Short On Federal Funding, Obamacare Enrollment Navigators Switch Tactics

Enrollment is down sharply on the federal health insurance marketplace this fall, and the consumer assistance groups that help with sign-ups think they know why.

They don’t have the staff to help as many customers as before because the Trump administration slashed funding. The federal government is spending $10 million this year on navigators who help individuals enroll in coverage. The government spent $36 million in 2017 and $63 million in 2016.

“We don’t have the people to provide the enrollment assistance nor to do the outreach and marketing to let people know what’s happening,” said Jodi Ray at the University of South Florida, who has overseen Florida’s largest navigator program since 2014.

Ray’s program received $1.2 million in federal funding this year, down from $5 million a year ago. Florida leads the nation in enrollment in the Affordable Care Act marketplace plans.

With less money, Ray can afford to pay only 59 navigators across the state this year, down from 152 a year ago. With fewer navigators, much of the group’s counseling is done by phone instead of in person. That complicates their job, she said, because it is much easier to talk with and show marketplace customers in person when looking at dozens of health plans with different costs and benefits.

Open enrollment in the Obamacare plans began Nov. 1 and will run until Dec. 15 for the 39 states covered by the federal exchange, healthcare.gov. The other exchanges — run by states — typically extend until the end of December or into January.

Obamacare plans are for people without workplace or government coverage.

Nationwide, navigator groups are scrambling to make up for the loss of federal funding to ensure they can help people make sense of their health insurance options.

  • In South Carolina, the Palmetto Project has transformed into the state’s first nonprofit insurance agency. Several of its former federally funded navigators are now licensed insurance agents. In their new role, they get paid a commission on their sales and don’t have to follow Trump administration rules that encourage navigators to talk to customers about short-term plans with limited benefits. The agents can also help customers enroll in Medicaid, Medicare and off-exchange plans.
  • The Community Council of Greater Dallas, which was funded last year to help with enrollment in 56 counties, has raised money from private donors to continue serving seven counties around Dallas. But it has 25 fewer navigators, so consumers seeking help must wait three days on average, compared with less than a day last year. Across Texas, 211 of 254 counties have no federally paid navigators.
  • In Wisconsin, the organization Covering Wisconsin has raised millions of dollars from cities, counties and local United Way chapters, as well as the state Medicaid agency, to make up for the federal cuts. Even still, it will be able to provide in-person assistance in only eight counties around Milwaukee and Madison. Twenty other counties are served by telephone.
  • The Kansas Association for the Medically Underserved is relying totally on volunteers to help consumers with in-person and telephone assistance. In the past year, the association was able to use government funding to pay about 20 navigators.

Nationally, nearly 800 counties served by the federal marketplace will not have any federally funded navigators this fall — up from 127 counties in 2016, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Federal officials said they were not providing funds for navigators in Iowa, Montana or New Hampshire because no organizations applied in those states.

Nearly 12 million people across the country — including nearly 9 million on the federal exchange — enrolled in Obamacare plans for 2018.

At the halfway point in the six-week enrollment period, 2.4 million people chose a plan for the 2019 coverage year on healthcare.gov, the federal health insurance exchange, according to data released Wednesday by the federal Centers for Medicare & Medicaid Services. That compares with nearly 2.8 million consumers who selected their coverage through the exchange during the first 25 days last year.

Among states with the largest enrollment drops: Pennsylvania (down 25 percent from last year), Missouri (down 25 percent) and Ohio (down 20 percent).

The annual enrollment tally is being closely followed in part because 2019 marks the first year since the marketplace plans began in 2014 that Americans won’t be fined for failing to have coverage.

But consumer experts think the lack of navigator funding could end up having a bigger impact on enrollment. Caroline Gómez-Tom, navigator program manager of Covering Wisconsin, said the end of the so-called individual mandate penalty has been a “non-issue” among people seeking coverage.

“Some folks mention it, but at the end of the day they still walk away with health coverage,” she said. “The ability to have coverage at affordable prices outweighs the penalty being gone because people still see health care insurance as important to have.”

Consumers generally have a greater choice of plans for 2019 as more companies enter the individual market and existing plans expand service areas. Plus, premiums are dropping in some areas, and where they are rising the rate of increase is among the lowest in several years.

Katrina McGivern, director of policy and public affairs for the Kansas Association for the Medically Underserved, said people in rural areas of the state will have the most difficulty getting help as a result of funding cuts.

After five years of experience, she said, she is hopeful that people are figuring out how to do it on their own. Still, she added, there are always “people who need assistance to get through it.”

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Fructose link to diabetes may be different for sodas than fruit

(Reuters Health) – – Sodas sweetened with fructose may have a greater impact on risk factors for diabetes than whole fruits that are natural sources of fructose, a research review suggests.

The link between fructose and diabetes has been unclear. Some research has suggested this relationship may be explained at least in part by what people eat and drink and whether they are overweight or obese.

For the current analysis, researchers examined data from 155 studies that assessed the effect of different food sources of fructose on blood glucose levels. Combined, these studies included about 5,000 people with and without diabetes.

Fruit and fruit juices as part of a diet with a healthy amount of calories appeared to have a slightly beneficial effect on blood sugar, especially in people with diabetes, the analysis found.

But foods, sodas and juices with lots of calories and few nutrients seemed to have harmful effects on blood sugar.

Most of this evidence was low quality, however, researchers report in the BMJ.

“While this analysis did not find consistent effects of fructose per se on risk for diabetes, results appear to support the adverse effects of added sugars in the form of sugar-sweetened beverages,” said Dr. Mark Herman of Duke University in Durham, North Carolina.

“This analysis also supported potentially beneficial effects of fruit,” Herman, who wasn’t involved in the study, said by email. “It is likely beneficial to restrict consumption of sugar-sweetened beverages, and someone that is craving something sweet might consider a piece of fruit instead.”

Globally, almost one in 10 adults has diabetes, according to the World Health Organization. Most have type 2 diabetes, which is associated with obesity and aging.

Doctors generally advise patients with diabetes and people at high risk for developing the condition to limit sodas, juices and other sugary treats with fructose, sucrose or other sweeteners that add lots of empty calories to the diet. This can help reduce the risk of weight gain, and help keep blood sugar within a healthy range.

Fructose occurs naturally in a range of foods, including whole fruits and vegetables, natural fruit juices and honey. It is also added to foods, such as soft drinks, breakfast cereals, baked goods, sweets, and desserts.

It’s possible fruit and certain other foods with naturally occurring fructose might help improve blood sugar levels because they are high in fiber, which can slow down the release of sugars in the blood stream, the study authors note.

“These findings might help guide recommendations on important food sources of fructose in the prevention and management of diabetes,” senior study author Dr. John Sievenpiper of St. Michael’s Hospital in Toronto said in a statement.

Sievenpiper has received money from a variety of food and beverage companies and advocacy groups including the International Dried Fruit and Nut Council, Calorie Control Council, Dr. Pepper Snapple Group, The Coca- Cola Company, and PepsiCo.

Patients should consume sweets in moderation, limit added sugars, and beware hidden sweeteners in processed foods, said Dr. Valerio Nobili of University La Sapienza in Rome.

“For example, 1 tablespoon of ketchup contains about 4 grams (about 1 teaspoon) of sugars, while a single can of sweetened soda contains up to 40 grams (about 10 teaspoons) of sugars,” Nobili, who wasn’t involved in the study, said by email.

“Both . . . patients with type 2 diabetes and healthy individuals should avoid added sugars while increasing the natural sugars, such as those contained in whole fruit,” Nobili advised.

SOURCE: bit.ly/2KIqlzt BMJ, online November 21, 2018.

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FDA picks eight medical device firms to help battle opioid crisis

(Reuters) – Eight medical device makers, including a startup that uses virtual reality to treat chronic pain, topped an innovation contest aimed at addressing the opioid crisis, the U.S. Food and Drug Administration said on Friday.

Silicon Valley-based startup CognifiSense, which is developing the virtual reality therapy, and iPill Dispenser, which uses a biometrically controlled mobile app that aims to cut overconsumption by dispensing pills based on prescriptions, were among the winners of the FDA’s contest.

The health regulator will work directly with the companies to expedite the development and review of their devices in a manner similar to the agency’s Breakthrough Devices Program, which fast-tracks the review of certain products.

Over 72,000 Americans died from drug overdose last year, including illicit drugs and prescription opioids, with President Donald Trump declaring the opioid addiction crisis a public health emergency.

The FDA received over 250 applications for the innovation challenge, which seeks to prioritize the approval of novel medical devices including digital health technologies such as mobile medical apps.

Under Commissioner Scott Gottlieb, the FDA has raised the bar for approval of opioid-based painkillers by restricting the distribution and use of these drugs. The agency has also rolled out initiatives to encourage developers of alternative therapies.

“We believe the greatest opportunities for medical devices to help prevent opioid use disorder are devices that could help identify people likely to become addicted, devices that manage pain as an alternative to opioids or reduce the need for opioid medications,” the FDA said in a statement here.

Reporting by Tamara Mathias in Bengaluru; Editing by Anil D’Silva

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Doctors’ Office Dementia Tests Are Often Wrong: Study

News Picture: Doctors' Office Dementia Tests Are Often Wrong: StudyBy Alan Mozes
HealthDay Reporter

Latest Alzheimer’s News

WEDNESDAY, Nov. 28, 2018 (HealthDay News) — Fast tests designed to help primary care doctors rapidly spot dementia in their elderly patients often get it wrong, a new British report contends.

The finding concerns three widely used quick dementia tests: the “Mini-Mental State Examination” (intended to assess mental orientation and verbal memory); the “Memory Impairment Screen” (which tests verbal memory); and “Animal Naming” (which gives patients one minute to quickly name as many animals as they can).

The result: more than one-third of the patients were misclassified — as either having or not having dementia — by at least one of the rapid tests in question.

“Dementia can be difficult to accurately detect, particularly in a primary care setting,” said study lead author Janice Ranson. But the rapid tests “are important screening tools to help clinicians decide who is likely to benefit from further testing for dementia,” she acknowledged.

“Our results suggest that some of the misclassification is due to test biases, such as a patient’s age, ethnicity or education level,” she added.

Ranson is a doctoral researcher in clinical epidemiology at the University of Exeter Medical School in England.

She and her colleagues reported their findings in the Nov. 28 online issue of the journal Neurology: Clinical Practice.

Ranson said quick tests are “routinely used” by primary care doctors as an initial screening. And if signs of dementia are found, a “full dementia investigation” typically ensues.

The study included just over 800 patients in the United States who underwent the tests. The participants ranged in age from 70 to 110, with an average age of 82.

The patients initially underwent comprehensive three- to four-hour dementia assessments. These involved a neurological exam, blood pressure readings, a medication review, DNA sampling, depression screening and lifestyle/family history interviews.

These comprehensive assessments revealed that about one-third of the patients had dementia.

All of the participants subsequently underwent each of the three quick dementia tests.

But when the research team compared the quick test results with the in-depth results, they found that 36 percent of the patients were mistakenly diagnosed by at least one of the quick tests.

Interestingly, the researchers found that individually, each quick test actually had a misdiagnosis rate of 14 to 21 percent, and only 2 percent of the patients were misdiagnosed by all three tests.

Why? Each test appeared to have a different problematic bias, the study authors said. For example, while one test appeared to underdiagnose dementia in highly educated patients, others appeared to miss the mark based on patient age, race or nursing home status.

“Each test is biased in different ways,” said Ranson, “and so some tests are more accurate than others for certain patient groups. While these results are at first concerning, knowing the specific limitations for each test will help clinicians decide which is the most appropriate for their patient.”

Still, she said there’s definitely room for improvement.

“We desperately need more accurate and less biased ways of detecting dementia swiftly in clinic,” said Ranson. “We are therefore developing new technology, using data science and artificial intelligence, to help clinicians get the best outcome for their patients. We are working hard to improve these tests with a more personalized approach to cognitive testing.”

Keith Fargo is director of scientific programs and outreach with the Alzheimer’s Association, in Chicago. “Diagnosing Alzheimer’s and other forms of dementia is an incredibly complex process, and not something that can be done on the quick,” he said.

“Simple cognitive tests can be a helpful first step toward diagnosis, but as the study points out, are imperfect,” Fargo explained.

“The Alzheimer’s Association supports efforts to better understand and account for potential biases in short assessments for cognitive impairment,” Fargo added. “Ensuring a timely and accurate diagnosis is critical, and this study identifies important biases that need to be considered when using these preliminary assessments.”

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SOURCES: Janice Ranson, M.Sc., doctoral researcher, clinical epidemiology, University of Exeter Medical School, Exeter, England; Keith Fargo, Ph.D., director of scientific programs and outreach, Alzheimer’s Association, Chicago; Nov. 28, 2018, Neurology: Clinical Practice, online


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Under Trump, Number Of Uninsured Kids Rose For First Time This Decade

After years of steady decline, the number of U.S. children without health insurance rose by 276,000 in 2017, according to a Georgetown University report released Thursday.

While not a big jump statistically — the share of uninsured kids rose to 5 percent in 2017 from 4.7 percent a year earlier — it is still striking. The uninsured rate typically remains stable or drops during times of economic growth. In September, the U.S. unemployment rate hit its lowest level since 1969.

“The nation is going backwards on insuring kids and it is likely to get worse,” said Joan Alker, co-author of the study and executive director of Georgetown’s Center for Children and Families.

Alker and other child health advocates place the blame for this change on the Trump administration and the Republican-controlled Congress, saying their policies and actions cast a pall on enrollment.

The number of children without coverage rose to 3.9 million in 2017 from about 3.6 million a year earlier, according to Census data analyzed by Georgetown.

The overall uninsured rate for people of all ages — which plummeted from 2013 to 2016 following the health law’s implementation — remained unchanged at 8.8 percent last year.

The share of children with employer-sponsored coverage rose modestly in 2017, but not by enough to make up for the drop in children enrolling in Medicaid or getting coverage from Obamacare insurance exchanges, Alker said.

While no states made any significant gains in lowering children’s uninsured rate, nine states experienced significant increases. The biggest occurred in South Dakota (up from 4.7 percent to 6.2 percent), Utah (up from 6 percent to 7.3 percent) and Texas (from 9.8 percent to 10.7 percent).

More than 1 in 5 uninsured children nationwide live in Texas — about 835,000 kids — by far the highest number of any state.

Florida had 325,000 uninsured children last year, as its uninsured rate for that age group rose 0.7 percentage points to 7.3 percent. California had 301,000 children without insurance, though its number remained virtually unchanged, relative to the previous year.

Other states with significant increases were Georgia, South Carolina, Ohio, Tennessee and Massachusetts.

The uninsured rates for children increased at nearly triple the rates in states that did not expand Medicaid under the Affordable Care Act, according to the report. Studies have shown that children whose parents are insured are more likely to have coverage.

The uninsured rate among Hispanic children was 7.8 percent, compared with 4.9 percent among whites and 4.6 percent among blacks overall. (Hispanics can be of any race.)

Georgetown has been tracking these figures since 2008 when 7.6 million children — or about 10 percent of kids — lacked health coverage.

Because nearly all low-income children are eligible for Medicaid or the federal Children’s Health Insurance Program, known as CHIP, the challenge is making sure parents are aware of the programs, getting them enrolled and keeping them signed up as long as they are eligible, Alker said.

Congress let the CHIP program funding lapse for several months in 2017, putting states in a position of having to warn consumers that they would soon have to freeze enrollment. Congress restored federal funding in early in 2018.

In addition, low-income families were bombarded by news reports last year of Congress threatening to repeal the health law that expanded coverage to millions. In the past two years, the Trump administration has slashed funding to Obamacare navigators to help people sign up for coverage.

Alker also pointed to the Trump administration’s September proposal, known as the “public charge” rule, which could make it harder for legal immigrants to get green cards if they have received certain kinds of public assistance — including Medicaid, food stamps and housing subsidies. Green cards allow them to live and work permanently in the United States.

OLE Health, a large health provider based in Napa Valley, Calif., that serves many immigrants, said it has seen patients disenroll from Medicaid in the past year. CEO Alicia Hardy said many have dropped coverage over fears the help could jeopardize their immigration status.

“They are afraid of being deported,” she said.

All those events could have deterred families from getting their kids covered. “The welcome mat has been pulled back and as a result we see more uninsured children,” Alker said.

She said the easiest way to change the trend would be for more states to expand Medicaid under the health law. Fourteen states have yet to do so. Though the expansion largely affects adults, as parents enroll, their children are likely to follow.


KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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Many incidental findings spotted on MRIs, few turn out to be cancer

(Reuters Health) – Many people who get magnetic resonance imaging (MRIs) for a variety of common health problems may get an unexpected cancer scare that turns out to be a false alarm, a research review suggests.

Researchers focused on what they called “potentially serious incidental findings,” that is, accidentally discovered abnormalities that aren’t related to the symptoms that led a doctor to order the test and that may be serious. For example, a chest X-ray to look for pneumonia reveals an unexpected spot on the lung that may or may not be cancer.

Unexpected abnormalties like these, also known as incidentalomas, are turning up more often as more people get high-resolution scans that can spot irregularities that once went undetected.

Overall, about 4 percent of people had potentially serious incidental findings, the study team reports in The BMJ. This jumped to almost 13 percent when researchers also included incidental findings of uncertain potential seriousness.

Patients should “consider how they feel about the chances of a potentially serious incidental finding being detected, and that if such a finding is detected, that they may have to undergo more tests (some of which may be uncomfortable or even have some associated risk) before reaching a final diagnosis, and that most findings may not in the end turn out to be anything serious,” said senior study author Dr. Cathie Sudlow of the University of Edinburgh in the UK.

“For patients, it is difficult to know at the outset of the diagnostic journey whether or not the tests being performed are unnecessary,” Sudlow said by email. “We can only make this judgement in retrospect.”

For the current study, researchers analyzed data from 32 previously published studies that looked at the potential for serious incidental findings in more than 27,000 patients who had MRIs.

The prevalence of incidentalomas varied substantially depending on the type of scan.

For example, there were potentially serious incidental findings with 1.4 percent of brain MRIs, 1.3 percent of chest scans and 1.9 percent of abdominal MRIs.

About half of the potentially serious incidental findings were suspected malignancies.

Only about one in five of these incidental findings turned out to lead to a serious diagnosis after additional tests or procedures.

One limitation of the study is that researchers lacked long-term data on patients to determine if any of the potentially serious incidental findings might turn out to be precursors of tumors discovered years later, the authors note.

However, previous research suggests that 9 in 10 incidental findings aren’t serious after follow-up, Sudlow said.

“With the advancement of imaging technology, our sophisticated scans are now capable of identifying lesions that are either non-cancerous, or will never grow to cause a patient harm in their lifetime,” said Dr. Jack O’Sullivan, a researcher at Stanford University in California who wasn’t involved in the study.

“The discovery of a cancerous lesion that would benefit from appropriate treatment is a clear benefit of incidental findings,” O’Sullivan said by email. “The harms are related to potentially unnecessary anxiety, further testing and treatment of a lesion that will never grow to harm them.”

When patients are told they have an incidental finding after a MRI, they should ask their doctor what the odds are that the abnormal tissue would be harmful to their health, what side effects might result from any tests or treatments, and what happens if they do nothing to find out if the finding is actually cancer, O’Sullivan advised.

“This is a very personal decision,” Sudlow said, “People’s opinions vary widely on what they would want to do.”

SOURCE: bit.ly/2zvY5vR The BMJ, online November 22, 2018.

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Measles cases rise in Europe, Latin America: WHO report

GENEVA (Reuters) – Measles is on the rise around the world and especially in Europe and Latin America, in part because parents shun vaccines, the World Health Organization (WHO) said on Thursday.

Some 173,000 measles cases were officially reported worldwide in 2017, a jump of more than 30 percent from the previous year, the WHO said in a report. The true number of cases is estimated at 6.7 million last year, it said.

An estimated 110,000 people died last year, mainly children, from the vaccine-preventable disease.

“What is more worrying than this increase … is that we are seeing sustained measles transmission in countries that had not previously seen measles transmission for many years,” said Martin Friede, acting director of WHO’s immunization, vaccines and biologicals division.

“This suggests that we are actually regressing in certain cases,” he told a news briefing.

The highly-infectious disease can be fatal or cause hearing loss and mental disorders in children. It is often a harbinger of other outbreaks such as diphtheria in an under-vaccinated population.

Germany, the Russian Federation and Venezuela had large measles outbreaks last year, leading to withdrawal of their certification for having interrupted transmission, the WHO said.

“We are seeing an uptick looking at the 2018 data and this uptick appears to be sustained so we are worried that what may begin as a spike is becoming a trend,” Friede said.

Katrina Kretsinger, WHO medical officer, said: “At this point in 2018 we’re on track to have more cases than we had for 2017.”

Global vaccine coverage for the first dose of measles vaccine has stalled at 85 percent, while 95 percent is needed to prevent outbreaks, the WHO report said. Second dose coverage is 67 percent.

“The majority of the children who miss out (on vaccination) live in the poorest and most disadvantaged communities around the world, many in conflict areas,” said WHO’s Ann Lindstrand.

But in some parts of Europe and Latin America, “negative misinformation or mistrust in immunization” discourages vaccination, she said, adding that the vaccine is safe.

“We’re losing ground on measles sometimes because people forget that this is a horrifying disease,” she said.

Reporting by Stephanie Nebehay; Editing by Matthew Mpoke Bigg

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Chronically Ill, Traumatically Billed: The $123,000 Medicine For MS

Shereese Hickson’s multiple sclerosis was flaring again. Spasms in her legs and other symptoms were getting worse.

She could still walk and take care of her son six years after doctors diagnosed the disease, which attacks the central nervous system. Earlier symptoms such as slurred speech and vision problems had resolved with treatment, but others lingered: she was tired and sometimes still fell.

This summer, a doctor switched her to Ocrevus, a drug approved in 2017 that delayed progression of the disease in clinical trials better than an older medicine did.

Genentech, a South San Francisco-based subsidiary of Swiss pharma giant Roche, makes Ocrevus. It is one of several drugs for multiple sclerosis delivered intravenously in a hospital or clinic. Such medicines have become increasingly expensive as a group, priced in many cases at well over $80,000 a year. Hospitals delivering the drugs often take a cut by upcharging the drug or adding hefty fees for the infusion clinic.

Hickson received her first two Ocrevus infusions as an outpatient two weeks apart in July and August. And then the bill came.

Patient: Shereese Hickson, 39, single mother who worked as a health aide and trained as a medical coder, living in Girard, Ohio. Because her MS has left her too disabled to work, she is now on Medicare; she also has Medicaid for backup.

Total Bill: $123,019 for two Ocrevus infusions taken as an outpatient. CareSource, Hickson’s Medicare managed-care plan, paid a discounted $28,960. Hickson got a bill for about $3,620, the balance calculated as her share by the hospital after the insurance reimbursement.

Medical Service: Two Ocrevus infusions, each requiring several hours at the hospital.

Service Provider: Cleveland Clinic, a nonprofit, academic medical center in Ohio.

What Gives: Hickson researched Ocrevus online after her doctor prescribed the new medicine. “I’ve seen people’s testimonies about how great it is,” on YouTube, she said. “But I don’t think they really go into what it’s like receiving the bill.”

That was particularly shocking because, covered by government insurance for her disability, she’d never received a bill for MS medicine before.

“I have a 9-year-old son and my income is $770 a month,” said Hickson. “How am I supposed to support him and then you guys are asking me for $3,000?”

Even in a world of soaring drug prices, multiple sclerosis medicines stand out. Over two decades ending in 2013, costs for MS medicines rose at annual rates five to seven times higher than those for prescription drugs generally, found a study by researchers at Oregon Health & Science University.

“There was no competition on price that was occurring,” said Daniel Hartung, the OHSU and Oregon State University professor who led the study. “It appeared to be the opposite. As newer drugs were brought to market, it promoted increased escalation in drug prices.”

With Ocrevus, Genentech did come up with a price that was slightly less than for rival drugs, but only after MS medicines were already extremely expensive. The drug launched last year at an annual list price of $65,000, about 25 percent lower than that of other MS drugs, Hartung said. MS drugs cost about $10,000 per year in the 1990s and about $30,000 a decade ago.

“We set the price of Ocrevus to reduce price as a barrier to treatment,” said Genentech spokeswoman Amanda Fallon.

It was also probably a response to bad publicity about expensive MS drugs, Hartung said. “Now companies are very aware at least of the optics of releasing drugs at higher and higher prices,” he said.

Patients starting Ocrevus get two initial infusions of 300 milligrams each and then 600 mg twice a year. Cleveland Clinic charged $117,089 for Hickson’s first two doses of Ocrevus — more than three times what hospitals typically pay for the drug, said John Hennessy, chief business development officer at WellRithms, a firm that analyzes medical bills for self-insured employers.

As is typical of government programs such as Medicare, the $28,960 reimbursement ultimately collected by the Cleveland Clinic was far less — but still substantial.

“We kind of got ourselves in a pickle here,” he said. “We’re more excited about the discount than we are about the actual price.”

Hickson’s nearly $3,620 bill represented the portion that Medicare patients often are expected to pay themselves.

Shereese Hickson, diagnosed with multiple sclerosis in 2012 and unable to work, supports herself and her son, Isaiah, on $770 a month.(Shane Wynn for KHN)

Last year, the Institute for Clinical and Economic Review, an independent nonprofit that evaluates medical treatments, completed a detailed study on MS medicines. It found that Ocrevus was one of three or four medicines that were most effective in reducing MS relapses and preventing MS from getting worse. But it also found that patient benefits from MS drugs “come at a high relative cost” to society.

At the same time, deciding which MS drug — there are about a dozen — would best suit patients is something of a shot in the dark: The science showing the comparative effectiveness of MS drugs is not as strong as it could be, researchers say.

“In general, there’s a real lack of head-to-head studies for many of these drugs,” said Hartung. The FDA has no required comparison standard for MS drugs, an agency spokeswoman said. Sometimes they’re rated against placebos. With everyone able to charge a high price, the companies have little incentive to see which works better and which worse.

Resolution: After Hickson questioned the charges over the phone, the billing office told her to apply to the hospital for financial assistance. Hickson had to print a form, provide proof of her disabled status, mail it and wait.

Hospital officials told her in October she qualified for assistance based on her income through a state program funded by hospital contributions and federal money. Cleveland Clinic wiped out the $3,620 balance.

“I’m grateful that they approved me for that, but not everybody’s situation is like that,” she said. She was worried enough about being billed again for her next Ocrevus infusion that she considered switching back to her old medicine. But her doctor wants her to give it more time to gauge its effects.

The Takeaway: Always ask about charity care or financial assistance programs. Hospitals have different policies and wide discretion about how to apply them, but often do not even tell patients such programs exist.

Because health care costs are so high, you may be eligible even if you have a decent salary. Cleveland Clinic gives free care to everybody below a certain income, said spokeswoman Heather Phillips. But it wasn’t until Hickson called that the hospital agreed to erase the charge.

While there are multiple new drugs to treat serious chronic conditions, they have often not been tested against one another. Moreover, your doctor may have no idea about their relative prices. He or she should. For newer drugs, all options may well be very expensive.

Keep in mind that drugs which must be infused often come with facility fees and infusion charges, which can leave patients with hefty copayments for outpatient treatment. Ask about oral medicines or those you can self-inject at home.

NPR produced and edited the interview with Elisabeth Rosenthal for broadcast. Marlene Harris-Taylor, from member station Ideastream in Cleveland, provided audio reporting.

Do you have an exorbitant or baffling medical bill? Join the KHN and NPR Bill-of-the-Month Club and tell us about your experience.


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Astellas Pharma gets U.S. nod for blood cancer treatment

(Reuters) – Japan’s Astellas Pharma Inc on Wednesday received approval from the U.S. Food and Drug Administration for its blood cancer treatment, according to the regulator’s website bit.ly/2SjB8CL.

The oral drug, Xospata, was approved to treat patients with acute myeloid leukemia (AML) with a FLT3 mutation, whose cancer has relapsed or proved treatment-resistant.

“Astellas intends to commercialize this product globally without a partner,” Steven Benner, a senior vice president at the company, told Reuters.

The drug is a targeted therapy that will be able to treat about 30 to 40 percent of the over 19,000 new patients that are expected to be diagnosed with AML in the United States this year, the company said.

The approval was based on an interim analysis of a late-stage trial, and makes the drug the first approved for patients with the FLT3 mutation who are currently largely treated with chemotherapy, Astellas said.

The FDA has authorized Xospata’s use in AML patients whose mutation has been diagnosed with a certain companion test.

Reporting by Tamara Mathias and Manas Mishra in Bengaluru; Editing by Shailesh Kuber

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U.S. FDA approves first biosimilar to Roche’s cancer drug Rituxan

FILE PHOTO: The logo of Celltrion is seen at company’s headquarters in Incheon, South Korea, October 28, 2016. REUTERS/Kim Hong-Ji

(Reuters) – The U.S. Food and Drug Administration on Wednesday approved Celltrion Inc’s Truxima, making it the first biosimilar to Roche Holding AG’s Rituxan available in the United States to treat non-Hodgkin’s lymphoma.

The approval was largely expected as the drug won unanimous backing from an FDA advisory panel in October, which deemed it highly similar to Rituxan.

The FDA had in February declined to approve the copycat drug, citing issues related to a certain manufacturing process at Celltrion’s facility.

Like Rituxan, Truxima’s label contains a boxed warning – the agency’s harshest – which highlights several health risks including a rare, serious brain infection and liver damage.

Roche’s drug, approved in 1997, is marketed as Rituxan in the United States, Japan and Canada and as MabThera elsewhere.

In October, Roche said it expected biosimilar competition in the United States in the first half of 2019.

Earlier this month, Novartis International AG said it would no longer pursue U.S. regulatory approval for its biosimilar of Rituxan after the FDA sought additional information to support the company’s application for the drug.

Celltrion entered into a partnership with Teva Pharmaceutical Industries in 2016 to commercialize Truxima in United States and Canada.

Reporting by Manas Mishra and Tamara Mathias in Bengaluru; Editing by Shailesh Kuber

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