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Wednesday, Oct 14 2020

Full Issue

CMS May Be Overpaying For Certain Molecular Tests

Read about the biggest pharmaceutical developments and pricing stories from the past week in KHN's Prescription Drug Watch roundup.

A Medicare administrative contractor has sent a cease-and-desist letter to a well-known diagnostic reimbursement expert containing lab test pricing and coding information that reveals instances where CMS may be overpaying for certain molecular tests. Palmetto GBA sent the letter to Bruce Quinn, asking him to delete information from a public blog and his own files. Palmetto's lawyer asserts that the information was included in a document, known as a master edit file (MEF), that is the contractor's intellectual property. (Ray, 10/13)

Also 鈥

For a long time, drug makers have been the most hated industry in America. Companies are blamed for gouging prices on lifesaving drugs and enriching themselves through the opioid crisis, among other sins. Now, with pharmaceutical companies racing to find vaccines to end the coronavirus pandemic, the industry is hoping to redeem itself in the public鈥檚 mind. (Drucker, Gelles and Thomas, 10/13)

The cost of prescription drugs has taken center stage in congressional races all over Texas. In battles from Austin to San Antonio to Houston, candidates are insisting they are committed to tackling the high price of prescription drugs while they claim their opponents can鈥檛 be trusted on the issue. (Wallace, 10/12)

Last year, Pfizer posted a billboard outside its midtown Manhattan headquarters showing a larger-than-life patient smiling at his partner. 鈥淒edicated to the brave of heart,鈥 it read. The patient, Walter Feigenson, 72, of Portland, Ore., says he was paid roughly $1,000 for taking part in the launch of tafamidis鈥攕old by Pfizer (ticker: PFE) under the names Vyndaqel and Vyndamax鈥攁 $225,000-a-year treatment for a potentially fatal heart condition. The price, which makes tafamidis the most expensive cardiovascular drug ever launched in the U.S., is 鈥渦nconscionable鈥 and 鈥渃ompletely unjustified,鈥 Feigenson said in an interview with Barron鈥檚. (Lalse, 10/12)

The rising costs of prescription drugs and health care could be a potent campaign issue for older voters in Utah ahead of the November elections. And according to a new survey, Utahns age 45 and above expressed support for a number of progressive policies to boost pay and reduce the influence of money in politics. The survey from AARP Utah found 75% of Utahns either 鈥渟trongly鈥 or 鈥渟omewhat鈥 support raising the state鈥檚 minimum wage to $12/hour over a three-year period. Just 23% were opposed. (Schott, 10/10)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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