Articles Posted in Health care law

MedicareJesimya David Scherer-Radcliffe, 21, passed away just a month after the loss of his health insurance forced him to begin rationing insulin to treat his diabetes. However, Scherer-Radcliff’s death is not the only of its kind, with insulin prices doubling from 2012 to 2016 causing many individuals to ration the drug.

Why have insulin prices grown exponentially over the past few years? There is no single reason, other than the privatization of America’s health care system which has allowed this practice to become standard. Many experts place the blame on large pharmaceutical companies and pharmacy benefit managers (PBMs) like CVS Health. PBMs regularly work with pharmaceutical companies in an effort to reduce the costs of various prescriptions through health insurance, but this reduced cost can result in higher out-of-pocket expenses for those without health insurance.

“Every time a PBM extracts a deeper discount, an insulin manufacturer has the incentive to take a price increase to quote ‘make themselves whole,’” stated Rena Conti, a health economist.

kickbacksIn 2009, the company Eli Lilly & Co. plead guilty to illegally marketing an antipsychotic drug, Zyprexa, for unapproved uses on patients, leading to a fine of $1.42 billion. This settlement ended a series of civil lawsuits, as well as a criminal investigation. At the time this large of a settlement was unheard of, but how did the company orchestrate such a massive kickback scheme?

The Kickback Scheme

Originally, Zyprexa was approved for a very narrow use of schizophrenia and bipolar disorder, however Eli Lilly & Co. soon began to market the drug for a variety of other purposes. In fact, it was alleged that Zyprexa was eventually marketed to treat dementia, and was even prescribed for illnesses related to pediatrics in high doses. The company was also accused of overcharging for the drug. This allowed the company to target a significantly wider audience, increasing their potential profits on the drug exponentially.

opioid-300x200DOJ Takes a Step That Could Help in The Opioid Crisis

This week the Justice Department made a big move that could be a game changer for the nation’s opioid crisis. According to, the DOJ will make a large swath of data on painkillers available, hoping the intel will be used in the fight against big pharma.

The DOJ has made its position clear when it comes to chasing after the legal makers and distributors of these drugs. Attorney General Jeff Sessions even went so far to create an Opioid Fraud Unit in order to target 12 federal districts the DOJ believes have been hardest hit by the opioid epidemic. The Opioid Fraud Unit uses data to find and target doctors or clinics they suspect are overprescribing opioids. They also want to go after pharmacists who are not properly distributing the pills. But with the release of this new data, they are hoping to help with settlement talks between the drug companies and the local governments suing them over the nation’s opioid epidemic.

After the Congressional Budget Office released its assessment of the American Health Care Act predicting an increase of 24 million Americans without health insurance by 2026, there was an interesting response from Senate Republicans. They suggested certain changes to the bill which, they said, would increase the chances of it being approved by the Senate. First, they want to see lower insurance costs for the poorer, older Americans and second an increase in funding for states with higher populations of hard to insure people.

The Governors of most all of the states, including Republican Governors voiced their anxiety about dealing with the bill’s proposed roll back on Medicaid expansion which would leave the poor with fewer dollars.

Because the bill is being pushed towards votes so quickly, what is obviously missing is a reasoned, articulated  and fulsome analyses of the various components of the law, explained in plain english and supported through real data as well as anecdotal examples. The reason this type of communication is so important is that Congress,  healthcare and insurance communities and the public at large must come to know this law. This means that thoughtful modeling and clear explanations are key. It has not happened.