Record High Credit Card Interest Rates Deemed Most Expensive Ever by CFPB

Dr. Julie Kanter, director of the Adult Sickle Clinic at the University of Alabama at Birmingham, recognizes Michael Goodwin’s reluctance to pursue gene therapy for sickle cell, a sentiment shared by many patients. Despite the approval of these therapies in December, Kanter estimates that only 10% of those affected would opt for the treatment even if it were universally accessible. With over 100,000 Americans having sickle cell disease, of whom 50-60% are covered by Medicaid, challenges in expanding treatment capacity and establishing facilities across the country persist.

As state and federal officials navigate the high costs of these therapies for Medicaid-covered patients, a University of Washington analysis suggests a lower price, around $1 million, would enhance accessibility. The Biden administration is initiating negotiations with Vertex and Bluebird Bio for discounts on state Medicaid plans, integrating payments with patient health outcomes through the Cell and Gene Therapy Access Model.

Despite ongoing lawsuits from pharmaceutical giants against the Biden administration over Medicare price negotiations, Vertex expresses confidence in the negotiation process. Discussions aim to address inequities in sickle cell care and ensure wide access.

Private employer health plans also grapple with covering these high-priced treatments, potentially leading to exclusions from benefit packages. Morgan Health explores risk-sharing payment models to aid smaller businesses in managing rising treatment costs. For individuals like Goodwin, covered by his wife’s employer health insurance, the decision to pursue gene therapy hinges on its guarantee of a favorable outcome.

Amidst discussions over payments, Vertex and Bluebird Bio actively engage in educating doctors and patient communities about the advantages of their therapies. Vertex anticipates its first commercial patient starting treatment soon, while Bluebird Bio expects its first Lyfgenia patient in the first quarter.

Novel sickle cell gene therapies offer hope, yet affording their steep prices poses a formidable challenge.

The approval of two gene therapies for sickle cell disease has instilled hope among patients affected by this debilitating condition, predominantly impacting Black individuals and people of color. Despite this medical breakthrough, ensuring fair access to these expensive treatments poses a significant challenge for health officials.

Individuals like Michael Goodwin, who experiences unpredictable and painful episodes due to sickle cell disease, find their lives disrupted by the ailment. Leaving jobs and separating from family become common for those grappling with this genetic blood disorder. While gene therapies like Casgevy and Lyfgenia are heralded as revolutionary, the extensive medical preparations, including chemotherapy, and the high costs, $2.2 million for Casgevy and $3.1 million for Lyfgenia, create hesitancy among potential beneficiaries.

Goodwin, covered by insurance but burdened with existing medical bills, expresses concerns about pursuing these new treatments. The approval of gene therapies in December raised optimism, but challenges in ensuring equitable access and a lack of infrastructure for widespread administration raise questions about their overall impact.

Dr. Julie Kanter, director of the Adult Sickle Clinic at the University of Alabama at Birmingham, anticipates that even if access gates were opened to everyone immediately, only a small percentage of those affected by sickle cell would opt for such therapies. The struggle lies not only in increasing treatment capacity but also in establishing facilities nationwide for large-scale patient care.

With over 100,000 Americans estimated to have sickle cell disease, of whom 50% to 60% are covered by Medicaid, officials grapple with providing access to these costly treatments. The high prices prompt a reevaluation of payment models, with the Biden administration initiating negotiations for discounts on state Medicaid plans with the gene therapy manufacturers.

A University of Washington analysis suggests that a lower price, closer to $1 million, would enhance accessibility. The ongoing legal battles over Medicare price negotiations with pharmaceutical giants add complexity to these discussions. Despite these challenges, Vertex and Bluebird Bio express confidence in the negotiation process, emphasizing outcomes-based agreements to ensure broad access and address disparities in care.

Private employer health plans also face the dilemma of covering these high-priced treatments, potentially leading to exclusions from benefit packages. Innovative risk-sharing payment models are being explored to help businesses manage the escalating costs of these specialty treatments.

As discussions continue on payment structures, Vertex and Bluebird Bio are actively engaging in education initiatives aimed at informing medical professionals and patient communities about the advantages of their respective gene therapies. The hope is to not only overcome financial barriers but also to encourage broader adoption of these groundbreaking treatments.

Federal Judge Upholds Medicare Drug Price Negotiations Amidst Legal Challenges

A federal judge has made a significant ruling in favor of the Biden administration’s efforts to lower drug prices within the Medicare program, preserving a controversial initiative that aims to provide affordable medications for elderly Americans.

In a decision that carries substantial implications for the pharmaceutical industry, Judge Michael Newman of the Southern District of Ohio rejected a preliminary injunction sought by the Chamber of Commerce, one of the nation’s largest lobbying groups. The Chamber of Commerce had sought to halt the implementation of Medicare drug price negotiations before the October 1st deadline, which marked the cutoff for manufacturers of the initial 10 selected drugs to participate in these negotiations.

The Chamber had filed a lawsuit against the Biden administration in June, contending that the drug negotiations violated both the First and Fifth Amendments of the U.S. Constitution, as well as the principle of separation of powers. However, Judge Newman’s 28-page order stated, “As to Plaintiffs’ motion for a preliminary injunction, they have demonstrated neither a strong likelihood of success nor irreparable harm. Consequently, their request for immediate preliminary injunctive relief… is denied.”

While Judge Newman denied the preliminary injunction, he also declined to dismiss the lawsuit entirely. Instead, he has given the Chamber until October 13th to amend its complaint, seeking clarification on specific aspects of the case. The Biden administration has been granted until October 27th to renew its motion to dismiss the case. The final decision on standing issues will be determined after a short 60-day discovery period and any renewed motions to dismiss.

This ruling represents a setback for the pharmaceutical industry, which has expressed concerns that the Medicare drug price negotiations could negatively impact revenue growth, profits, and drug innovation. President Joe Biden’s Inflation Reduction Act, passed in a party-line vote last year, granted Medicare the authority to directly negotiate drug prices with manufacturers, marking a historic shift in the federal program’s nearly six-decade history.

The Chamber of Commerce, along with pharmaceutical giants like Merck and Johnson & Johnson, initiated multiple lawsuits in recent months challenging the constitutionality of these negotiations. However, the Chamber’s lawsuit was the only one to seek a preliminary injunction.

The Chamber’s argument centers on the claim that the program infringes upon drugmakers’ due process rights under the Fifth Amendment, as it allows the government to essentially dictate drug prices without providing procedural safeguards to ensure fair pricing. The Chamber cites the precedent set in the 2001 case Michigan Bell Telephone Co. v. Engler.

During a hearing earlier this month, Jeffrey Bucholtz, an attorney for the Chamber, expressed concern about the potential for “unfair” pricing, asserting that drugmakers would have to accept the government’s set prices or face excise taxes of up to 1,900% of U.S. sales of the drug.

However, lawyers for the Department of Justice argued that participation in the program was not obligatory. Drug manufacturers have the option to withdraw their voluntary participation in the Medicare and Medicaid programs if they disagree with the terms, according to attorney Brian Netter.

The legal battles over Medicare drug price negotiations are not limited to this case, as other lawsuits are currently scattered in federal courts across the United States. Legal experts suggest that the pharmaceutical industry hopes to obtain conflicting rulings from federal appellate courts, potentially fast-tracking the issue to the Supreme Court.

Medicare, which covers approximately 66 million Americans, is expected to save an estimated $98.5 billion over a decade through the drug price negotiations, according to the Congressional Budget Office. In August, the Biden administration unveiled the initial 10 drugs subject to negotiation, initiating a lengthy process set to conclude in August 2024. However, the reduced prices for these medications will not take effect until January 2026. Among the drugs selected for negotiation are blood thinners from Bristol-Myers Squibb and J&J, diabetes drugs from Merck and AstraZeneca, and a blood cancer drug from AbbVie, one of the companies represented by the Chamber of Commerce.