From The Well…

September 28, 2018




AP analysis shows brand-name prescription drug prices business as usual. ABC News reports, “President Donald Trump made reducing drug prices a key promise during his election campaign, repeatedly accusing drugmakers of ‘getting away with murder.’ At the end of May, he promised that drug companies would be announcing ‘massive’ voluntary drug price cuts within two weeks.


“That hasn’t happened, and an Associated Press analysis of brand-name prescription drug prices shows it’s been business as usual  for drugmakers, with far more price hikes than cuts. The number of increases slowed somewhat and were not quite as steep as in past years, the AP found.”


Addiction centers see increase in meth patients. WCHS reports, “With methamphetamine use on the rise in West Virginia, addiction treatment centers are now seeing an increase of those seeking help to stop using meth.”


Federal legalization biggest marijuana investor obstacle. CNBC reports, “But buyer beware: The biggest obstacle these [cannabis] companies, and you as an investor, face is overcoming a high federal legalization hurdle.”


West Virginia physician wrote 130 opioid prescriptions per day. NBC News reports, “From December 2002 to January 2010, more than 335,130 prescriptions for painkillers were issued under the name of Dr. Katherine Hoover at the West Virginia clinic where she worked —a rate of about 130 per day, assuming she worked seven days a week.”


Gilead ‘disrupting the system’ with generic hepatitis drugs. The Motley Fool reports, “The U.S. drug pricing system is a mess. It’s an absolute disaster…

“The government has plans to try and fix it, but now Gilead Sciences (NASDAQ:GILD) … is taking matters into its own hands, disrupting the system with a pair of authorized generics of its hepatitis C drugs, Epclusa and Harvoni, which will be launched through a new subsidiary, Asegua Therapeutics.”

…Hopes to increase share of Medicaid population. Biocentury reports, “Gilead Sciences Inc. hopes a plan to launch authorized generics of two HCV drugs will lower out-of-pocket costs for patients and increase its share in the Medicaid population.”


‘PBMs play an important role in constraining the costs of prescription drugs.’ Forbes reports, “President Trump has insisted that ‘eliminating the middlemen,’ that is, the PBMs, would push drug prices lower. However, that notion is a facile non-solution: In a convoluted market in which consumers have little incentive to economize, PBMs play an important role in constraining the costs of prescription drugs, and there is no valid reason to believe that abolishing them would reduce prices.”


…Consultants don’t steer companies to best deals. Axios reports, “Employers hire consultants to help them manage their prescription drug costs. But industry sources say those consultants don’t steer companies toward the best deals.”

Tobacco companies likely to get into marijuana business. Rolling Stone reports, “According to cannabis industry experts, it’s very likely that the country’s largest tobacco companies will get into the marijuana business, in some way, when it is possible. The question becomes how much control these corporate giants will have over the industry, what they will do to marijuana products and how these changes will occur.”



GQ (!) profiles Manchin as ‘the last of a dying breed.’ GQ reports, “He’s a lonely Democrat in deep red West Virginia. Senator Joe Manchin is also the last of a dying breed. A moderate. A nice guy! Now, in these not-so-nice times, he’s fighting for his life. And somehow both control of Congress and the future of his party hang in the balance.”


Republican chairwoman says Morrisey ‘with Donald Trump every bit of the way.’ WAJR reports, “With President Donald Trump scheduled to visit West Virginia on Saturday, the West Virginia Republican Party chairwoman is feeling confident about the chances of the U.S. Senate candidate Trump will be touting, state Attorney General Patrick Morrisey.


“’He’s been with Donald Trump every bit of the way on deregulating some industries like the coal industry, and I think that is huge because we put coal miners back to work,’ Melody Potter said. ‘He’s a Second Amendment person, he’s pro-life, and I think people know that Patrick Morrisey does his job.’”



Davis alleges gender bias. The Star Tribune reports, “An impeached former West Virginia Supreme Court justice has filed a federal lawsuit accusing elected officials of gender bias and other violations.

“Former Justice Robin Davis’ 40-page lawsuit … said she would not have been impeached ‘had she not been a woman.’ It seeks to halt her upcoming impeachment trial in the state Senate.”



Courts rule Hepatitis C treatments can’t be withheld. Governing reports, “A series of recent court rulings and settlements … have found that states cannot withhold  potentially life-saving but expensive medications from Medicaid beneficiaries and prison inmates who have chronic hepatitis C.”


…Thought bubble. Here’s our 2014 reporting. Jim Becker, MD, medical director for the Bureau for Medical Services, the state Medicaid office, told members of the Legislative Oversight Commission on Health and Human Resources Accountability … Medicaid is paying for a Hepatitis C drug that costs $1,042 per capsule. The average course of treatment costs between $85,000 and $170,000…


The high-cost drug has been receiving a lot of publicity as Medicaid programs and private insurance companies across the country wrestle with its cost. In West Virginia, which has the second highest rate of Hepatitis C infections in the nation, 41 Medicaid clients have received approval for treatment with the drug; 206 have requested it.


Hepatitis C can lead to liver cancer and death. To be approved for the therapy in West Virginia, Becker said patients must have severe fibrosis and be compliant in other areas, such as alcohol use.


…Generic coming out. We reported this week: Gilead to launch generic Hepatitis C drug. Physician’s Weekly reports, “Gilead Sciences Inc said … it plans to launch generic versions of its hepatitis C drugs in the United States, at a time when regulators are looking to lower healthcare costs.”



Tobacco companies use openness to sell new heating products. Spiegel reports, “…Heating products don’t burn tobacco but release nicotine by raising the temperature to around 300 degrees Celsius (572 degrees Fahrenheit). According to the cigarette companies, this prevents the combustion of carcinogens, which are found in normal cigarette smoke. [Philip Morris President Andre] Calantzopoulos conveniently made the jump from conventional cigarettes to the product, which he himself is helping bring to market and that Philip Morris has marketed under the brand Iqos. It is a minimalistic-looking, battery-powered device, similar in form to an e-cigarette, but containing a lithium-ionic battery, a temperature regulator and a hot plate made of gold, platinum and ceramic.


“As a part of its offensive, Big Tobacco needs public health officials in its corner. It needs politicians to confirm that the new products are less dangerous than cigarettes. It needs them as allies, not enemies. Hey, tobacco companies say, we can help smokers who want to quit but can’t — and in return, please help us with Iqos.


“For this to work, the tobacco companies have started a campaign of radical sincerity. They no longer deny smoking is bad for your health. Instead, they warn against the dangers of cigarettes — most of all because they finally have products to offer as an alternative.”


Walmart uses database technology to track lettuce, spinach. The New York Times reports, “Walmart says it now has a better system for pinpointing which batches of leafy green vegetables might be contaminated. After a twoyear pilot project, the retailer announced on Monday that it would be using a blockchain, the type of database technology behind Bitcoin, to keep track of every bag of spinach and head of lettuce.”


National opioid bill passes. Axios reports, “Republican and Democratic lawmakers from the House and Senate released their final opioids package …

The big picture: This is a big bill and there are provisions in here that public health experts believe will make a difference.

·    “But those same experts say Washington still needs to make substantial investments — of money as well as policymaking energy — in the treatment system for mental health and substance abuse, in order to bring this crisis under control…

“The details: The bill … would…

·    “Temporarily lift a cap on Medicaid payments for large treatment facilities. States can allow those facilities to receive Medicaid funding, on a limited basis, for all substance abuse treatment.

·    “Allow more health care providers to prescribe medication-assisted therapies.”

…Addiction experts say investment meager and scattershot. The New York Times reports, “But addiction experts say that while many of the measures will help incrementally, the investment remains meager and scattershot compared with what is needed, and with what the government spent to stem the tide of AIDS-related deaths in the 1990s.”


…Thought bubble:

We reported Sept. 17: The state is expanding its medically assisted treatment program [Department of Health and Human Resources Secretary Bill] Crouch said plans are in the work to involve local health departments in offering MAT. (DHHR officials later clarified participation will be voluntary.) Sen. Mark Drennan encouraged the secretary to closely monitor the program, noting the treatment drugs often create another level of addiction.


We reported in August: DHHR has filed an agency-approved rule with the secretary of state dealing with office-based medication-assisted treatment (69CSR12). The major rule revision comes about because of the passage by the legislature and approval by the governor of SB 273, the governor’s primary bill to address the state’s opioid crisis. Filed with the rule are 64 pages of comments...

The rule filed for public comment removed requirements from 25 sections of the 56-page rule.


The rule will be considered by the Legislative Rule-Making Review Committee prior to the 2019 session. Expect lots of negotiation, right up to the passage of the rule by the legislature sometime in March 2019.


Hepatitis risk depends on several factors. West Virginia Public Broadcasting reports, “The infectious liver disease hepatitis A has hit Appalachia hard during the past several months. But your risk of contracting the disease depends on several factors.”


Association of American Physicians and Surgeons opposes Aetna, CVS merger. HEALTHCARE FINANCE reports, “The [conservative] Association of American Physicians and Surgeons has added its voice to that of the American Medical Association in opposing the proposed merger between CVS Health and Aetna.”


Syphilis among pregnant women on rise. HuffPost reports, “The number of pregnancies affected by the sexually transmitted infection syphilis is at a 20-year high in the U.S., according to a new report from the U.S. Centers for Disease Control and Prevention. That indicates a serious breakdown in prenatal care delivery to the most vulnerable women in the U.S.”


Third monkeypox diagnosis in England. CNN reports, “A third person has been diagnosed with monkeypox in England, Public Health England have confirmed.”


Gaming, Lottery, Hospitality

Sports gaming at casinos in Charleston, Wheeling areas delayed Launches of sports betting at Wheeling Island and Mardi Gras casinos, tentatively expected by the end of this month, have been delayed, Lottery spokesman Randy Burnside said Thursday.


“Delaware North has pushed back their timeline for opening the sportsbooks at both Wheeling and Mardi Gras,” Burnside said. “The Lottery is waiting to hear back from them to schedule testing at some point in October.”


Gaming industry officials have expressed concern that the Justice administration might attempt to amend legislative rules governing sports betting — which have to be filed with the secretary of state before Oct. 7 — to mandate that the state’s casinos share sports betting profits with professional sports leagues.


Cavacini says lottery changes came from ‘philosophical differences.’ Legal Sports Report reports, “More at liberty to speculate than some, [West Virginia Gaming and Racing President John] Cavacini says the [lottery] staff changes stemmed from ‘philosophical differences between the lottery staff and the governor’s office.’ Those differences center around whether or not league-friendly provisions, including financial provisions, should be part of the WV sports betting framework.”