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Medicare Cuts | Hollywood Heart Attacks
August 19, 2024
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Together with
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“With politics very much front and center right now, we do worry that another very large shoe is likely to drop on Feb. 1, or even sooner as both parties seem to view the pharmaceutical industry as an adversary to be defeated, rather than a force for good.”
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Piper Sandler analyst Christopher Raymond after The White House unveiled its negotiated Medicare drug prices.
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The White House finally unveiled its negotiated Medicare drug prices, bringing 38%-76% reductions to the first 10 drugs, while drawing mixed industry reactions.
- Medicare drug price negotiations are one of the highlighted results of 2022’s Inflation Reduction Act, allowing CMS to negotiate drug prices for the very first time.
- Between 2026 and 2029, CMS will select 60 targeted meds based on a range of factors (costs, usage, “single-source,” lack of generics, etc.) and negotiate their Medicare “maximum fair prices” for a one month supply.
Half of the 10 meds in the ‘Class of 2026’ treat cardiovascular conditions, and these heart drugs saw some of the largest reductions:
- Novartis’ HF drug Entresto (-53% to $295)
- BMS’ anticoagulant Eliquis (-56% to $231)
- Janssen’s anticoagulant Xarelto (-62% to $197)
- BI/Lilly’s HF and diabetes drug Jardiance (-66% to $197)
- AstraZeneca’s HF, diabetes, and CKD drug Farxiga (-68% to $179)
The other five drugs targeted diabetes (Januvia & Fiasp), rheumatoid arthritis (Enbrel), blood cancers (Imbruvica), and psoriasis, Crohn’s disease, and ulcerative colitis (Stelara).
If these first 10 reductions were in place in 2023, it would have cut $6B in prescription costs, which actually represents a much smaller 22% net reduction due to these drugs’ pre-existing Medicare discounts and rebates.
- Looking forward – the negotiations are estimated to cut $1.5B in patients’ out-of-pocket costs in 2026, and save the government over $200B through the first decade.
Although promoted as a win for patient and government spending, these negotiated cuts faced plenty of criticism…
- Some analysis suggests that they won’t meaningfully reduce government spending.
- Pharma lobbies unsurprisingly argued that they will reduce access, should’ve targeted insurers and PBMs, will drive up other costs elsewhere, and are unconstitutional.
- Wall Street noted that many of the drugs already have hefty rebates (so actual reductions are minimal), and some will soon stop having market exclusivity (so generics are coming anyway).
Still, others forecast that these negotiations will have a bigger long-term impact than initial numbers suggest.
The Takeaway
The U.S. spends over $400B annually on prescription meds, placing heavy burdens on patients and significant pressure on politicians. Although truly reigning in these costs will require more than negotiating Medicare list prices, it’s clear that the government is finally taking action on drug costs, and that’s a step in the right direction (unless you work in pharma).
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AI Algorithms in Cardiology: Navigating the Path from Research to Practice
Join Tempus on Tuesday, September 24 for an in-depth webinar exploring the transformative power of cardiology AI algorithms. Learn from leading experts, including Cedars Sinai’s Dr. David Ouyang and Tempus’ senior cardiology team Dr. Brandon Fornwalt and Dr. John Pfeifer, about how cardiology AI algorithms are unlocking new possibilities for diagnosis, treatment, and patient outcomes. Secure your spot now to be part of this pivotal discussion.
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Experience the Future of Learning: Medtronic Academy 2.0 is Here!
Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!
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An All-in-One Coronary Care Solution
See how HeartFlow ONE is transforming precision heart care as the first all-in-one CCTA pathway, combining FFRCT, stenosis, and plaque analysis in a single workflow.
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- It’s Not Like in the Movies: Heart attacks happen to people across all genders and races, with symptoms that are often subtle, but that’s not usually how they’re depicted in the movies. An AHA study analyzed 100 heart attack scenes from popular films, finding that MI events overwhelmingly happened to men and white people (90% & 94%). The vast majority of male and female heart attack symptoms involved falls (88% & 100%) and loss of consciousness (68% & 88%), both signs of severe AMI.
- Cardiac MRI Predicts Heart Failure: U.K. researchers used a specialized cardiac MRI technique to predict which patients out of a 39k-person population would develop heart failure. Researchers used CMR to estimate pulmonary capillary wedge pressure, finding that PCWP was associated with a nearly 3x higher risk of heart failure and almost 50% higher risk of MACE (HR=2.91 and 1.48). These findings echo other recent studies on the value of CWP for predicting heart failure.
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- Two-for-One Mobile CT Screening: West Virginia University researchers showed that mobile lung cancer screening programs could also be used to screen for CVD. WVU launched its mobile CT program in 2021, scanning rural patients for lung cancer, and then used those scans to assess CAC scores. Analysis of 526 patients revealed that 54% had coronary calcifications, including 14% with CAC scores ≥400. However, better follow up might be needed: only 6.2% of untreated patients with ≥1 CAC scores started taking statins.
- Jupiter’s Exit: Jupiter Endovascular exited stealth with $21M in fresh funding and a vision to develop an endovascular technology that combines the “precision and control of surgery” with “the safety and simplicity of catheter interventions.” At the center of this strategy is Jupiter’s Endoportal Control device, which the company is initially trialing for pulmonary embolism, and will later expand to other clinical applications.
- DES Best for ISR: In an analysis of several major in-stent restenosis studies, the three-year target lesion revascularization rate for an everolimus-eluting stent (5.2%, Abbott’s Xience) was well below rates for bioresorbable vascular scaffolds (14.1%, Abbott, now discontinued) and drug-coated balloons (12.9%, B. Braun’s SeQuent Please). In a landmark analysis (>1 year), the target lesion revascularization rate was three times higher after BVS than after DES and DCBs, and very late vessel thrombosis was more common (1.8% vs. 0 for DES and 0.4% for DCB).
- Stopping the Bleed After TAVR: A new trial suggests that routine protamine use after transfemoral TAVR can significantly improve hemostasis. The ACE-PROTAVI study found that protamine, a medication used to reverse the anticoagulant effects of heparin, boosted the rate of successful hemostasis (98% vs. 92% with placebo) and cut the average time to hemostasis (279 to 181 seconds). Patients also had fewer vascular complications (5% vs 13%), and no adverse events tied to protamine.
- Alabama Breach: Birmingham-based Alabama Cardiovascular Group experienced a nearly month-long data breach, exposing the personal information of its patients and employees. Hackers gained access to the six-location, 22-physician practice’s network on June 6th and weren’t detected until July 2nd, potentially exposing a range of personal data (names, diagnosis and care details, personal info including SSNs).
- A New Spin on Cardiac Troponins: SPINCHIP’s new high-sensitivity cardiac troponin I (hs-cTnI) was able to diagnose MI with high accuracy in a recent JACC study. The test ruled out MI in 51% of patients with 100% sensitivity, while ruling in MI in 27% of patients with 91% specificity. Importantly, it performed well across different sample types, and a comparison to other standard lab assays showed similar diagnostic accuracy (AUC=0.94)
- SPECT AI Alliance: Nuclear medicine scanner vendor Spectrum Dynamics and AI developer DeepDense Medical announced a partnership that will make DeepDense’s cardiac and spine AI solutions available in Spectrum Dynamic’s SPECT scanners. DeepDense AI will enable Spectrum Dynamics customers to perform automatic quantitative analysis while also improving image quality and reducing scan times.
- Outpatient Healthcare Savings: Shifting healthcare services from the hospital to outpatient settings could save up to $148B annually in the U.S. In a study in JAMA Network Open, researchers asked 1.1k clinicians which Medicare services they thought could be shifted out of the hospital without compromising clinical outcomes; they then calculated the amount saved due to lower costs in the outpatient setting. The shift would save $114B to $148B, or 3.2% to 4.1% of annual U.S. healthcare expenditures.
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The Behavioral Science Behind Optum’s Hemo System
When Optum set out to design its next-generation Cardiology Hemodynamics monitoring system, it put behavior science at the heart of its product strategy. See how Optum’s UX designers applied its behavioral science team’s findings to improve its Hemodynamics solution to help make physicians and technicians even more efficient and user-centric.
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AI-Driven Novice Heart Failure Screening
We hear a lot about AI’s potential to expand echocardiography to far more users and clinical settings, and a study using Us2.ai’s AI-automated echo analysis and reporting solution showed that echo AI might make novice-led heart failure screening possible.
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- How to Improve Cardiology Workflows and Get More Patient Time: Complex processes and reporting requirements can mean cardiologists spend more time with clinical systems than they do with their patients. See how Merge Hemo and Merge Cardio work together to help you streamline and scale your clinical and data management workflows, so you can have more time in front of your patients.
- Accurately Measuring Heart Rate Variability: Heart rate variability measurement and analysis involves two critical elements – the ability to accurately discern the R wave in noisy environments, and using the correct analysis method for a given application. Check out how Monebo’s Kinetic HRV ECG Algorithm excels at both of these essential tasks.
- Tracking Your Post-Treatment Plaque: Tune-in to this on-demand Cleerly webinar where preventative cardiologist John Osborne, MD, PhD, FACC, FNLA explores how to use CTA to track plaque progression and identify residual risk post-treatment.
- New Horizons in Structural Heart: TAVR and TMVR rates are rising rapidly, placing more pressure on interventional planning. Tune into this Circle CVI and Radcliffe Cardiology breakout detailing how to leverage modern CT workflows to produce efficient and accurate pre-procedural plans.
- The Post-Acute Stroke Game Changer: See how Viz Connect solution can optimize your post-acute stroke pathway. The Viz.ai solution allows the cardiology team to promptly receive Neurology referrals to evaluate patients with suspected AFib for cardiac monitoring and reduce their risk of secondary stroke.
- PIA’s Post-Processing Solution: Advanced cardiac imaging often calls for a time-consuming post-processing step, requiring costly software, hardware, and training. See how PIA provides this post-processing at lower cost, improved consistency, and greater efficiency.
- Nothing Is More Expensive Than a Missed Opportunity: The emergence of AI CAC detection and new CVD treatments could transform preventative CVD care. Check out this Johns Hopkins editorial in JACC detailing how solutions like Bunkerhill Health’s Incidental CAC algorithm can create opportunities for more effective preventative CVD care, but only if providers seize that opportunity.
- Catch up on 2024’s Cardiology Coffee Breaks: Join GE HealthCare on a journey to bridge the gaps to connected cardiovascular care with this season’s Cardiology Coffee Breaks. In the time it takes you to finish your coffee, these Coffee Breaks demonstrate how GE’s integrated solutions empower healthcare organizations to provide precision care, achieve operational efficiency, and enhance patient satisfaction.
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