Seeking to Grow Market Share?

Get a FREE assessment of your CDH products —
a $3,000 value.

Readout of U.S. Surgeon General VADM Jerome Adam’s Visit to Local Addiction Treatment Facility

HHS Gov News - October 31, 2017

Following President Donald Trump’s call to action on Thursday regarding America’s opioid epidemic, U.S. Surgeon General Vice Admiral Jerome Adams visited Phoenix House in Arlington, VA, to highlight work being done by nonprofit organizations to combat the epidemic and hear from treatment experts and other heroes on the frontlines.

Phoenix House offers evidence-based addiction treatment to teens, adults, and families, as well as unique services for pregnant women, mothers with young children, and the military community. During his visit, Surgeon General Adams was able to tour various parts of the facility, meet with current patients and learn firsthand of their experience and treatment programs.

Surgeon General Adams had the following to say about his visit:

“It was an honor to visit a treatment center today in Virginia as part of a coordinated effort for top Trump Administration officials to hold listening sessions on the frontlines of the opioid epidemic, the day after the President directed agencies to use all appropriate emergency and other relevant authorities to address the opioid crisis and the Acting Secretary of Health and Human Services declared a nationwide public health emergency as a result of the opioids crisis. Empowering local communities and civil-society groups is a key part of the Department of Health and Human Services’s comprehensive strategy for tackling opioid addiction. We enjoyed hearing the perspectives of a number of treatment experts today. We look forward to more such visits to come, as we raise awareness of the crisis that President Trump has made a top priority.”

More information on Phoenix House may be found here:

Readout of Assistant Secretary McCance-Katz’s Opioids Listening Session in Nashua, New Hampshire

HHS Gov News - October 31, 2017

On Friday, Assistant Secretary for Mental Health and Substance Use, Dr. Elinore McCance-Katz, and senior HHS officials visited Harbor Homes in Nashua, New Hampshire.

Along with New Hampshire Governor Chris Sununu and Nashua Mayor Jim Donchess, they toured the Harbor Homes facility and held a roundtable discussion with first responders, medical experts, local non-profit leaders, and people receiving treatment in all stages of the recovery process.

Mary-Sumpter Lapinski, Counselor to the Secretary of HHS for Public Health & Science, opened the meeting by welcoming participants and thanking them for their willingness to share their stories. She reiterated President Trump and the entire Administration’s commitment to confront the opioids epidemic and discussed the historic significance of yesterday’s actions.

During the session, recovering addicts shared their personal stories in vivid detail. They spoke of friends and relatives who lost their lives to the scourge of addiction. Community leaders and experts talked about the challenges and opportunities they experience providing services in New Hampshire. They also discussed Nashua’s Safe Spaces Program and its unique approach to providing assistance to those looking to start their path to recovery.

The federal government is marshaling all relevant agencies and personnel to address this crisis. Yesterday afternoon, following a Presidential Memorandum, HHS declared a Public Health EmergencyToday, Acting Secretary Eric D. Hargan, Surgeon General Jerome Adams, Assistant Secretary McCance-Katz, and other top officials are fanning out across the country to hear from communities on the front lines.

The following individuals participated in the New Hampshire event:

  • Dr. Elinore McCance-Katz, Assistant Secretary for Mental Health and Substance Use
  • Governor Chris Sununu, State of New Hampshire
  • Mayor Jim Donchess, City of Nashua
  • Peter Kelleher, President and CEO, Partnership for Successful Living
  • Mary-Sumpter Lapinski, Counselor to the Secretary for Public Health & Science
  • Jaime Gormley, LICSW, MLADC, Director of Residential Services, Keystone Hall
  • Scott Slattery, Director of Housing, Harbor Homes
  • Christopher Stawasz, Regional Director, American Medical Response
  • Chief Steve Galipeau, Nashua Fire Rescue
  • Assistant Chief Brian Rhodes, Nashua Fire Rescue
  • Dr. Garciela Sironich-Kalkan, Medical Director, Harbor Care Health and Wellness Center
  • Allen Irwin, Peer Recovery Support Manager, Revive Recovery Resource Center
  • Harbor Homes patients (names withheld to respect their privacy)

Readout of Acting HHS Secretary Hargan’s Opioids Listening Session in Lexington, Kentucky

HHS Gov News - October 31, 2017

On Friday, Acting Health and Human Services Secretary Eric Hargan and senior HHS officials traveled to Lexington, Kentucky, to visit the Polk-Dalton Clinic and the PATHways Program, which serves pregnant women recovering from addiction and their babies. Acting Secretary Hargan toured the facility and held a roundtable discussion with medical experts, local non-profit leaders, individuals receiving treatment and in recovery, and others impacted by the opioid epidemic.

Acting Secretary Hargan opened the roundtable discussion by thanking the group for their willingness to share their stories and for their work to address the crisis in the community. He highlighted HHS’s and the Trump Administration’s continued commitment to address the opioid epidemic and the significance of Thursday’s action of declaring a nationwide public health emergency on the opioid crisis.

During the meeting, individuals in recovery shared their personal stories, many of which began with addiction in early teen years. One woman shared how the unique approach of the PATHways program has allowed her to stay sober, become a more present mother, and even become a peer support specialist to other women joining the PATHways program. A mother shared the personal story of losing her son to the epidemic and her commitment to educate others about the crisis. Community expert and leaders discussed opportunities and challenges they experience in providing services in Kentucky. The individuals participating in the roundtable shared their personal views that addiction must be addressed as a chronic condition requiring a multi-layered approach to include community connection, innovative treatment and ongoing support.

The following individuals participated in the Kentucky event:

  • Acting Health and Human Services Secretary Eric Hargan
  • Mark Birdwhistell, Vice President for Administration & External Affairs, UK HealthCare  
  • Alex Elswick, Co-Founder, Voices of Hope
  • Dr. Agatha Critchfield, Co-Founder & Medical Director, PATHways Program
  • Nikki Strunk, Parent of Deceased, Brendan Strunk
  • “L,” PATHways Patient
  • Rachel Coburn Smith, Executive Director, Refuge Clinic
  • Cornelia ‘Neal’ Vaughan, Founder, Chrysalis House
  • Dr. Peter Giannone, Chief, Division of Neonatology & Vice Chair, Pediatric Research, UK  HealthCare

Past-Due Premiums, Missing Tax Forms May Hamstring Marketplace Customers

Kaiser Health News:HealthReform - October 31, 2017

The 2018 annual open-enrollment period for coverage on the health insurance marketplaces starts Wednesday. But if you don’t take care of lingering issues from your past coverage, they may come back to haunt you when you try to sign up this fall.

Unpaid Premiums

New rules will allow some insurers to require you to pay any back premiums you owe for the 12 months prior to the effective date of your new coverage.

The rule, which became effective in June, generally applies only if you try to enroll in a plan with the same insurer, not if you choose coverage from another company. It’s up to insurers to decide whether to come after you for the money.

But there may be only one insurer offering coverage in many areas. In those cases, if you’ve fallen behind on payments, “you really won’t be able to escape this policy,” said Tara Straw, a senior health policy analyst at the Center on Budget and Policy Priorities, a research and policy institute in Washington, D.C.

Insuring Your Health

KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.

To contact Michelle with a question or comment, click here.

This KHN story can be republished for free (details).

Insurers have to notify you before you miss premium payments if they plan to implement the rule.

The Affordable Care Act offers some protection for people who fall behind on their payments. Under the law, you have a 90-day grace period in which to catch up on unpaid premiums. Once that grace period ends, your coverage would be canceled retroactive to the end of the first month of delinquency and you’ll be responsible only for your portion of the first month’s unpaid premium. (You wouldn’t be responsible for premium tax credits paid by the government on your behalf to the insurer.)

But if you stop paying your premiums during the last three months of this year, you could get hit with a bill for a full three months of premiums if you re-enroll for 2018 coverage. This is because your 90-day grace period hasn’t ended.

“Effectively your coverage has never terminated, and therefore you owe for the full period,” said Timothy Jost, an emeritus professor of law at Washington and Lee University in Virginia who specializes in health law.

If you want to drop a marketplace plan, it’s not enough to just stop paying premiums.

“Make sure you go to the marketplace and terminate your plan,” said Straw. “Otherwise you could be on the hook for these payments during open enrollment or during a special enrollment period if you try to sign up again.”

Unfiled Tax Documents 

Most people who get marketplace coverage qualify for tax credits that provide money to help pay for their premiums. Those are available to consumers whose income is less than 400 percent of the federal poverty level (about $48,000 for one person). If you had a marketplace plan in 2016, you were supposed to include a special document — IRS Form 8962 — when you filed your 2016 federal income taxes this year. This document reconciled how much you received in advance premium tax credits against how much you should have received based on your actual income for the year.

If you didn’t file the form with your taxes, “you’ll be able to sign up for coverage, but you won’t be able to get subsidies,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

To fix the problem, you’ll generally have to file the Form 8962, along with the second page of your income tax Form 1040 and the 1095-A form you received from the marketplace showing your 2016 enrollment details, said Straw. If you want to receive premium tax credits starting in January, you’ll need to get that done before the open-enrollment period ends Dec. 15.

This issue will primarily affect people who are automatically re-enrolled in a plan for the following year, as were 31 percent of marketplace customers last year. If you sign into your marketplace account to update your income and other personal information — as everyone should do for so many reasons — you’ll be asked whether you’ve filed and reconciled your taxes. That is a signal the issue needs to be addressed.

Some policy experts are concerned that this filing requirement will be particularly challenging for people whose annual income is below the usual threshold required to file an income tax return (about $10,000 for one person or $20,000 for a married couple) but who must do so now because they receive advance premium tax credits.

“It’s confusing enough, and many people don’t remember that they now have to file an income tax form,” said Mara Youdelman, managing attorney at the National Health Law Program, which has been working to ensure people receive proper notification that their benefit may be at risk if they don’t comply with filing requirements.

Please visit to send comments or ideas for future topics for the Insuring Your Health column.

5 Things To Know About ACA At Year 5

Kaiser Health News:HealthReform - October 31, 2017

Open enrollment for people who buy their own health insurance starts Wednesday and ends Dec. 15 this year. That’s 45 days, six weeks shorter than last year — and only one of the big changes consumers need to consider. The Trump administration has cut back on marketing and funding for navigators to help people through the process.

Here are five important factors to keep in mind if you plan to sign up for 2018 coverage under the Affordable Care Act.

1. The health law has NOT been repealed.

Despite the efforts of President Donald Trump and the Republican-led Congress, the Affordable Care Act is still the law of the land.

That means if you don’t get insurance through your job or a government program, you will still be able to get coverage for a set of comprehensive benefits regardless of whether you have preexisting conditions. It also means that if you meet income eligibility requirements, you will be able to get help from the federal government to afford your premiums, and, possibly, deductibles and other out-of-pocket costs.

This KHN story also ran on NPR. It can be republished for free (details).

Those “cost-sharing reduction” subsidies help hold down out-of-pocket costs for people with incomes under 250 percent of poverty (a little more than $30,000 a year for an individual). They will be available despite Trump’s decision to stop the federal government from reimbursing insurers for the required discounts. Most insurers are making up the difference by raising premiums.

Meanwhile, if you get premium assistance in the form of tax credits, what you pay for coverage is not likely to be much higher, either. That’s because as premiums go up, so do federal premium subsidies. (More about this below.)

2. The requirement for most people to have insurance — and most employers to offer it — is also still in effect.

Under the law, most households that earn enough to owe federal income tax are required either to have health insurance or pay a fine due with their taxes. The fine for not having insurance in 2017 (and 2018) is the greater of $695 or 2.5 percent of the taxpayer’s income. You can claim an exemption from the fine if you demonstrate that you cannot afford insurance offered in your area.

The IRS has said it will start rejecting returns filed in 2018 that do not indicate whether the taxpayer had health insurance.

Larger employers (those with 50 or more full-time workers) are also mostly required to offer coverage to their workers or pay a penalty. That coverage must be comprehensive and affordable.

Enrollment Resources

The federal marketplace English-language website:

The federal marketplace Spanish-language website:

The federal call center for consumer questions, available 24/7: 1-800-318-2596

The Kaiser Family Foundation’s FAQ on the ACA

3. Like your mama said, you better shop around. 

While it’s always been important to compare options, this year it’s more crucial than ever.

For starters, you want to shop and pick a plan yourself so that the marketplace doesn’t automatically enroll you for 2018 coverage. That’s because the auto-renewal date this year is expected to be Dec. 16, the day after the open-enrollment period ends. So, if you are assigned a plan you don’t like, you won’t be able to change it until the 2019 open-enrollment season.

Shopping allows you to compare plans, including which doctors and hospitals are in-network, as well as premiums and copayments, which can vary.

4. Cost will be a factor.

This year, premiums are going up, in some areas by double digits, due in part to the Trump administration’s mid-October decision to cut off cost-sharing subsidies to insurers.

But the premium increases may not affect all plans and “metal levels” — which is why you should compare prices.

Some states, for example, instructed insurers to load those additional costs only onto the “silver-level” plans, which are midlevel plans that cover about 70 percent of an average person’s medical costs. The policyholder picks up the rest of the cost in deductibles and copayments. As a result of the state’s pricing decisions, though, “gold-level” plans, which cover an average of 80 percent of costs, might in some cases have lower premiums than silver plans.

Of course, if you get a cost-sharing reduction — meaning lower copayments and deductibles — because your individual income is below $30,150, you will need to stay in a silver plan.

Another factor to consider, however, is that the increased prices for silver plans may drive up a different subsidy — the tax credits that help people pay premiums. Those remain in place for people earning up to 400 percent of the federal poverty level. They could rise because they are tied to the cost of a benchmark silver plan in each region.

In some cases, the tax credit increase could be enough to make a “bronze” or gold plan have a very low or even zero monthly premium, according to a Congressional Budget Office analysis done before the administration took action. But, of course, consumers not getting either type of subsidy could be looking at higher costs. That gives them all the more reason to comparison-shop.

Some experts suggest looking beyond the official federal and state marketplaces — whether directly checking out an insurer’s website, working through a broker or consulting a private online website — because some states ordered insurers to load additional costs resulting from the Trump order only onto marketplace plans. Therefore, plans off the marketplace might cost less.

5. Buyers should also beware. 

Outside of the official marketplaces there may be more insurers selling lower-cost, “short-term policies.”

Sabrina Corlette, who studies the marketplace for Georgetown University’s Health Policy Institute, said that such plans, while less expensive, may not cover all benefits and might exclude coverage of preexisting conditions.

Those plans also don’t meet ACA requirements for “minimum essential coverage,” so policyholders would still be liable for paying a tax penalty. “There are going to be some folks out there taking advantage of consumer confusion,” warned Corlette, adding that shoppers who buy outside of state or federal marketplaces “should go to a reputable broker.”

Postcard From Canada: In The Land Of Single-Payer, Bernie Sanders Gets Hero’s Welcome

Kaiser Health News:Insurance - October 30, 2017

TORONTO — Sen. Bernie Sanders (I-Vt.) wasn’t scheduled to come onstage to talk health care until after 11 a.m. But college students started lining up as early as 5 a.m. — the Sunday morning of Halloween weekend, no less — in the hopes of scoring what appeared to be the weekend’s hot ticket.

In Washington, D.C., Sanders is often portrayed as a radical, a politician on the fringe. The popularity of his 2017 campaign for the Democratic presidential nomination caught party insiders off-guard and much of the political establishment views his signature single-payer health plan as unworkable or impractical.

Use Our ContentThis KHN story can be republished for free (details).

But here at the University of Toronto’s Convocation Hall, flanked by Ontario’s premier, Kathleen Wynne, and leadership from Canada’s left-wing New Democratic Party (NDP), Sanders received a celebrity’s welcome.

“He’s a bit of a folk hero up here,” said Dr. James Sugiyama, a Toronto-based family physician, who, after failing to procure a ticket to Sunday’s lecture, watched the event with friends on a web-based livestream at a restaurant down the street. “We’re staunch supporters and believers that what Bernie is talking about is the right thing to do.”

Canada’s universal health care system, which dates to 1968, is beloved by much of its citizenry — it’s a point of pride, many locals say.

Thank you, Toronto. I’m proud to join with you in the global fight for universal health care.

— Bernie Sanders (@SenSanders) October 29, 2017

Sanders’ speech capped off a weekend trip to Toronto, which included hospital visits and roundtables, and which his office framed as an educational tour of the Canadian health care system — an example of the single-payer approach that Sanders often cites in speeches on his home turf. The lecture was the one public component of the trip, which also grabbed headlines from the Canadian Broadcasting Corp. and other local outlets.

Tickets were snapped up well in advance, though the 5 a.m. college students eventually made it off the waitlist. Organizers estimated about 1,700 tickets were available, which sold out in about 30 seconds, according to Sanders’ office.

The lecture took on the tenor of a practiced American rally — albeit, one where the crowd was warmed up by a string quartet — featuring Sanders’ familiar talking points, repurposed for a new audience.

James Sugiyama, a Toronto-based doctor, watched Sanders’ speech on a livestream from a restaurant down the street. The Vermont senator is viewed as a “folk hero” by many Canadians, he said. (Shefali Luthra/KHN)

Sanders’ comments went well beyond universal health insurance, touching on the importance of a $15 minimum wage and combating climate change. And there were the standard critiques of Obamacare repeal efforts in Washington, of income inequality and of the influence of so-called special interests.

The audience — which included left-leaning doctors, politicians and college students — was there to experience the Sanders’ magic, to “feel the Bern” firsthand. They snapped photos and burst frequently into claps, cheers and whistles, even for policies that more obviously affected their American neighbors to the south. They gave more than one standing ovation.

“Our mission is to have the courage to ask the questions … to take on the incredible special interests who have so much power in my country, your country and all over the world,” he said.

Timeline: Insulin Market Under Scrutiny

Kaiser Health News:Marketplace - October 30, 2017

The price of lifesaving diabetes drugs has skyrocketed over the past decade. And patients aren’t the only ones who have noticed. Five states and a federal prosecutor are demanding information from insulin manufacturers and the pharmaceutical industry’s financial middlemen.

Below, we detail when legal action related to insulin drugs began, with links to documents.

March 2016

The U.S. Attorney’s Office for the Southern District of New York launches the first of several civil investigative demands (CIDs), beginning with Sanofi and Novo Nordisk.

Novo Nordisk establishes federal demand (p. 82) The note, like those of Eli Lilly and Sanofi, establishes that the federal prosecutor is interested in the company's business relationships with pharmacy benefit managers and demands information on specific insulins. View entire document on DocumentCloud
  • The federal prosecutor’s demand of Novo Nordisk specifies information is needed regarding insulins Novolog, Novolin and Levemir, according to the company’s annual report; Sanofi reports the request for information is also in relation to pharmacy benefit managers and regarding top-selling insulin drug Lantus as well as Apidra since 2006, according to the company’s annual 20-F filing.
July 2016
  • Eli Lilly discloses that the U.S. Attorney’s Office for the Southern District of New York issued a CID also for information related to pharmacy benefit managers, according to its July 2016 quarterly filing.
Use Our Content This KHN story can be republished for free (details). August 2016
  • Express Scripts receives a CID from the U.S. Attorney’s Office for the Southern District of New York. It too notes the federal prosecutor is asking for information about relationships. No specific drugs are named, according to the company’s 2016 annual report.
November 2016 January 2017
  • Minnesota’s attorney general launches what appears to be the first state investigation, issuing civil investigative demands to Sanofi and Novo Nordisk. February 2017
  • Berman’s lawsuit is transferred to New Jersey and combined with a related case filed by attorney James Cecchi, representing patients against the insulin makers.
March 2017
  • Washington’s attorney general issues a CID to Sanofi echoing Minnesota’s request and specifying the request is for insulin drugs Lantus, Toujeo, Apidra and Soliqua from 2005 to present, according to the company’s half-year financial report.
The Rebate Game (p. 37) Attorneys allege that the relationship between drug manufacturers and pharmacy benefit managers harms patients and allows for rising insulin prices. View entire document on DocumentCloud
  • Julia Boss, the Type 1 Diabetes Defense Foundation and other patients file suit on March 17 in the U.S. District Court of New Jersey against the three big insulin manufacturers as well as the pharmacy benefit managers.
April 2017
  • CVS Health receives a CID from Washington’s AG seeking information regarding pricing and rebates for insulin and epinephrine products connected to a pending investigation. Under the bullet item “Insulin Products Investigation,” CVS states that the Washington attorney general’s office will share information with the attorneys general of California, Florida and Minnesota, which filed a CID in July.
  • Scott Christensen and other patients file suit April 20 in the U.S. District Court of New Jersey alleging violations of the Sherman Antitrust Act. Defendants include Novo Nordisk, Eli Lilly, Sanofi, Express Scripts, CVS Health, UnitedHealth Group with its PBM division OptumRx.
May 2017
  • Eli Lilly does not specify drugs but confirms it has a received a CID from Washington’s attorney general about the “pricing of our insulin products and our relationships with pharmacy benefit managers.” It also states New Mexico’s attorney general issued a CID related to “the pricing of our insulin products,” according to its quarterly financial filing.
July 2017
  • CVS Health receives a CID from Minnesota’s AG seeking information regarding pricing and rebates for insulin and epinephrine products connected to a pending investigation, according to a quarterly filing.
  • Eli Lilly says it has received a CID from Minnesota’s AG “relating to the pricing and sale of our insulin products.” California and Florida’s attorneys general requested information related to pricing of insulin products,  according to its quarterly filing.
  • Sen. Amy Klobuchar (D-Minn.) sends letters to insulin manufacturers asking for “an explanation of the extreme price increases” of insulin.  Eli Lilly, Sanofi and Novo Nordisk each respond.
September 2017

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.