What We're Reading: Resuming Risk Adjustment Program; New Endometriosis Drug; Lilly Denounces Drug Imports

July 25, 2018

The Trump administration said it will restart the risk adjustment payment program just weeks after suspending the payments; the first pill in a decade has been approved to treat pain caused by endometriosis; Eli Lilly executives said during the second quarter earnings call that the idea of importing drugs from abroad was “the wrong road to go down.”

Trump Administration Reverses Decision on Risk Adjustment Payments

The Trump administration said it will restart the risk adjustment payment program established under the Affordable Care Act that pays money to insurers who take on higher-risk patients. According to The New York Times, in reversing the decision, the administration is acknowledging that ending the payments could destabilize the insurance markets. The program was suspended July 8 after a court ruling. CMS’ decision had put $10.4 billion in risk adjustment transfer payments for the 2017 benefit year on hold. Payments will resume around October 22.

New Treatment for Endometriosis Approved

The first pill in a decade has been approved to treat pain caused by endometriosis, a common gynecologic disorder that affects approximately 1 in 10 women of reproductive age. It can cause severe pain and infertility. Testing of the drug found that it significantly reduced menstrual pain in 45% of women on the low dose and in 75% of women on the high dose, reported the AP. Side effects include hot flashes, headaches, and bone thinning. The drug will cost $845 every 4 weeks without insurance.

Eli Lilly Criticizes Trump Administration Drug Importation Proposal

During Eli Lilly’s second quarter earnings call, executives said the idea of importing drugs from abroad was “the wrong road to go down.” The Hill reported that Lilly’s CEO said regulatory reforms would more successfully improve access to prescription drugs and keep prices affordable. He added that he is open to changing the Medicare drug rebate structure, under which drug companies negotiate rebates with insurers or pharmacy benefit managers.