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Pledges To Reduce Health Care Costs, Spending Growth Could Violate Antitrust Laws, Lawyers Say
U.S. antitrust laws could affect health care industry groups" efforts to work together to rein in health care costs, the New York Times reports (Pear, New York Times, 5/27). In a letter sent to President Obama on May 10, a coalition of groups -- the American Medical Association, the American Hospital Association, Pharmaceutical Research and Manufacturers of America, the Advanced Medical Technology Association, America"s Health Insurance Plans and the Service Employees International Union -- pledged to reduce the annual health care spending growth rate by 1.5%. The groups did not elaborate on what specific measures they would use to achieve such reductions, but the Obama administration has requested specific plans from the groups by June 1 (Kaiser Daily Health Policy Report, 5/26). According to the Times, many of the plans being considered by the health care industry would require greater cooperation across health care providers. Robert Leibenluft, a former Federal Trade Commission official, said, "Any agreement among competitors with regard to prices or price increases -- even if they set a maximum -- would raise legal concerns." In addition, while Obama is asking for specific plans from the health care industry, the administration has not offered any relief from antitrust laws, the Times reports. Furthermore, during his campaign Obama pledged to increase enforcement of antitrust laws, according to the Times.Antitrust laws have had a negative effect on previous health reform efforts, the Times reports. In 1993, the drug industry established a voluntary cost control plan that limited each drug company"s annual increase in the average price of prescription drugs to the increase in the Consumer Price Index, but the Department of Justice ruled that the proposal would violate antitrust laws. DOJ officials said that the U.S. Supreme Court made it clear that setting price maximums was akin to setting price minimums, which is illegal. In a letter to the Senate Finance Committee, AHA wrote that uncertainty regarding the enforcement of antitrust laws "makes it difficult for a hospital and doctors to collaborate to improve care" and reduce costs. AMA has asked Congress to amend antitrust laws to allow physicians to collectively negotiate with insurers over fees and other concerns, but FTC repeatedly has designated the practice illegal price-fixing, according to the Times. FTC officials said that consumers could benefit from cooperation among health care industry groups but that cooperation also could lead to increased bargaining power for physicians and hospitals, making it easier for them to set prices and eliminate competition (New York Times, 5/27). Reform Developments

Sen. Graham Announces Support For Sotomayor As Republicans Continue To Weigh Votes
Sen. Lindsey Graham (R-S.C.) on Wednesday said he intends to vote for Supreme Court nominee Sonia Sotomayor, making him the fifth Republican senator to endorse the nominee, USA Today reports. Meanwhile, Senate Minority Whip Jon Kyl (R-Ariz.) became the 10th Republican to say that he will vote against her confirmation. During Sotomayor"s confirmation hearings last week, both Graham and Kyl "grilled her extensively," USA Today reports (Kiely/Brettschneider, USA Today, 7/23). According to Politico, Republicans privately estimate that Sotomayor could receive upward of 70 votes (Kady, Politico, 7/23). The Senate Judiciary Committee is scheduled to vote on the nomination Tuesday, followed by a full Senate vote late next week or the first week of August (Stanton, Roll Call, 7/22).According to CQ Today, Graham"s support could encourage other conservatives to back Sotomayor (Perine, CQ Today, 7/22). Graham said that Sotomayor "is definitely more liberal" than any Supreme Court nominee a Republican president would have chosen but that she also is "one of the most qualified" nominees in decades. He added, "I do believe that elections have consequences, and it"s not like we hid from the American people during the campaign that the Supreme Court nomination was at stake. The American people spoke" (USA Today, 7/23). Graham also said that he believes that Sotomayor "follows precedent" and "would not be an activist judge" (CQ Today, 7/22). He continued, "On balance, I do believe that the court will not dramatically change in terms of ideology with her selection," adding, "On some issues, quite frankly, (she) may be more balanced in her approach" (Hirschfeld Davis, AP/Boston Globe, 7/22).Kyl said, "Unfortunately, I have not been persuaded that Judge Sotomayor is absolutely committed to setting aside her biases and impartially deciding cases based upon the rule of law," adding, "And I cannot ignore her unwillingness to answer senators" questions straightforwardly" (Politico, 7/23).Broadcast Coverage NPR"s "All Things Considered" on Wednesday reported on Graham"s support of Sotomayor (Shapiro, "All Things Considered," NPR, 7/22).
News of the day
Eliminating Cell Receptor Prevents Infections In Animal Study
New research from The Children"s Hospital of Philadelphia sheds light on the role of cell receptors in acting as gatekeepers for infectious viruses. By using mice genetically engineered to lack a particular receptor in heart and pancreas cells, the study team prevented infection by a common virus that causes potentially serious diseases in humans.
Mental Health

Recession Forcing People With Asthma To Skip Vital Medicines

New research1 conducted by Asthma UK suggests that people with asthma are struggling to afford the medicines they need to stay well and out of hospital, and that this situation has been made even worse since the recession began. Asthma UK"s poll of people with asthma reveals that more than a third (37%) of people with asthma are finding it harder to afford their prescriptions since the start of the recession, while a separate study2 by Dr Ellen Schafheutle of Manchester University has found that people with asthma are making dangerous decisions to stretch or skip doses of their inhaled medicines because they can"t afford to pay for them, with the majority saying they would not raise issues of cost and affordability with their GP. Inhaled steroids are an essential medicine that most people with asthma need to use in order to keep their asthma under good control. Across the whole of the UK, there are more than 73,000 emergency admissions to hospital for asthma every year, three quarters of which could be avoided if people"s asthma was better controlled, potentially saving the economy around ÷£46 million. Asthma UK"s research also reveals that a third of people with asthma in England have never heard of prescription Pre-Payment Certificates (PPCs), which can save a considerable amount of money. Official figures published in January 2009 for the first six months of the Scottish Government"s policy of reducing prescription charges (ahead of their abolition in 2011) showed a rise in the number of PPCs being purchased and a 25.9% rise in the amount of drugs dispensed using them, which suggests that those with long-term conditions may now be buying medicines they avoided taking before. Eddie, 35, from London has brittle asthma, which means it can deteriorate very quickly. He says: "My Pre-Payment Certificate has just run out but I"m holding off on renewing it because I just can"t afford the cost alongside my rent and other bills like gas, which seem to be going up and up. Because I don"t have the money for a new certificate, I"m taking less of my preventer medicine than I should be but sadly I don"t really feel I have any other choice." Victoria, 22, is from Leeds and suffers from severe asthma. She says: "Last summer I was in and out of hospital and spent about ÷£200 on medicines as no-one had told me that I could save money by buying a Pre-Payment Certificate. It"s incredibly frustrating that despite being in a recession, these money and stress-relieving aids are not being well-promoted". A coalition of 19 charities including Asthma UK launched the "Prescription Promise" campaign (prescriptionpromise.org) on 1 April 2009, which is calling on the Government to honour the promise it made last year to abolish prescription charges for people with long-term conditions, and to do so before the next General Election. A review of how to implement this promise was due to report over the summer, but this has been delayed until the Autumn. Neil Churchill, Chief Executive of Asthma UK, says: "We know that people with asthma who don"t take their preventer medicines as prescribed are more likely to end up in hospital and that three quarters of hospital admissions for asthma could be avoided through better asthma management. Reducing hospital admissions across the UK could help the NHS save around ÷£46 million every year, which makes a compelling argument for implementing free prescriptions in England as soon as possible." Dr Mike Thomas, GP and Chief Medical Adviser to Asthma UK, says: "I know of numerous cases where people have stretched or stopped using their preventer medicines to try to reduce prescription charge costs. This is often because they notice the immediate effects of relievers more than the potent long-term effects of their preventers. "It seems illogical that people with some long-term conditions, like thyroid disease, receive free prescriptions, while those with conditions like asthma do not. Unfortunately, there isn"t much that GPs can do other than increase the number of inhalers on a prescription, which can encourage waste and is discouraged by primary care trusts." 1 Asthma UK National Asthma Panel 2009 2 Research by Ellen Schafheutle at Manchester University, which has been published on the Primary Care Respiratory Journal website ahead of press: see here. Notes - The asthma nurses who work on our Adviceline receive many calls about prescription charging, particularly from people who can"t afford the charges and feel it"s unfair that people in other parts of the country get their prescriptions for free or at a reduced cost (research from the Citizen"s Advice Bureau suggests that around 800,000 people in England every year do not get all the medicines they need because they cannot afford them). - Many people with asthma and other long-term conditions are unaware about the saving they could make with Pre-Payment Certificates as they are poorly publicised. These let you pay a certain amount up front or by regular Direct Debit to limit your prescription costs for that quarter or that year. If someone with a long-term condition opts to purchase a Pre-Payment Certificate, the cost of all of their prescriptions for 12 months would be ÷£104. However, if someone doesn"t have a PPC and needs to pay for extra courses of steroids, antibiotics or other medicines (eg treatment for rhinitis such as nasal spray) on top of their regular medicines, they could end up paying several hundred pounds over the course of a year. - Official figures published in January 2009 for the first six months of the Scottish Government policy of reducing prescription charges (ahead of their abolition in 2011) showed a 25.9% rise in the amount of drugs dispensed using cut-price, Pre-Payment Certificates. The policy has so far not led to the feared upsurge in over-the-counter drugs being provided on the NHS. Health Secretary Nicola Sturgeon said she believes this shows people with chronic illnesses previously unable to afford medication before are now getting the treatment required. "More people are using pre-payment certificates and by definition they are going to be people who need more than the odd prescription, ie people who have long-term conditions. It is just the first six months, but I am incredibly encouraged by what we see. One of our big health themes is self-management, allowing people with long-term conditions to look after themselves. That is obviously going to be harder if people cannot afford their medicines as regularly as they need them." - The cost of a Pre-Payment Certificate for four months" medicine in Scotland fell from ÷£35.85 to ÷£17 in April 2008. The price of a 12-month PPC was cut from ÷£98.70 to ÷£48. In the following six months, the volume of drugs purchased using these certificates rose from 1.82 million to 2.29 million. - Exempting people with long-term conditions from prescription charges would directly improve drug compliance and health outcomes among those who are struggling to afford their medicines. We would also expect the NHS to be able to treat long-term conditions more cost effectively as a result of prescription charge exemption, given the evidence that under-treatment of long-term conditions due to cost issues results in increased use of health services. People who struggle to afford prescription charges adopt a number of coping strategies, including not going to see their GP (to avoid the prescription), not getting the prescription dispensed, or prioritising amongst different items. Asthma UK


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