NCHC Joins Over 60 Health Care Stakeholders in a Letter Urging Congress to Repeal the SGR During the Lame Duck Session

WASHINGTON D.C.–This afternoon, the National Coalition on Health Care (NCHC) joined over 60 other leading health care stakeholders in a letter to Congressional leaders calling for the passage of legislation to repeal the Sustainable Growth Rate (SGR) formula, reform payment for physicians and other health professionals, and address crucial healthcare “extenders” during the lame duck session of Congress.

“Repeated temporary SGR patches have only put off the need for permanent reform and prolonged the threat of staggering reimbursement cuts that would threaten Medicare beneficiaries’ access to care,” said NCHC President and CEO John Rother. “Businesses, consumers, and health care providers agree that now is the time for Congress to act.”

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SNHPA Joins Campaign for Sustainable Rx Pricing

Safety Net Hospitals for Pharmaceutical Access (SNHPA) has joined the Campaign for Sustainable Rx Pricing (CSRxP), a broad-based coalition concerned about the skyrocketing cost of prescription medicines.

“SNHPA will bring a much needed perspective and make a valuable contribution to the effort to find sensible solutions to irrational prescription drug prices, especially those for new specialty drugs,” says John Rother, president and CEO of the National Coalition on Health Care (NCHC), which heads up CSRxP. “We need to move to an approach where drug pricing is based on value to the health care system. New medicines offer extraordinary promise, but we are concerned that the system that has brought us these advances will become unsustainable if we can’t find a way to bring greater rationality to prices.”

SNHPA represents more than 1,000 hospitals that participate in the federal 340B drug discount program. The 340B program requires drug manufacturers to sell pharmaceuticals at a discount to public and private non-profit hospitals that serve high volumes of low-income patients. These hospitals provide over $28 billion in uncompensated care every year. The savings they realize from 340B drug discounts enable them to expand and improve care for their vulnerable patient populations.

“Hospitals and clinics in the 340B program must care for all patients whether they can pay or not,” says SNHPA President and Chief Executive Officer Ted Slafsky. “Today, on average, 340B hospitals are either squeaking by on historically slim operating margins – around 2 percent – or they are in the red. Major drug manufacturers’ profit margins average more than 20 percent.”

Mr. Slafsky noted the significant growth in the specialty drug market. “While many of these medications offer great promise, the price tag for health care providers and patients is simply unsustainable. Even at a discount, our hospitals and patients are struggling to afford medications that can cost hundreds of thousands of dollars. We look forward to working with the Campaign for Sustainable Rx Pricing to address these challenges.”

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Gilead Rejects Reasonable Approach with $94,500 New Hepatitis C Drug

“By charging $94,500 for Harvoni, Gilead has made clear that it values Wall Street above the interests of patients, taxpayers, employers, and working families who must shoulder the burden of high health care costs. The company’s refusal to take a more reasonable and moderate approach to pricing cements its status as the poster child for everything that is wrong with pharmaceutical industry pricing.

Gilead’s escalator pricing could undermine the system of health care finance that has supported the biomedical innovation that we all want to continue. Unreasonable pricing not based on value threatens the sustainability of our entire health care system.”

Read John Rother’s blog post.

Read John Rother’s letter to lawmakers urging them to consider value transparency for pharmaceuticals.

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After Bipartisan Push, President Signs Into Law a First Step Toward Post-Acute Care Reform

“Credit is due to the House Ways and Means and Senate Finance Committees for piloting this bill through today’s treacherous health care politics. Let’s hope yesterday’s signing of the IMPACT Act of 2014 is only the first, not the last, health policy win to emerge from bipartisan, bicameral efforts this year.

This new law will enable physicians, hospitals, and post-acute providers to better track and improve care for beneficiaries after a hospital stay by requiring providers to submit patient assessment data in a standardized format, and by developing systems of measurement for clinical quality, outcomes and resource use that can be applied across all post-acute settings. With this information, payers, providers, consumers, and family caregivers can work together to identify the best care setting for each individual. And policymakers can begin the challenging work of bringing broader reform to Medicare’s post-acute care systems.

We hope Congress will soon repeat this bipartisan, bicameral success in the areas of SGR reform, transparency, and care coordination. If they don’t, we will continue to see unchecked health costs erode the prosperity of American families and businesses.”

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NCHC’s Inaugural Report Card Finds that 113th Congress Fails to Make the Grade on Health Care Costs

WASHINGTON D.C.–Today, the National Coalition on Health Care (NCHC) released “Health Costs and the American Family: A Report Card on the 113th Congress,” finding that despite strong bipartisan efforts, this Congress has yet to make the grade in curbing health care costs.

The seven-page report card grades actions taken by the 113 Congress in three areas of health policy where common-ground, bipartisan solutions were possible: modernizing physician payment and SGR repeal, price and quality transparency, and strengthening Medicare. The report card concludes that Congress has so far failed to make meaningful progress toward greater health care affordability.

“Families have seen a decade’s worth of income gains wiped out by rising health care costs. Our elected officials have to stop arguing and instead work on taking smart, bipartisan action on issues like physician payment reform, transparency, and Medicare,” said John Rother, NCHC’s President and CEO.

NCHC’s report card goes on to document the financial burdens imposed by unchecked health care costs, finding that, in 2013, the total cost of waste and inefficiency in the US care system amounted to $3,211 per person or $12,844 for a family of four.

“Workers and businesses alike are struggling to keep up with the cost of providing coverage to their families and employees, respectively. Providers, payers, and patients are engaged in new ways to keep the cost of care within reach, but they simply cannot do it alone. In payment reform, transparency, and Medicare, a few Congressional champions have put compromise ahead of partisanship to make progress toward a higher-performing health system. It’s time Congress as a whole does the same,” said Chris Dawe, a Senior Advisor to NCHC and former health policy advisor in the Obama White House.

The report card also urges Congress  to take action on these issues in the approaching lame duck session, while announcing NCHC’s plans to work with health care provider, payer, and consumer groups on an aggressive agenda for the next Congress. The document concludes by stating that health care stakeholders will soon be on Capitol Hill “demanding results, not more rhetoric.”

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As Drug Costs Begin to Surge Again, Hatch-Waxman Offers Lessons on the Path Ahead

“Hatch-Waxman is one of the true success stories in health policy, saving trillions for consumers and taxpayers over the past thirty years. But with spiraling drug costs looming in the specialty pharmaceutical sector, it’s time we drew some lessons from that achievement.

Thirty years ago, Senator Orrin Hatch and Representative Henry Waxman refused to heed naysayers who claimed that you couldn’t have both affordability and innovation. Policymakers and stakeholders of very diverse interests and perspectives dialogued, debated, and ultimately settled on an approach that balanced the need to reward innovation with the need to maintain system-wide affordability. The results were trillions of dollars in savings from generic competition and three decades of continued breakthroughs in brand-name drugs.

As a new generation of exciting but expensive drugs emerges, we must acknowledge, as Hatch and Waxman did in the 1980s, that innovation has to come at a price our health system can afford.”

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Campaign for Sustainable Rx Pricing Gains New Members

Concerned with high prescription drug prices that limit access to life-saving medicines for millions of HIV/AIDS and hepatitis C patients, the Fair Pricing Coalition (FPC), the National Alliance of State and Territorial AIDS Directors (NASTAD), and Project Inform today joined the Campaign for Sustainable Rx Pricing, a project of the National Coalition on Health Care (NCHC).

“We are delighted to become a member of the Campaign for Sustainable Rx Pricing as part of our ongoing fight against alarming prescription drug pricing and our advocacy for more and better drug company access programs for HIV and hepatitis C virus (HCV) drugs” said FPC spokesperson Lynda Dee. “Stakeholders need to work together to combat unsustainable prescription drug costs. Gilead’s recent pricing of its new HCV drug Sovaldi at $1000 per pill is a prime example of drug pricing run riot and is the cause of untold access issues for people with both government and commercial insurance coverage. The time is now for us to come together to turn the tide of unreasonable drug pricing.”

“NASTAD is joining the Campaign for Sustainable Rx Pricing as part of our ongoing efforts to ensure that everyone needing access to life-saving medications can get them, particularly those in public payer programs or without insurance” said NASTAD Executive Director Julie Scofield. “We believe this can be accomplished through stakeholder partnerships, and in fact, we have seen successes where this has occurred.  But the alarming trend of ever-increasing prices and greater access restrictions threatens these successes. We must reverse this tide in order to continue to see progress in ending the HIV and HCV epidemics.”

“Project Inform is pleased to join the Campaign for Sustainable Rx Pricing given our commitment to ensuring that people with HIV and HCV can access affordable medications,” said Project Inform Executive Director Dana Van Gorder. “Working in coalition with other organizations is key to addressing the current drug pricing and drug access crisis in the United States. We have the tools to end the HIV and HCV epidemics in the United States. Ensuring that people living with HIV and HCV have access to the medications they need is critical to achieving that mission.”

“Sovaldi is just the first in a coming wave of exorbitantly priced specialty drugs that could bankrupt our health care system,” said NCHC President and CEO and John Rother. “Our system cannot afford prices that threaten to bust state health care budgets, divert funds away from critical health care needs, and force consumers to have to decide between paying for their medicines or their mortgage. We welcome the Fair Pricing Coalition, NASTAD, and Project Inform in our effort to ensure that pharmaceutical innovation achieves maximum impact though affordability and accessibility.”

The issue of unsustainable drug pricing, especially that for “specialty drugs,” is escalating. Seventy percent of new FDA drug approvals in 2013 were specialty drugs, and one estimate notes that by 2020, spending on specialty drugs will quadruple from $87 billion to more than $400 billion. This continued growth in spending is putting significant upward pressure on premiums in the private marketplace as well as in public programs including Medicare and Medicaid.

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Without Changes, Proposed Labeling Rule Would Drive Up Costs for Consumers, Taxpayers

“Unless the FDA changes course, consumers and taxpayers will soon shoulder an additional $4 billion a year in drug costs. Worse, the FDA’s plan to allow different labels on brand name drugs and their generic competitors could confuse patients and their doctors—threatening patient safety.

Representative Steve Israel and Representative Tim Bishop should be commended for speaking out in their recent letter to the FDA. They join a growing chorus from stakeholders and elected officials of both parties who support a different approach. It’s time that the FDA heeded them.”

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John Rother Sends Open Letter to Gilead CEO Listing Steps to Address Unsustainable Drug Pricing

Yesterday’s blockbuster earnings announcement from Gilead underscores how much room the drug manufacturer has to lower the price of its Hepatitis C drug Sovaldi. In fact, nearly all of Gilead’s profits came from its U.S. sales of Sovaldi.

The $3.48 billion that Gilead earned from sales of Sovaldi in the second quarter is only going to increase demands from across the health care system that Gilead lower the price of this $1,000 pill.

With pressure mounting, National Coalition on Health Care’s President John Rother sent an open letter to Gilead CEO John C. Martin laying out three steps that the company can immediately take. The letter comes after a meeting in June where Gilead representatives asked for suggestions for actions the drug maker could take to address concerns in the health care community about sustainable drug pricing. In his letter, Rother wrote:

“To that end our coalition has three requests that would help demonstrate your commitment to responsible pricing:

1.       Substantially lower the pricing of Sovaldi. Based on yesterday’s record-breaking earnings, two points became abundantly clear. First, you will easily recoup the investment you made in purchasing and testing Sovaldi. Second, your company has plenty of financial wherewithal to lower the price. Substantially lowering the price would be an important good faith gesture to the health care system that you understand your responsibility in ensuring everyone can access and afford this treatment.

2.       Pledge not to increase the price for subsequent versions. We understand you plan to introduce new versions that could be used without some of the other drugs that now accompany Sovaldi. Further increasing your price here would be unconscionable and demonstrate contempt for the concerns expressed across the health care stakeholder community.

3.       Commit to greater pricing transparency and advance notice about pricing decisions. Disclose the calculations that you believe justify pricing. Also commit to advance warning of launch prices and price increases to help the system better plan for expensive new therapies.”

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Earnings Report Shows Gilead Can Lower Sovaldi’s Unsustainable Price

Earnings Report Shows Gilead Can Lower Sovaldi’s Unsustainable Price

Statement from the National Coalition on Health Care’s President and CEO John Rother on the latest quarterly earnings report from Gilead Sciences, Inc., manufacturer of the hepatitis C drug Sovaldi:

“It’s clear Gilead has plenty of room to reduce the $1000 per pill price in order to ensure patients have access to this critical treatment. It’s this sort of pricing for drugs needed by millions of Americans that is putting unsustainable pressure on patients and the health care system as a whole.”

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