POLICY BRIEFINGS


Portman, Carper Unveil Report on Cost of Overdose Reversal Treatment


The Senate’s Permanent Subcommittee on Investigations has released a new report examining the price increase of naloxone auto-injector EVZIO by drug company Kaléo. According to the report, Kaléo raised the price of EVZIO by more than 600 percent, from $575 in 2014 to $4,100 in 2017. The price increase has cost the Medicare and Medicaid programs more than $142 million over the past four years. The report, which was led by Subcommittee Chairman Rob Portman (R-Ohio) and Ranking Member Tom Carper (D-Del.), states that Kaléo exploited the opioid crisis in its decision to raise the price of EVZIO, and that the company encouraged physicians to attest that the treatment was medically necessary, thus ensuring that it would be covered by Medicare and Medicaid despite the existence of cheaper alternatives. Kaléo has stated that EVZIO was provided to patients free of charge if their insurance did not cover the drug, and that it has never turned a profit on EVZIO.


Senators Question Role of Insurers in Cost of Insulin


Sens. Susan Collins (R-Maine) and Jeanne Shaheen (D-N.H.) have written to United Healthcare, Anthem, and Aetna raising questions about rebates and how insulin prices are set. According to the letter, insulin prices have risen 240 percent over the last decade. Collins and Shaheen pose seven questions to each of the companies regarding the insulin supply chain and the role insurance plans play in promoting affordable access to diabetes treatment. The lawmakers request a response by Dec. 14.


Additional Race Called for 2018 Midterm Elections


Salt Lake County Mayor Ben McAdams (D) defeated incumbent Rep. Mia Love (R) by fewer than 700 votes in the race for Utah’s 4th Congressional District.


GAO Releases Report on MCO Encounter Data Reliability


The Government Accountability Office (GAO) has released a new report making recommendations to the Centers for Medicare and Medicaid Services (CMS) to ensure regulatory compliance by states with regard to Medicaid managed care organization (MCO) encounter data reliability. The report is a consequence of questions raised by members of the House Energy and Commerce Committee. While the GAO found that all eight states sampled in the report checked MCO-submitted encounter data for reasonableness, the agency asserts that CMS has not provided adequate information on the circumstances under which federal match funds would be deferred or disallowed as a result of data submissions that do not comply with CMS standards. The GAO also found that CMS has only provided limited information on how states should comply with newer regulatory requirements that entail independent audits and annual assessments of state encounter data. The agency recommends that CMS outline the required scope and methodology of audits and annual encounter data assessments.



November 26, 2018: | Page 1 Page 2 Page 3

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