Questions From High Court Suggest Concerns About ‘Pay-For-Delay’ Deals

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English: The United States Supreme Court, the highest court in the United States, in 2010. Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg. (Photo credit: Wikipedia)

Topics: Supreme Court, Marketplace

Mar 26, 2013

The Supreme Court heard arguments yesterday in a case which pits brand name and generic drug manufacturers against the Federal Trade Commission.

Reuters: Supreme Court Justices Signal Uncertainty On Drug Settlements
Supreme Court justices on Monday signaled uncertainty over how they would rule on whether brand-name drug companies can settle patent litigation with generic rivals by making deals to keep cheaper products off the market. Eight justices, lacking the recused Justice Samuel Alito, asked questions that indicated concerns about such deals, but several seemed unsure how courts should approach the matter (Hurley, 3/25).

MedPage Today: SCOTUS Questions FTC Stance on ‘Pay-for-Delay‘
Several Supreme Court justices had hard questions about the Federal Trade Commission’s (FTC) stance against “pay-for-delay” drug patent settlements during arguments before the court on Monday (Pittman, 3/25).

In other courtroom action –

The New York Times: Salesmen In The Surgical Suite
It is not the first time patients have claimed they were harmed by Intuitive’s robotic surgical equipment, called the da Vinci Surgical System. But the Taylor case, set for trial in April, is unusual. Internal company e-mails, provided to The New York Times by lawyers for the Taylor estate, offer a glimpse into the aggressive tactics used to market high-tech medical devices and raise questions about the quality of training provided to doctors before they use new equipment on patients. Intuitive, based in Sunnyvale, Calif., declined to comment on the lawsuit but said studies showed that its robotic equipment results in better outcomes than conventional open surgery (Rabin, 3/25).

Supreme Court To Hear Case About ‘Pay To Delay’ Deals Between Generic And Branded Drug Makers

U.S. Supreme Court building. (Photo credit: Wikipedia)

Topics: Supreme Court, Marketplace

Mar 25, 2013

Generic and the brand-name drug companies — usually fierce competitors — will be on the same side as they argue their case against the federal government. At issue is whether brand name drug manufacturers may pay generics to keep generic competitors off the market.

The New York Times: Justices To Look At Deals By Generic And Branded Drug Makers
Just about anyone who has gone to a pharmacy and paid for a prescription knows that a generic copy costs much less than the brand-name drug. The makers of those two versions of a drug, therefore, usually compete fiercely for market share and profits. But at the Supreme Court on Monday, the generic and the brand-name drug companies will be on the same side, arguing against the federal government in the legal equivalent of a heavyweight title bout (Wyatt, 3/24).

NPR: Supreme Court Hears ‘Pay To Delay’ Pharmaceutical Case
The U.S. Supreme Court hears arguments on Monday in a case worth billions of dollars to pharmaceutical companies and American consumers. The issue is whether brand name drug manufacturers may pay generic drug manufacturers to keep generics off the market. These payments — a form of settlement in patent litigation — began to blossom about a decade ago when the courts, for the first time, appeared to bless them (Totenberg, 3/25).

The Associated Press/Washington Post: High Court Weights Drug Companies‘ Payments To Delay Release Of Cheaper Generic Drugs
The Obama administration, backed by consumer groups and the American Medical Association, says these so-called “pay for delay” deals profit the drug companies but harm consumers by adding 3.5 billion annually to their drug bills (3/25).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Studies Gauge Health Law’s Impact On Consumer Savings, Rx Drug Coverage

Topics: Supreme Court, Insurance, Marketplace, Health Reform, States

Dec 05, 2012

The Commonwealth Fund concluded that consumers saved $1.5 billion in 2011 as a result of a provision that limits how much insurers can spend on expenses not related to medical care. Meanwhile, Avalere Health found that drug coverage plans offered on health exchanges will vary by state.

Los Angeles Times: ‘Obamacare’ Saves Consumers Nearly $1.5 Billion
Consumers saved nearly $1.5 billion in 2011 as a result of rules in President Obama’s healthcare law that limit what insurance companies can spend on expenses unrelated to medical care, including profit, a new analysis shows. Much of those savings — an estimated $1.1 billion — came in rebates to consumers required because insurers had exceeded the required limits. The study by the New York-based Commonwealth Fund also suggests that the Affordable Care Act forced insurers to become more efficient by limiting their administrative expenses, a key goal of the 2010 law (Levey, 12/5).

Modern Healthcare: Reform Law Aiding Insurance Consumers: Report
A new report estimated insurance consumers benefited from $1.5 billion in either rebates or reduced costs last year, due to requirements of the healthcare overhaul. But insurers warned that money could have funded anti-fraud and quality-improvement programs. Research supported by the Commonwealth Fund, which backed the Patient Protection and Affordable Care Act, concluded that the law’s medical loss-ratio requirements implemented in 2011 provided big savings—mainly in the individual insurance market. Individual market policyholders had “substantially reduced premiums” due to the law’s requirement that insurers spend at least 80% of premium dollars on direct healthcare or quality-improvement activities, or else pay a rebate to their customers, according to the report (Daly, 12/5).

The Associated Press/Washington Post: Study: Prescription Drug Coverage Under Obama Health Care Law Could Vary Markedly By State
A new study says basic prescription drug coverage could vary dramatically from state to state under President Barack Obama’s health care overhaul. That’s because states get to set benefits for private health plans that will be offered starting in 2014 through new insurance exchanges (12/4).

The Hill: Analysis Finds Big State-By-State Swings In Prescription Coverage
President Obama’s signature healthcare law requires insurance plans to cover a range of prescription drugs, but the number of drugs covered will vary widely from state to state, according to a new analysis from Avalere Health. The Affordable Care Act requires plans to cover a set of “essential health benefits,” including prescription drugs. To prevent benefit mandates from driving up premiums, the Health and Human Services Department has said it will let states fill in most of the details about their essential-benefits packages (Baker, 12/4).

In other coverage related to the health overhaul –

MPR: Federal Health Care Law
The federal health care overhaul is here to stay after surviving an epic legal battle at the United States Supreme Court and the contentious 2012 elections. But that does not mean the massive law will remain intact, as enacted. Congress may be tempted to raid some of the Affordable Care Act’s funding as part of a deal to avert the collection of automatic tax hikes and spending cuts known as the “fiscal cliff.” The court battles are hardly over; legal challenges involving issues the Supreme Court did not address when it upheld the law in June, 2012, are already underway. But for the most part, key provisions, such as the individual mandate requiring most Americans to obtain health insurance, will take effect January 1, 2014 (Stawicki, 12/4).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

English: President Barack Obama’s signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

Medicaid Official Outlines State Flexibility In Health Law’s Medicaid Expansion

Topics: Insurance, Medicaid, Marketplace, States, Health Reform

Aug 07, 2012

Politico Pro reports that Centers for Medicare & Medicaid Services official Cindy Mann outlined Monday how states could choose to expand their coverage under the health law and then later drop it if they choose. This is the first time states will be allowed to drop such new coverage. Meanwhile, Modern Healthcare reports on how employers might be impacted if states opt not to expand their Medicaid programs.

Politico Pro: Mann: States Can Drop Medicaid Expansion
CMS Medicaid Director Cindy Mann said Monday that if states decide to expand Medicaid to new populations under the Affordable Care Act, they can later drop the coverage, according to sources who attended the meeting. Mann made the remarks at the National Conference of State Legislatures meeting in Chicago on Monday and outlined the new policy in a PowerPoint presentation obtained by Politico.  She acknowledged that that was the first time she said states will be allowed to drop the new coverage later if they want, according to several attendees (Haberkorn, 8/6).

Modern Healthcare: Reform’s Reduced Effect On Medicaid Could Impact Employers
Employers could be liable for stiff financial penalties as a result of a portion of the U.S. Supreme Court’s health care reform law ruling that invalidated massive federal sanctions against states that fail to expand eligibility for their Medicaid programs. In addition, the Medicaid part of the ruling could result in a much smaller reduction in the number of uninsured U.S. residents compared with earlier projections, according to estimates by the Congressional Budget Office. If those projections hold true, the effect of one of the big positives of the Patient Protection and Affordable Care Act for employers — a reduction of uncompensated care costs, which providers now shift to employer health plans — could be much smaller than employers had hoped (Geisel, 8/6).

Meanwhile, news outlets continue to report on the federal role in creating and operating health exchanges —

The Associated Press: Governors Aside, Feds Building Health Care Markets
Don’t look now: The feds may be gaining on GOP governors who’ve balked at carrying out a key part of President Barack Obama’s health care overhaul law. Opponents of the law say they won’t set up new private health insurance markets called exchanges. But increasingly it’s looking like Washington will just do it for them. That means federal officials could be calling the shots on some insurance issues that states traditionally manage, from handling consumer complaints to regulating plans that will serve many citizens (Alonso-Zaldivar, 8/7).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Scalia Renews Criticism Of Roberts’ Health Law Ruling But Denies Infighting

Topics: Supreme Court, Health Reform

Jul 29, 2012

USA Today: Scalia Disputes Talk Of Supreme Court Infighting
Supreme Court Justice Antonin Scalia is dismissing reports of infighting among court conservatives regarding the health care decision. Appearing today on Fox News Sunday, Scalia also said he did not know if Chief Justice John Roberts changed his mind about the heath care law and decided to provide the key vote to uphold it. “You’ll have to ask him,” Scalia said (Jackson, 7/29).

The Hill: Scalia: Future Cases Could Establish New ‘Limitations’ On Guns
In the wide-ranging interview, Scalia defended his view that “there’s simply no way to interpret” the individual mandate at the center of the 2010 healthcare law as a tax – the finding by Chief Justice John Roberts Jr. that prevented the law from being overturned. “You don’t interpret a penalty to be a pig. It can’t be a pig,” Scalia said of the ruling. “You cannot give the text a meaning it will not bear” (Berman, 7/29).

Politico: Scalia On Obama: ‘What Can He Do To Me?’
Supreme Court Justice Antonin Scalia on Sunday said he did not “view it as a threat” when President Barack Obama in April predicted his signature healthcare overhaul “will be upheld because it should be upheld” and that anything less would constitute “judicial activism” by the high court. Scalia conceded in an appearance on “Fox News Sunday” that Obama’s forceful comments on a pending Supreme Court case were “unusual, but as I say I don’t criticize the president publicly. And he normally doesn’t criticize me.” But when host Chris Wallace pressed, asking whether Scalia, who in June sided with a minority seeking to overturn the law, felt “any pressure as a result of that to vote a certain way,” Scalia laughed. “No. What can he do to me? Or to any of us?” the justice responded (Vogel, 7/29).

Meanwhile, in another Sunday interview show-

The Hill: Sen. Durbin Optimistic Lawmakers Can Avert Impending Sequester Cuts
Senate Majority Whip Dick Durbin (D-Ill.) said Sunday he expects lawmakers to reach a deal after the election that would fix the agreed-on sequester which will automatically cut $109 billion from defense and discretionary spending next year and over $1 trillion the next 10 years, including $500 billion from defense (Needham, 7/29).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.