning Consult.

This week, insurance companies must submit their rate increase proposals for health exchanges operating under the Affordable Care Act. The Associated Press reports that insurers in Maine have already filed proposals “with the Maine Bureau of Insurance would raise individual plan premiums between 14 percent and 23 percent.”

“It’s time for the American people to brace themselves for what once again will be huge increases,” Sen. John Barrasso of Wyoming said earlier this week. “People are finding out that their insurance premiums are now higher than their mortgage.”

The Department of Health and Human Services is already in full damage control mode, saying that the eventual rate hikes will be lower than the current proposals.

“Marketplace consumers would do well to put little stock in initial rate filings,” said HHS spokesman Ben Wakana. “A report by the Department of Health and Human Services debunks the myth — based on last year’s rate filings — that average consumers experienced double digit percentage premium increases for coverage on the Health Insurance Marketplace in 2016.”

Evicted!

ABC News reports that an increasing number of nursing homes are evicting “difficult” patients.

“When they get tired of caring for the resident, they kick the resident out,” Richard Mollot of the Long Term Care Community Coalition, a New York advocacy group, tells ABC News.

Since 2000, complaints about nursing home discharges and evictions are up 57 percent, an Associated Press analysis of federal data from the Long-Term Care Ombudsman Program found. In 2014, more than 11,000 complaints were filed with Long-Term Care Ombudsman Program.

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