(DES MOINES) - Today, Gov. Terry E. Branstad announced an extension of the time period in which Medicaid providers are able to receive full reimbursement.  This measure allows all Medicaid providers, whether in-network or out-of-network for the partner insurance plans, to receive 100 percent reimbursement for services provided until April 1, 2016.

The Iowa Medicaid Modernization plan always included a safe harbor reimbursement floor of 100 percent current Medicaid rates for any provider who contracts with a partner insurance plan. The extension announced today is intended to give patients peace of mind that they can continue seeing their providers. The measure also gives providers additional time within the safe harbor to contract with a partner plan.

This announcement comes on the heels of news that three major hospital systems have signed up with a managed care organization last week. Extending the safe harbor for provider reimbursement coupled with the hospital systems signing demonstrates Iowa will have a robust provider network for Medicaid patients on Jan. 1, 2016.

This safe harbor extension builds upon an already thoughtful transition to deliver improved health outcomes for Iowans on Medicaid.  Phased-in details were announced back in November and can be found here.

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Q: Why are you working to increase imports of pharmaceuticals from Canada into the United States?

 

A: Americans ought to have the ability to benefit from free markets, including when they fill their prescription medicines. It makes no sense that a woman in Ottumwa, Iowa, would pay double or triple the amount for the same medication that her sister might pay in Ottawa, Ontario, as an example.  I don't blame Americans who are fed up with subsidizing for the rest of the world the research and development costs that it takes to bring life-saving miracle medicine to market. This is a free trade issue. Imports create competition and keep the domestic industry more responsive to consumers. A healthy dose of competition results in better services, better prices and better choices for consumers. From airlines to restaurants and gas stations, consumers will spend their travel, entertainment and fuel dollars where they can stretch them for the best value.  The same goes for insurance premiums and prescription medicines.  At the same time, policymakers must protect the ingenuity of the free market system that rewards innovation and the discovery of breakthrough medicine. It's a tricky balance to enact patent and trade laws that foster innovation and keep medicines affordable and accessible to Americans. One thing is for certain. Americans are paying more than their fair share for the high cost of pharmaceutical research and development.

Q: Are Americans allowed to import drugs from Canada?

 

A: Congress passed a law in 2003 that allows the Food and Drug Administration (FDA) to permit pharmacists and wholesalers to import prescription medicines from Canada. The FDA also may issue a waiver to individuals. But first, the Department of Health and Human Services (HHS) must certify that importation would not pose risks to public health and safety. Moreover, HHS must certify that importation also would lower prices for the same prescription medicine sold in the United States.  Let's remember that American consumers have grown accustomed to the idea that "you get what you pay for." That couldn't be more important in a policy debate about importing prescription medicine. When cancer or diabetic patients pay for their life-saving treatments and medicines, they deserve to know they are getting the safest, highest quality product. That's why importation of prescription drugs needs to come from a trading partner with a regulatory regime comparable to the U.S. regime, for example.  Taxpayers and consumers are coughing up more and more out-of-pocket to pay for prescription medicine. Policymakers have an obligation to figure out the best way to keep prescription prices affordable without crippling innovation. That's why I've urged HHS to use its full authority under the law to allow for pharmaceutical drug imports if certain circumstances are met, including significant and inexplicable price hikes and that the imported drug is produced by the name brand manufacturer that originally developed the drug or by a reputable generic manufacturer that commonly does business in the United States.

Q: What other measures are you working on to address instability, affordability and accessibility for prescription medicine?

 

A: In November, I released the results of an 18-month, bipartisan investigation that took a deep dive into the pricing and marketing strategy of a name brand drug prescribed to treat Hepatitis C. The price tag for a 12-week treatment cost $84,000 or $1,000 per pill. Taxpayers have a tremendous stake in this debate as federal programs pay for a significant share of prescription drug coverage for the elderly, individuals with disabilities and veterans. That's why I'm also working to crack down on anti-competitive arrangements, known as "pay for delay" deals that abuse litigation to keep affordable generics off the pharmacy store shelves. My bipartisan Preserve Access to Affordable Generics Act would help make sure consumers have access to the cost-saving generic drugs.

University of Iowa Hospitals and Clinics, UnityPoint Health and Genesis Health System all reach agreements with a managed care organization

(DES MOINES) - Today, Gov. Terry E. Branstad and Lt. Gov. Kim Reynolds announced three major hospital systems, University of Iowa Hospitals and Clinics, UnityPoint Health and Genesis Health System have all come to agreements with a managed care organization (MCO's).  Iowa's Medicaid Modernization plan will improve quality, access, and health care outcomes and create a more predictable and sustainable Medicaid program that begins Jan. 1, 2016.

"I'm very pleased with today's announcement that three major hospital systems have signed contracts to serve Iowa Medicaid patients and partner with Medicaid plans," said Branstad.  "These hospitals have signaled they are ready to provide quality care to Medicaid patients all over Iowa on Jan. 1, 2016.  We appreciate the commitment these hospitals are showing to Medicaid patients and their willingness to put politics aside and put sound policy and patients first."

Lt. Gov. Reynolds added, "We have learned a great deal from 30 other states who have taken steps to modernize how they serve Medicaid patients.  Our phased-in approach ensures a smooth transition on day one for all Medicaid patients.  The news today of three major hospital systems signing contracts is a clear signal we will be ready to serve our patients on Jan. 1, 2016."

University of Iowa Hospitals and Clinics, UnityPoint Health and Genesis Health System represent over 3,300 Medicaid providers.  The over 3,300 Medicaid providers represent 28 different types of providers including doctors, nurses and specialists.

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Time is running out to nominate a Great Nurse

In its 12th year, the 100 Great Iowa Nurses program hopes to reach every corner of the state

There is still time to recognize outstanding Iowa nurses who have gone above and beyond. The 100 Great Iowa Nurses program is pleased to accept nominations through December 31 at www.greatnurses.org. Over the past 11 years the program has recognized 1,100 Great Iowa Nurses. Each year, the program celebrates 100 nurses across the state whose courage, competence, and commitment to patients and the nursing profession stand out above all others.

Patients, coworkers, friends and family members have nominated exceptional nurses from 93 of Iowa's 99 counties. 100 Great Iowa Nurses Fundraising Chair Liz Swanson says, "We couldn't be more pleased with the abundance of nominations we've seen in the last decade; our hope is to recognize the great work that nurses do in every county in Iowa."

100 Great Iowa Nurses hopes to continue to see statewide support for nurses, as well as an increase in nominations from the counties that have not yet been recognized: Fremont, Howard, Monona, Page, Van Buren, and Worth.

Nurses selected for this honor represent many sectors of health care, working as nurses in hospitals, long-term care facilities, schools, and offices. They come from all practice areas, including acute care, sub-acute care, school nursing, parish nursing, nurse leadership, and academics.

The 100 honorees are recognized each year in Des Moines at the annual 100 Great Iowa Nurses Celebration. This is a meaningful event for the honorees as well as their nominators.

"I was flabbergasted when I received notification that I was chosen. It was a great honor that I will never forget. I am a nurse leader now, and have been for years, but it really made me think that those patients you have touched will never forget the care you provided them," says 2014 100 Great Iowa Nurse honoree Patti Peterson, MHA, BSN, RN, CEN, Director of Emergency Services, PICC Team, Infusion Center, for Mercy Family Health Line.

After undergoing a two-part review process, 100 Great Iowa Nurses are honored each year at a ceremony created for the state of Iowa by nurse and community leaders. On May 1, 2016, 100 Great Iowa Nurses will gather to be honored at the Iowa Events Center in Des Moines. The celebration is an annual prelude to National Nurses Week, which begins on May 6 and ends on May 12 (the birthday of Florence Nightingale).

This statewide initiative is made possible through generous donations from our sponsors and supporters. In addition to recognizing 100 Great Iowa Nurses every year, the program also offers financial awards to nursing students. Current and future nurses across Iowa are encouraged to apply for financial award opportunities to complete or further their nursing education. Applications can be found at www.greatnurses.org/financialawards.

CONTACT: Cassie Raasch or Leah Grout Garris, Communications and Marketing, 100 Great Iowa Nurses, (319) 335-7003, info@greatnurses.org

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Floor Speech of Sen. Chuck Grassley on Obamacare and Reconciliation

Delivered Tuesday, Dec. 1, 2015

 

Several years ago, I gave a speech about Obamacare.  As we begin debate, I harken back to that speech.  Obamacare wasn't working then; it's not working now.  Webster's Dictionary defines the word "success" as the correct or desired result of an attempt. I want to discuss the definition of the word "success" as we consider repeal of Obamacare.

On the day the bill was signed into law, President Obama said the following:  QUOTE:  Today we are affirming that essential truth, a truth every generation is called to rediscover for itself, that we are not a nation that scales back its aspirations.  END OF QUOTE

Such grand words for where we are today.  Five years later, the success of the law that now bears his name, Obamacare, is defined in much more meager terms.

Think of all that we have been through to this point.  The fight over the bill and the extreme legislative means used to pass it through Congress.  The Supreme Court decision that effectively repealed half of the law's coverage.  Think of all the changes made to the law through regulation to make sure Obamacare launched. The postponing of the employer mandate.  The postponing of lifetime limits.  Think of the impact this law has had on our economy. People losing jobs.  People losing the health insurance they currently have, because if you like what you have you may NOT be able to keep it.

And let's talk about that for a moment. If you like what you have, you can keep it.  This was the promise the President made to the American people on at least thirty-six separate occasions.  It's a great soundbite.  It's easy to say; it rolls off the tongue.  It's also not true.  It was never true.  It was obviously not true when the law was written.  It was obviously not true when the first proposed regulation came out.  This is what I said on the Senate floor in September of 2010:

QUOTE: Only in the District of Columbia could you get away with telling the people if you like what you have you can keep it, and then pass regulations six months later that do just the opposite and figure that people are going to ignore it. END OF QUOTE

It's not that I have some magic crystal ball.  We all knew it.  The Administration certainly knew that the day would come when millions of people would receive cancellation notices.

Now, my constituents clearly know it. I heard from many Iowans who found out the hard way that the President made a bunch of pie-in-the-sky promises that he knew he couldn't keep.  Constituents like this one from Perry, Iowa, who wrote to me saying:

QUOTE: My husband and I are farmers. For nine years now we have bought our own policy. To keep the cost affordable our plan is a major medical plan with a very high deductible. We recently received our letter that our plan was going away.

Effective Jan 1, 2014, it will be updated to comply with the mandates of Obamacare.

To manage the risk of much higher premiums, our insurance company is asking us to cancel our current policy and sign on at a higher rate effective Dec 1, 2013 or we could go to the government exchange.

We did not get to keep our current policy. We did not get to keep our lower rates. I now have to pay for coverage that I do not want or will never use. We are not low income that might qualify for assistance.

We are the small business owner that is trying to live the American dream. I do not believe in large government that wants to run my life. END OF QUOTE

And from a constituent living in Mason City:

QUOTE: My wife and I are both 60 years old, and have been covered by an excellent Wellmark Blue Cross Blue Shield policy for several years.

It is not through my employer. We selected the plan because it had the features we wanted and needed...our choice. And because we are healthy, we have a preferred premium rate.

Yesterday, we got a call from our agent explaining that since our plan is not grandfathered, it will need to be replaced at the end of 2014.

The current plan has a $5,000 deductible and the premium is $511 per month. The best option going forward for us from Wellmark would cost $955 per month (a modest 87% increase), and have at $10,000 deductible!

And because we have been diligent and responsible in saving for our upcoming retirement, we do not qualify for any taxpayer-funded subsidies.  END OF QUOTE.

These are just two of the many letters, emails, and phone calls I've received from Iowans.

Several years ago, it was about losing the coverage you have.  And now the issue has turned to cost.  Millions of Americans face rising premiums.  The impact is real and undeniable.  Here's another from a constituent from Des Moines.

QUOTE: In 2013, I encountered some medical problems which caused me to retire early.

My spouse works as an adjunct instructor ... thus not qualifying for medical coverage.

In 2014, with 4 part-time jobs between us, we made $44,289 in Adjusted Gross Income.

Our Obamacare insurance cost $968 per month and after credits, we paid $478 per mo. or approximately 13% of our Adjusted Gross Income.

In 2015, our Adjusted Gross Income will be approximately the same, however our Obamacare insurance jumped to a premium of $1,028.82 and our cost to $590.12.

The insurance company touted that premiums went up less than 10%, but as you can see, my cost went up 23%!

The impact to Adjusted Gross Income went to 16%, a 23% increase.

I just received my 2016 premium estimate.

Our Adjusted Gross Income is likely to be the same.

Our gross premium is scheduled to rise 36% to nearly $1,400; our cost after the credit is jumping 63% and the impact to our Adjusted Gross Income is that 25% of our income will be spent on Health Insurance (a 56% increase!).  END OF QUOTE

Thousands of Iowans have contacted me asking what can be done, now that we clearly see that what the President sold the American people was a bag of Washington's best gift-wrapped hot air.   All the grandiose talk about the importance of this statute.  And what we ultimately have is an optional Medicaid expansion with a glorified high risk pool and a government portal that makes the DMV look efficient.

Finally, I would be remiss if I didn't mention the co-op disaster.  The first co-op to fail was Iowa's CoOportunity.   CoOportunity enrolled the second most beneficiaries of any co-op in America.  CoOportunity knew they were in trouble because they enrolled more than 100,000 people when they were planning for less than 20,000.  CoOportunity was in contact with CMS and so was the State of Iowa. CMS chose not to further fund CoOportunity and CoOportunity has since been liquidated.

American taxpayers have billions of dollars invested in these co-ops. The taxpayer only gets their money back when co-ops succeed.  CMS stewardship of this program has proven that CoOportunity was not an exception, but unfortunately the rule as more and more co-ops have failed.

Americans deserve better. They voted for better.  It is time to admit that Obamacare has not achieved the correct or desired result of an attempt.  It has not been a success by any measure.

Unless of course you lower your standard to the point that the mere act of keeping the doors open is a success. That simply has not changed.

How sad is that for all we have been through.  Maybe, just maybe, it is time to admit that massive restructuring has failed.  Partisanship has failed.  Perhaps it is time to sit down and consider common sense, bipartisan steps that we could take to lower cost and improve quality.

Perhaps we could enact alternative reforms aimed at solving America's biggest health-care problems.  Reforms like revising the tax code to help individuals who buy their own health insurance; allowing people to purchase health coverage across state lines and form risk pools in the individual market; expanding tax-free Health Savings Accounts; making health-care price and quality information more transparent; cracking down on frivolous medical-malpractice lawsuits; using high-risk pools to insure folks with preexisting conditions; giving states more freedom to improve Medicaid; and using provider competition and consumer choice to bring down costs in Medicare, and throughout the health care delivery system.

The American people need to know that this failed program is not the only answer and we are not scaling back our aspirations.  And with this vote this week, we once again demonstrate to the American people our willingness to not accept failure and aim for better.

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WASHINGTON - Sen. Chuck Grassley of Iowa is the lead Republican on a bipartisan investigative report released today that gives rare insight into how a company prices a landmark prescription drug.  In this case, the company anticipated it would face public outcry over a high price for a Hepatitis C drug but went forward anyway.

"This report sheds light on one example of the pricing decisions made by one company with a new prescription medicine that entered the market without competition in high demand," Grassley said.  "This might be an example that received the most attention in some time, but it won't be the last.  I look forward to discussions with my colleagues and the public on the policy questions in the report.  I encourage everyone to read the report for the level of detail into pricing strategy that we don't often see."

Grassley and Sen. Ron Wyden released the results of their 18 month investigation into the pricing and marketing of Gilead Sciences' Hepatitis C drug Sovaldi and its successor, Harvoni.  The investigation draws on internal documents from the company.  These include a chart linking  price points with levels of potential public outcry and an email from a company executive saying the company should "not fold to advocacy pressure" and should "hold our position whatever competitors do or whatever the headlines" on the price.

The drug went on the market for $1,000 per pill, or $84,000 for a single course of treatment, creating significant expense for Medicare, Medicaid and private insurance companies.  Iowa and many other states faced significant pressure on their Medicaid programs over the costs, struggling with wanting to give patients access to a landmark treatment and how much taxpayers can afford.

This is the second time in recent weeks that Grassley has weighed in significantly on high prescription drug costs.  Last month, he and Sen. John McCain pressed the secretary of the Department of Health and Human Services to use her full authority to allow the importation of prescription drugs from Canada.

The Sovaldi report, along with more information on the investigation, is available here.  Video of the senators' news conference unveiling the report is available here.

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Be part of something meaningful by giving blood

PEORIA, Ill. (Dec. 1, 2015) - The American Red Cross encourages eligible donors to end the year with real meaning by donating blood for hospital patients in need.

Holiday activities, severe weather and seasonal illnesses, like the flu, can pull people away from their regular blood donation schedules. This creates a greater need for blood donations this time of year, especially around the winter holidays. To encourage donations, all those who come to donate Dec. 23, 2015, through Jan. 3, 2016, will get a long-sleeve Red Cross T-shirt, while supplies last.

Jamie Czesak made her first blood donation on Dec. 27, 2013. "As I spent Christmas with my family, I realized how lucky I was to have my health and how we never really know when our last Christmas will be. I decided that I would face my fears and do one of the few things I can do to help save someone's life donate blood."

Healthy donors with all blood types are needed, especially those with types AB, O, B negative and A negative. To make an appointment to donate blood, download the free Red Cross Blood Donor App from app stores, visit redcrossblood.org or call 1-800-RED CROSS (1-800-733-2767). Donors can now use the Blood Donor App to access their donor card and view vital signs from previous donations.

Upcoming blood donation opportunities:

Carroll County, Illinois

Savanna

12/28/2015: 10 a.m. - 2 p.m., Savanna Fire Department, 101 Main St.

Henry County, Illinois

Kewanee

12/17/2015: 7 a.m. - 12 p.m., Kewanee OSF Saint Luke Medical Center, 1051 W. South St.

12/17/2015: 12 p.m. - 5 p.m., Kewanee OSF Saint Luke Medical Center, 1051 W. South St.

Whiteside County, Illinois

Fulton

12/22/2015: 8 a.m. - 1 p.m., Robert Fulton Community Center, 912 4th St.

Rock Falls

12/16/2015: 2 p.m. - 6 p.m., Rock Falls Blood Donation Center, 112 W. Second St.

12/23/2015: 10 a.m. - 2 p.m., Rock Falls Blood Donation Center, 112 W. Second St.

12/30/2015: 2 p.m. - 6 p.m., Rock Falls Blood Donation Center, 112 W. Second St.

Sterling

12/22/2015: 10 a.m. - 3 p.m., Duis Center, 211 E. 23rd St.

How to donate blood

Simply download the American Red Cross Blood Donor App, visit redcrossblood.org or call 1-800-RED CROSS (1-800-733-2767) to make an appointment or for more information. All blood types are needed to ensure a reliable supply for patients. A blood donor card or driver's license or two other forms of identification are required at check-in. Individuals who are 17 years of age (16 with parental consent in some states), weigh at least 110 pounds and are in generally good health may be eligible to donate blood. High school students and other donors 18 years of age and younger also have to meet certain height and weight requirements.

Blood donors can now save time at their next donation by using RapidPass to complete their pre-donation reading and health history questionnaire online, on the day of their donation, prior to arriving at the blood drive. To get started, visit redcrossblood.org/RapidPass and follow the instructions on the site.

About the American Red Cross

The American Red Cross shelters, feeds and provides emotional support to victims of disasters; supplies about 40 percent of the nation's blood; teaches skills that save lives; provides international humanitarian aid; and supports military members and their families. The Red Cross is a not-for-profit organization that depends on volunteers and the generosity of the American public to perform its mission. For more information, please visit redcross.org or visit us on Twitter at @RedCross.

 

WYDEN-GRASSLEY SOVALDI INVESTIGATION FINDS REVENUE-DRIVEN PRICING STRATEGY BEHIND $84,000 HEPATITIS DRUG

18-Month Investigation Reveals a Pricing and Marketing Strategy Designed to Maximize Revenue with Little Concern for Access or Affordability

 

Report Includes Landmark Release of Medicaid Data: In 2014, More than $1 Billion Spent by Medicaid Programs on Sovaldi Treated Less than 2.4 Percent of Enrolled Patients with Hepatitis C

 

Medicare Spent More on Gilead Hepatitis C Drugs in the First Half of 2015 than in All of 2014

WASHINGTON - Senate Finance Committee Ranking Member Ron Wyden, D-Ore., and senior committee member Chuck Grassley, R-Iowa, today released the results of an 18-month investigation into the pricing and marketing of Gilead Sciences' Hepatitis C drug Sovaldi and its second-wave successor, Harvoni. Drawing from 20,000 pages of internal company documents, dozens of interviews with health care experts, and a trove of data from Medicaid programs in 50 states and the District of Columbia, the investigation found that the company pursued a marketing strategy and final wholesale price of Sovaldi - $1,000 per pill, or $84,000 for a single course of treatment - that it believed would maximize revenue. Building on that price, Harvoni was later introduced at $94,500. Fostering broad, affordable access was not a key consideration in the process of setting the wholesale prices.

In the 18 months following Sovaldi's approval, Medicare spent nearly $8.2 billion before rebates on Sovaldi and Harvoni. Over that same span, Medicare's monthly spending on Hepatitis C treatments increased more than six-fold. In 2014 alone, Medicare and Medicaid combined to spend more than $5 billion on Sovaldi and Harvoni before rebates. That total is projected to climb in 2015. Gilead's recent financial statements show U.S. sales of Sovaldi and Harvoni, including through public programs and private payers, totaled $20.6 billion after rebates in the 21 months following Sovaldi's introduction.

Senators Wyden and Grassley will hold a press conference today at 11:15 a.m. in the Senate Radio/TV Gallery, S-325, to discuss the investigation. Details are below, including a streaming feed for media unable to attend in person. Further resources are also online and additional findings from the investigation are below.

 

"Gilead pursued a calculated scheme for pricing and marketing its Hepatitis C drug based on one primary goal, maximizing revenue, regardless of the human consequences. There was no concrete evidence in emails, meeting minutes or presentations that basic financial matters such as R&D costs or the multi-billion dollar acquisition of Pharmasset, the drug's first developer, factored into how Gilead set the price. Gilead knew these prices would put treatment out of the reach of millions and cause extraordinary problems for Medicare and Medicaid, but still the company went ahead. If Gilead's approach to pricing is the future of how blockbuster drugs are launched, it will cost billions and billions of dollars to treat just a fraction of patients," Senator Wyden said. "America needs cures for cancer, Alzheimer's, diabetes and HIV. If those cures are unaffordable and out of reach to millions who need them, Congress will not have met its responsibilities to the American people. I reject the idea that America has to choose between soaring, out-of-reach drug prices and one-size-fits-all government policies. Solving this challenge will take fresh, bipartisan thinking and political independence to bring people together."

"The Finance Committee has tremendous responsibility in overseeing the federal programs paying for prescription drug coverage," Senator Grassley said.  "With that responsibility, the committee should know how the costs to the public programs and private insurance companies of a single innovative drug entering the market without competition can have major effects on which patients get the new drug and when.  This report sheds light on one example of the pricing decisions made by one company with a new prescription medicine that entered the market without competition in high demand.  This might be an example that received the most attention in some time, but it won't be the last.  I look forward to discussions with my colleagues and the public on the policy questions in the report.  I encourage everyone to read the report for the level of detail into pricing strategy that we don't often see."

Additional major findings from the investigation include :

  • Gilead justified Sovaldi's high price point based on price-per-cure: Documents acquired during the course of investigation illustrate that Gilead was aware it was in a position to create clear savings for payers, but chose to pursue a "regimen neutral" price justified by "cost-per-cure" calculations that resulted in greater revenue per treatment than previous direct acting anti-virals [see page 42]. Given the increased clinical efficacy of Sovaldi, Gilead believed that it was more than justified in using the cost-per-cure pricing model [37, 46].
  • Gilead set a high price for Sovaldi with an eye toward ensuring a future high price for Harvoni: The documentation reviewed shows that Gilead considered a number of factors in determining a price point for Sovaldi, including costs for the existing standard of care for Hepatitis C treatment and setting a high baseline for the next wave of drugs, such as Harvoni [32-58]. In documents obtained during the course of investigation, Gilead officials noted the "value capture opportunity is in Wave 1," and "Wave 2 access will be enhanced with a high Wave 1 price." It went on to say that "[a]t any price, access for Wave 2 improves as the price for Wave 1 is increased, suggesting that Wave 1 will set a price benchmark against which Wave 2 will ultimately be evaluated." By elevating the price for the new standard of care set by Sovaldi, Gilead intended to raise the price floor for all future Hepatitis C treatments, including its follow-on drugs and those of its competitors [44].
  • Gilead underestimated the degree of access restrictions that it expected would result from its pricing decision: Gilead set a price as high as it thought the market would bear before significant access restrictions would be imposed [30]. Gilead's analyses were ultimately incorrect on this point as many payers adopted substantial access restrictions at the final price of $84,000 [81-88, 96-98].
  • Despite significant access restrictions, Gilead refused to significantly lower the net price: When confronted with the widespread initiation of access restrictions [99-106], Gilead refused to offer substantial discounts and did not significantly modify its contracting strategy to improve patient access. For example, Gilead offered Medicaid programs supplemental rebates of up to 10 percent; however, its offer came with the precondition that states had to drop some or all of their access restrictions [106]. For states already facing a steep financial burden, accepting that precondition in most cases would have increased the budgetary impact rather than easing it [107]. Only five state Medicaid programs reached agreements with Gilead to receive supplemental rebates in 2014 [138].
  • The burdens on Medicare, Medicaid, and the Bureau of Prisons were significant: The price of Sovaldi constituted a large burden?notably among state Medicaid programs, Medicare, and the BOP?and triggered access restrictions across public and private payers, thus limiting the number of Hepatitis C-infected patients who could access the new treatment options [81-88, 96-98]. For example, state Medicaid programs nationwide spent $1.3 billion before rebates on the drug in 2014. Even with that expenditure, less than 2.4 percent of the roughly 700,000 Medicaid enrollees with Hepatitis C were treated with Sovaldi [82-87]
  • Competition entered the market, prices responded, but there are still significant concerns: Three days following Viekira Pak's approval on December 19, 2014, Express Scripts Holding Co., the nation's largest pharmacy benefit manager, announced that it would make Viekira Pak its preferred treatment for Hepatitis C genotype 1 and would no longer cover Sovaldi and Harvoni for these patients [112]. Gilead responded in January and February 2015 by entering into discounting agreements for Harvoni and Sovaldi with CVS, Anthem, Humana, Aetna, and UnitedHealth Group. Cigna struck agreements with Gilead for Harvoni only [113]. Even as competition lowered prices for therapies, this report documents that concerns remain, particularly in the public payer community, about high costs for treating millions of people in the U.S. infected with Hepatitis C, as well as the budgetary effects of a future single source innovator that might not face competition as quickly [114-122].

The report in full is available here.

An executive summary is available here.

A timeline of events pertaining to Gilead, Sovaldi and Harvoni is available here.

A glossary of terms pertaining to the investigation is available here.

Letters from state Medicaid programs are available here.

DAVENPORT, IA - DECEMBER  2015 - Gilda's Club and UnityPoint Trinity are partnering to present a special dinner for head and neck cancer patients on Monday, December 7th at 5:30 pm.

According to the American Cancer Society, head and neck cancer accounts for about 3% of all cancers in the United States. Head and neck cancer patients, anyone experience treatment related eating difficulties and their family members are invited to this free dinner, prepared by Chef Kevin Vargas.

Dinner included. For more details and to register, please call Gilda's Club at 563-326-7504 or email kelly@gildasclubqc.org.

About Gilda's Club

Free of charge, Gilda's Club Quad Cities provides support, education and hope to all people affected by cancer.  As a Cancer Support Community affiliate, we are part of the largest employer of psychosocial oncology mental health professionals in the United States.  Our global network brings the highest quality cancer support to the millions of people touched by cancer.

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Wednesday, Nov. 25, 2015

CONTACT: Governor's Office 515-281-5211

 

(DES MOINES)  - Tonight, Gov. Terry Branstad's Communications Director, Ben Hammes, issued a statement on the ALJ's decision on Medicaid Modernization that was released late this afternoon.

"The ALJ's decision this evening allows Medicaid Modernization to move forward.  Tonight's decision emphasizes that the process was both "thorough and methodical."  We continue to evaluate the next steps in the administrative review of the procurement process and remain on schedule to implement our plan on January 1, 2016."

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