The state Legislature is considering a host of health care-related bills at the end of the session. But the Empire Report is deeply suspicious of some of them. Empire Report’s Director of Health Policy Bill Hammond recently warned that the Legislature may be trying to act too fast, without considering all the consequences.
One bill he called out was A02969/S02849, which would block insurance companies from dropping a prescription drug, limiting its use or moving it from one tier to another during the plan year.
On its face, that sounds good: If a drug is dropped or becomes more expensive, the patient suffers. Many wise patients choose one insurance policy over another partly because of the price for an expensive prescription they have to take.
But Hammond thinks legislators are being manipulated.
“If, over the course of the year, the drug company changes its price, and you can’t do anything about it, you’re going to reward that behavior,” he said.
He would prefer a bill that required insurance companies to “hold consumers harmless” while they negotiate the drug price change.
“The bill should be focused that way,” he said.
He argues that legislators don’t realize the “warfare” going on behind the scenes between health care players.
“Drug manufacturers try to create alliances with patient groups,” he said. “The groups that will go to the legislators are often a patient group. But behind the scenes ...”
The legislation allows drugs to be moved to higher tiers if a generic or interchangeable prescription is added. They could be removed if the Food and Drug Administration removes the drug from the market. The bill would also require insurers to notify the public 30 days before the next open enrollment period begins.
Nursing home problems
Here’s a list you don’t want to be on: the candidates for special focus facility.
Until now, the public only knew which nursing homes were “SFF,” meaning special focus facility.
It’s not a good thing. It’s a determination made by the Centers for Medicare & Medicaid Services that the home has a history of serious quality issues. CMS focuses on special focus homes for 18 to 24 months, inspecting twice as often as normal and issuing increasing fines if quality doesn’t improve.
But CMS can only focus on a few homes at a time, so it has another list. That’s for homes that are candidates for special focus, once the current homes are off the list.
That list was released recently by Senators Bob Casey, D-PA, and Pat Toomey R-PA.
Only one home in this region was on that list: the Saratoga Center for Rehabilitation and Skilled Nursing Care.
Two calls to the home’s administrator were made, but the administrator’s voicemail was full and not accepting messages. No one else answered the phone there to take a message.
If the home ends up on the official special focus list, it will get inspected by survey teams twice a year. Within two years, CMS will expect significant improvements in care or it will ban the home from receiving Medicaid and Medicare funds.
Sometimes, the home is given more time, but as CMS put it in a flyer about special focus, extensions are only given for “very promising progress, such as the sale of the nursing home to another owner with a much better track record of providing quality care.”
Could prediabetes lead to dementia?
Researchers at Albany Medical College were awarded a $1.8 million grant last month to study how prediabetes and menopause influence dementia.
They don’t think it leads to Alzheimer’s, but the issue seems connected to other types of dementia, particularly VCID (vascular contributions to impairment and dementia).
“We know that diabetic women have a greater risk of developing VCID than non-diabetic women, but little is known about the effects of prediabetes on VCID,” said Kristen Zuloaga, assistant professor in the Department of Neuroscience and Experimental Therapeutics at Albany Medical College, who is leading the study.
Her team will use mice to see whether menopause exacerbates the medical problems caused by prediabetes. They will see whether it leads to reduced blood flow to the brain, inflammation of the brain and cognitive defects.
They will also look at the loss of aromatase, an enzyme, during menopause. They want to know whether that makes blood flow to the brain worse.
They will also look at whether it helps to increase the hormone estradiol in the brain.
“There is a critical gap in the knowledge of how menopause influences VCID,” Zuloaga said. “Until we understand the effects of menopause on VCID in prediabetic females, we cannot develop therapies to treat this high-risk population.”