Health Policy Reporter

THE PROGNOSIS

Congress still can’t agree on directing more dollars to combat the U.S. opioid crisis. But over the past year, private industry has stepped up its own efforts to stem the troubling tide of overdose deaths from prescription painkillers and other opiate drugs.

Over the course of 2017, insurers and drugmakers announced new goals to reduce the prescribing of opioid painkillers, limit how many pills patients can get at one time and give them better access to medication-assisted treatment. Furthermore, new medications came on the market to help those struggling with addiction.

Most experts say the addiction problem has grown much too big to adequately address without more public funding. But they agree that getting industry on board can go a long way in helping patients access treatments they need or avoid getting hooked to begin with.

“I think having industry involved reinforces this is a health issue,” said Jessica Nickel, president of the nonprofit Addiction Policy Forum. “It is not typically how we’ve approached this, but at the end of the day we are better off by having the white lab coats in the room.”

On Dec. 1, the FDA approved a new experimental drug from Indivior, making it the fourth medicine available to treat opioid addiction.

This week, the influential drug lobbying group Pharmaceutical Research and Manufacturers of America released a new set of policy proposals that include limiting opioid prescriptions to a seven-day supply for acute pain and a 30-day supply for chronic pain (with exceptions for those suffering from cancer or receiving palliative care) and prohibiting doctors from dispensing Schedule II medications — which include OxyContin and Percocet — in an office setting.

Aetna, one of the country’s biggest insurers, also announced this week that it’s fighting the opioid crisis by waiving co-pays for the overdose-reversing medication Narcan and limiting first-time opioid prescriptions.

“Aetna is committed to addressing the opioid crisis through prevention, intervention and treatment,” Harold Paz, the company’s chief medical officer, said in a statement.

Two other major insurers — Cigna and Anthem — have set goals of reducing opioid use among their customers. In May 2016, Cigna said it would endeavor to reduce opioid use by 25 percent over three years. This past August, Anthem announced it had met its 30 percent reduction goal early, and upgraded the goal to a 35 percent reduction by 2019.

Anthem is also aiming for its affiliated health plans to double the number of patients who receive both medication and behavioral therapy for their addiction, a dual approach that research shows to be the most effective. Progress toward that secondary goal has been slower, Sherry Dubester, the company’s vice president of Behavioral Health and Clinical Programs, told me.

This is where insurers see their niche in the opioid war — in narrowing the doorway to overprescribing while opening it wider to the kinds of treatments and providers that give patients the best results. Dubester said Anthem is on the lookout for “innovative” providers — such as the Connecticut-based Aware Recovery Care, a rehab center that delivers care to patients in their homes.

“I think that’s a great example of where the payer side can find providers doing interesting things and innovative approaches, and look to embrace that early,” Dubester said.

Here’s another upside to private industry tackling the opioid abuse problem: It doesn’t require action from a hopelessly partisan and divided Congress. Although President Trump has declared opioid overdose a public-health emergency -- his counselor Kellyanne Conway told Stat News this week she's been holding weekly meetings with administration officials to develop a response plan -- the administration hasn’t called for extra funding, and the GOP-led Congress doesn’t appear likely to supply extra dollars anytime soon.

Conway has been leading weekly meetings at the White House with officials across a dozen federal departments to develop a plan to respond to the opioid crisis and to implement recommendations from a presidentially appointed commission, she and other officials told STAT.

The “opioids cabinet,” as the group is known, is intended to help streamline efforts across the government and includes staffers from the Department of Health and Human Services and the Office of National Drug Control Policy, among other executive branch offices.

Yesterday, White House spokeswoman Sarah Huckabee Sanders was non-committal about more opioid funding:

But Senate Democrats poured on the pressure yesterday, chiding their Republican colleagues for calling to raise caps on defense spending yet being unwilling to provide more dollars for health-care providers and law enforcement to take on opioids.

“Those very same Republican House members that are saying they want more money to fight terrorism overseas — those Republicans have a responsibility to help us fight that terror,” said Sen. Ed Markey (D-Mass.), noting that there are around 33,000 deaths in the United States every year involving opioids.

Markey is pushing for a bill he is co-sponsoring with Sen. Bob Casey (D-Pa.), which would provide $45 billion for prevention, detection, surveillance and treatment of opioids over a decade — the same level of funding Senate Republicans proposed adding to their health-care bill over the summer to get senators from hard-hit states on board.

Of course, $45 billion is just a fraction of the $500 billion the White House Council of Economic Advisers recently said the opioid epidemic costs the U.S. economy every year. But Senate Democrats said it would be a good start.

“Words are nice, but they are not enough,” said Sen. Chris Van Hollen (D-Md.). “We can continue talking about this issue as a country, or we can start doing something about this issue as a country.”

From a producer at Cox Media Group's Washington bureau:

From Sen. Jeanne Shaheen (D-N.H.):

Sen. Maggie Hassan (D-N.H.):

AHH, OOF and OUCH

AHH: Ohio may soon bar abortions when they're sought because of a Down syndrome diagnosis, our colleague Sandhya Somashekhar reports. The state legislature approved such a measure on Wednesday, sending it to Republican Gov. John Kasich who hasn't said whether he'll sign it -- although he opposes abortion and earlier this year called for a prohibition on abortion in cases of the genetic disorder “appropriate.”

The bill would make Ohio the latest state to try to stop women from aborting fetuses when they discover through prenatal testing that they have a chromosomal defect, Sandhya writes. Similar laws have been passed in North Dakota, Indiana and Louisiana, though the latter two have been blocked by the courts.

"The issue of abortion in the case of genetic disorders is particularly fraught because of recent advances in prenatal testing. Down syndrome, which occurs when a person has an extra 21st chromosome and causes cognitive delays and other problems, can now be predicted through a blood test as early as 10 weeks into pregnancy," Sandhya writes. "A firm diagnosis usually requires more-invasive follow-up testing."

OOF: So exactly how dire is the CHIP funding situation? The New York Times reports that 4.9 million children could lose coverage in the 16 states that will run out of funding at the end of January if Congress doesn't act to reauthorize the kids health insurance program.

--By the end of February, 5.6 million kids in 24 states would be affected.

--By the end of March, 7.7 million kids in 36 states and D.C. would be affected.

--If Congress doesn't reauthorize funding by summer's end, 8.4 million children in 46 states and D.C. would be affected.

"States are struggling to figure out how they will make up for the shortfall," NYT's Haeyoun Park writes. "If they can’t find money from other sources, some states might freeze enrollment, while others may shut down their programs. Five of the states — Colorado, Connecticut, Texas, Utah and Virginia — have already said that they could terminate the program, which insures children whose parents earn too much for Medicaid but cannot afford other coverage."

OUCH: As babies born with microcephaly -- due to the spread of the Zika virus a year and a half ago -- become toddlers, a new report finds they are at an increased risk for cerebral palsy, seizures, vision problems and other conditions. The report, published yesterday by the Centers for Disease Control, followed 19 babies born with Zika-related microcephaly between Oct. 1, 2015 and Jan. 31, 2016, Stat News reported.

Here are some of the key findings:

  • 15 of the 19 children had not met developmental milestones characteristic of a healthy 6-month-old, including being able to sit up
  • 14 had motor impairment problems that seemed to be cerebral palsy
  • 11 children screened positive for symptoms indicating possible seizure disorder
  • 10 children had frequent difficulty sleeping
  • 9 had issues eating and swallowing
  • 4 children had retinal abnormalities and 11 children had impaired response to visual stimuli

Cynthia Moore, chief medical officer in CDC’s division of congenital and developmental disorders, told Stat News it was unlikely these children would be able to develop out of any of the problems. “Any babies that have this degree of microcephaly, we would not expect them to catch up,” Moore said. “We can’t make predictions about exactly what’s going to be their status as they go through childhood into adulthood. But we believe they’ll have lifelong challenges.”

HEALTH ON THE HILL

--House Speaker Paul Ryan (R-Wis.) said yesterday lawmakers need to “revisit” Obamacare next year, though he didn't specify whether it would be one of Republicans’ top agenda items -- an interesting question given the extra difficulties in getting a health-care bill through the Senate with the election of Alabama Democrat Doug Jones.

"Obamacare is collapsing and failing, so we won’t be able to ignore that problem," Ryan said during his weekly news conference. "So we’re going to have to revisit the problem of a health care marketplace that is collapsing and that is something that we’re just going to have to get on to."

Last week, Ryan listed changes to health-care entitlement programs such as Medicare as priorities for congressional Republicans next year, saying during an interview on Ross Kaminsky’s talk radio show that “it's the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that's really where the problem lies, fiscally speaking.”

But Ryan appeared to walk back his comments yesterday, saying that by "entitlement reform" he was instead referring to a broad swath of policy changes to improve the lives of Americans.

"Next year we want to take on criminal justice reform, we want to take on skills, getting people the skills they need to get the jobs they want, career and technical career education and welfare reform, so those are the kind of entitlement reforms that we’re talking about," Ryan said.

STATE SCAN

--A note to readers: If you live in a state relying on Healthcare.gov, today is the last day of open enrollment for 2018 marketplace plans.

This caught our eye yesterday: People are actually seeing more ads on TV about health insurance during this year's open enrollment season than they did during the same period last year. A new report from the Wesleyan Media Project found television commercials during the first 37 days of the Affordable Care Act sign-up season were up 51 percent over the same time in 2016 -- even though the Trump administration drastically cut the Obamacare advertising budget by 90 percent.

The advertising boost is likely coming from health insurance companies and other nongovernment advertisers. The ads don’t necessarily mention Healthcare.gov, and may advertise the insurers themselves, per the report. Erika Franklin Fowler, co-director of the Wesleyan Media Project told the Washington Examiner that increased ads during this year's halved enrollment period “make it more likely that consumers will encounter health insurance messaging on television, which may help to boost awareness and encourage enrollment generally, complimenting other efforts to spread the word.”

A few more good reads from The Post and beyond:

Progressive activists met with Senator Susan Collins, Republican of Maine, in a bid to persuade her to vote against the $1.5 trillion tax bill.
New York Times
Sources in the Senate tell CNN they have been worried about Sen. John McCain recently, following a week when the Arizona Republican was kept from the Senate to address side effects from his brain cancer treatment.
CNN
Republican leaders in the Senate are keeping a close eye on the health conditions of two senior members -- John McCain of Arizona and Thad Cochran of Mississippi -- ahead of a crucial vote on the GOP tax plan next week.
CNN
Social Issues
“As a new mom, I don’t want to recess my committee each time I need to pump.”
Michael Alison Chandler and Fenit Nirappil
MEDICAL MISSIVES
The latest national survey of adolescent drug use found declining use of most substances, including alcohol, tobacco, prescription opioids and stimulants.
New York Times
REPRODUCTIVE WARS
A top anti-abortion group warned Congress Thursday to not pass insurer payments to stabilize Obamacare unless they include anti-abortion protections.
Washington Examiner
DAYBOOK

Today

  • Bloomberg Government holds a webinar on the status of fiscal 2018 appropriations.
SUGAR RUSH

The Fact Checker's list of the biggest Pinocchios of 2017:

White House press secretary Sarah Huckabee Sanders said she is “not aware of what” types of regulations could prevent mass shootings:

Sen. Sheldon Whitehouse (D-R.I.) shares a clip of one of President Trump's judicial nominees struggling to answer a question from Sen. John Neely Kennedy (R-La.):

Tom Hanks on portraying former Washington Post Editor: ‘I was lucky' to meet Ben Bradlee: