ASH Clinical News ACN_4.5_FULL_ISSUE_DIGITAL - Page 14

Latest & Greatest

Legislation to Improve SCD Data Collection and Care Moves Through Congress

On February 28 , Sens . Tim Scott ( R-SC ) and Cory Booker ( D-NJ ) introduced the Sickle Cell Disease Surveillance , Prevention , and Treatment Act of 2018 . This legislation will authorize a program within the Centers for Disease Control and Prevention ( CDC ) allowing states , academic institutions , and non-profit organizations to apply for grants to gather information on the prevalence of SCD , and the health outcomes , complications , and treatment experienced by patients . This bill also reauthorizes SCD treatment grants awarded by the Health Resources and Services Administration ( HRSA ), which will help improve access to care and quality of care for individuals with SCD .
“ While we know that many people living with SCD are unable to access quality care , policymakers and healthcare providers lack the data on just how widespread this need is , and where it is greatest ,” American Society of Hematology ( ASH ) President Alexis A . Thompson , MD , MPH , said in a statement commending the legislation . “ By expanding efforts to better understand the prevalence and treatment needs of people with this disease , and increasing access to quality care , the legislation introduced today by Sens . Scott and Booker has the potential to dramatically improve the quality of life of the 100,000 Americans with SCD . ASH is committed to working with the Senate to ensure passage of this vital legislation and collaborating with CDC and HRSA in our quest to conquer SCD .”
Similar legislation , sponsored by Reps . Danny Davis ( D-IL ) and Michael Burgess ( R-TX ), passed the House of Representatives on February 26 .
Source : American Society of Hematology press release , February 28 , 2018 .

Obesity Influences Hematopoietic Stem Cell Health

According to research published in the Journal of Experimental Medicine , obesity affects the long-term health of hematopoietic stem cells ( HSCs ). The researchers said their findings provide groundwork for investigating how lifestyle choices affect blood formation and may contribute to the development of blood cancers .
Investigators at the Cincinnati Children ’ s Cancer and Blood Diseases Institute found that obesity-related stresses alter the cellular architecture of the HSC compartment and reduce its long-term functional fitness . These alterations appear to be linked to overexpression of the transcription factor Gfi1 ( a regulatory gene ). In genetic models of obese mice , these effects were progressive and some of the manifestations persisted after the animals ’ weight normalized through researcherimplemented dietary controls .
“ There is now an understanding that the blood stem cell compartment is made up of numerous cell subsets ,” said principal investigator Damien Reynaud , PhD . “ Keeping this compartment healthy is essential to human health . This includes maintaining the diverse pool of HSCs needed to produce blood cells the body needs to function properly .”
He added , “ We want to better understand the molecular alterations in obesity to predict potential risks associated with the therapeutic use of stem cells isolated from obese donors .”
Sources : Cincinnati Children ’ s Hospital Medical Center press release , December 27 , 2017 ; Lee JM , Govindarajah V , Goddard B , et al . Obesity alters the long-term fitness of the hematopoietic stem cell compartment through modulation of Gfi1 expression . J Exp Med . 2017 December 27 . [ Epub ahead of print ]

Report Finds Drug Discounts to Insurers Continue to Rise

Analysts found that the average sale , rebate , and allowance offered to insurers for prescription medications increased from 28 percent in 2012 to 41 percent in 2016 . This trend is expected to increase , according to a recent Wells Fargo analysis .
Among large-cap pharmaceutical companies ( defined as a market capitalization value of more than $ 10 billion ), Eli Lilly saw the largest increase , with average rebates and discounts rising from 19 percent to 39 percent over the same four-year period . Merck followed , with discounts rising from 22 percent to 41 percent . Some specialty pharmaceutical companies also saw greater discounts , including Horizon ( from 18 % to 70 %) and Valeant ( 19 % to 41 %).
“ In reality , we believe that drug price increases are both a way to ‘ feed the beast ’ and a way to increase product profitability ,” wrote David Maris , MBA , author of the Wells Fargo report , in a note to investors . “ Many drug companies say they only net approximately half of the price increases they announce .”
Mylan representatives made a similar argument in a September 2016 congressional committee hearing on the company ’ s continual list price increases for its EpiPen product .
Because insurance copays are tied to the list price ( not the lower discounted price for a medicine ), consumers still pay more at the pharmacy counter . Drug makers have lobbied for a change that requires copays to be based on the discounted price .
Sources : FiercePharma , January 23 , 2018 ; STAT News , January 24 , 2018 .

ACA Reduced Outof-Pocket Spending , Study Finds

A study published in JAMA Internal Medicine found that the implementation of the Affordable Care Act ( ACA ) was associated with reduced out-of-pocket spending , although mean premium spending increased .
Anna L . Goldman , MD , MPA , from the Cambridge Health Alliance in Massachusetts , and colleagues used data from the Medical Expenditure Panel Survey to study changes in out-of-pocket spending , premium contributions , and total health spending after the ACA ’ s 2014 expansion of coverage . The study population included a sample of 83,431 U . S . adults aged 18 to 64 years .
Implementation of the ACA was associated with an 11.9-percent decrease in mean out-of-pocket spending in the full sample . These decreases were largest for the lowest-income cohorts ( 21.4 %), followed by the low- and middle-income cohorts ( 18.5 % and 12.8 %, respectively ).
“ However , many of these individuals continue to experience high-burden outof-pocket and premium spending ,” the authors concluded . “ Repeal or substantial reversal of the ACA would especially harm poor and low-income Americans .”
Mean premium spending increased 12.1 percent in the full sample and rose most sharply in the higher-income group ( 22.9 %). In the lowest-income group , the combined out-of-pocket plus premium spending decreased (– 16 %).
In the full sample and the lowestincome group , the odds of a household spending more than 10 percent of the family income in out-of-pocket costs decreased ( odds ratios [ OR ] = 0.8 for each ). In the middle-income group , there was an increase in the odds of high-burden premium spending ( OR = 1.28 ).
Sources : Physician ’ s Briefing , January 23 , 2018 ; Goldman AL , Woolhandler S , Himmelstein DU , et al . Out-of-pocket spending and premium contributions after implementation of the Affordable Care Act . JAMA Intern Med . 2018 January 22 . [ Epub ahead of print ]

Employer-Sponsored Health-Care Spending Rises to Highest Point in 2016

According to an annual report by the Health Care Cost Institute ( HCCI ), employer-sponsored health-care spending
12 ASH Clinical News April 2018
Latest & Greatest “There is now an understanding that the blood stem cell compartment is made up of numerous cell subsets,” said principal investigator Damien Reynaud, PhD. “Keeping this compartment healthy is essential to human health. This includes maintaining the diverse pool of HSCs needed to produce blood cells the body needs to function properly.” He added, “We want to better under- stand the molecular alterations in obesity to predict potential risks associated with the therapeutic use of stem cells isolated from obese donors.” Sources: Cincinnati Children’s Hospital Medical Center press release, December 27, 2017; Lee JM, Govindarajah V, Goddard B, et al. Obesity alters the long-term fitness of the hematopoietic stem cell compart- ment through modulation of Gfi1 expression. J Exp Med. 2017 December 27. [Epub ahead of print] Legislation to Improve SCD Data Collection and Care Moves Through Congress On February 28, Sens. Tim Scott (R-SC) and Cory Booker (D-NJ) introduced the Sickle Cell Disease Surveillance, Prevention, and Treatment Act of 2018. This legislation will authorize a program within the Centers for Disease Control and Prevention (CDC) allowing states, academic institutions, and non-profit organizations to apply for grants to gather information on the prevalence of SCD, and the health outcomes, complications, and treatment experienced by patients. This bill also reauthorizes SCD treatment grants awarded by the Health Resources and Services Administration (HRSA), which will help improve access to care and quality of care for individuals with SCD. “While we know that many people living with SCD are unable to access quality care, policymakers and health- care providers lack the data on just how widespread this need is, and where it is greatest,” American Society of Hematolo- gy (ASH) President Alexis A. Thompson, MD, MPH, said in a statement com- mending the legislation. “By expanding efforts to better understand the prevalence and treatment needs of people with this disease, and increasing access to quality care, the legislation introduced today by Sens. Scott and Booker has the potential to dramatically improve the quality of life of the 100,000 Americans with SCD. ASH is committed to working with the Senate to ensure passage of this vital legislation and collaborating with CDC and HRSA in 12 ASH Clinical News our quest to conquer SCD.” Similar legislation, sponsored by Reps. Danny Davis (D-IL) and Michael Burgess (R-TX), passed the House of Representa- tives on February 26. Source: American Society of Hematology press release, February 28, 2018. Obesity Influences Hematopoietic Stem Cell Health According to research published in the Journal of Experimental Medicine, obesity affects the long-term health of hemato- poietic stem cells (HSCs). The researchers said their findings provide groundwork for investigating how lifestyle choices af- fect blood formation and may contribute to the development of blood cancers. Investigators at the Cincinnati Chil- dren’s Cancer and Blood Diseases Institute found that obesity-related stresses alter the cellular architecture of the HSC compartment and reduce its long-term functional fitness. These alterations appear to be linked to overexpression of the tran- scription factor Gfi1 (a regulatory gene). In genetic models of obese mice, these effects were progressive and some of the manifestations persisted after the animals’ weight normalized through researcher- implemented dietary controls. Report Finds Drug Discounts to Insurers Continue to Rise Analysts found that the average sale, re- bate, and allowance offered to insurers for prescription medications increased from 28 percent in 2012 to 41 percent in 2016. This trend is expected to increase, accord- ing to a recent Wells Fargo analysis. Among large-cap pharmaceutical companies (defined as a market capitaliza- tion value of more than $10 billion), Eli Lilly saw the largest increase, with average rebates and discounts rising from 19 per- cent to 39 percent over the same four-year period. Merck followed, with discounts rising from 22 percent to 41 percent. Some specialty pharmaceutical compa- nies also saw greater discounts, including Horizon (from 18% to 70%) and Valeant (19% to 41%). “In reality, we believe that drug price increases are both a way to ‘feed the beast’ and a way to increase product profitabil- ity,” wrote David Maris, MBA, author of the Wells Fargo report, in a note to investors. “Many drug companies say they only net approximately half of the price increases they announce.” Mylan representatives made a similar argument in a September 2016 congres- sional committee hearing on the com- pany’s continual list price increases for its EpiPen product. Because insurance copays are tied to the list price (not the lower discounted price for a medicine), consumers still pay more at the pharmacy counter. Drug ЦW'2fR&&VBf"6vRFB&WV&W062F&R&6VBFRF66VFVB&6R6W&6W3fW&6U&V'#2#5DBWw2V'#B#4&VGV6VBWBЦb6WB7VFr7GVGfG07GVGV&Ɨ6VBFW&VF6RfVBFBFRVVFFbFRff&F&R6&R7B4v0766FVBvF&VGV6VBWBb6W@7VFrFVvV&V֗VЧ7VFr7&V6VBvFBg&ЧFR6'&FvRVFƖ6R2Ч66W6WGG2B6VwVW2W6VBFFg&ЧFRVF6WVFGW&RV7W'fWF7GVG6vW2WBb6WB7VFr&V֗V6G&'WF2BFFVF7VFrgFW"FR4( 2#BWЧ6b6fW&vRFR7GVGVFখ6VFVB6Rb2C3R2GVG0vVBFcBV'2खVVFFbFR4v22Ч66FVBvFW&6VBFV7&V6PVWBb6WB7VFrFPgV6RFW6RFV7&V6W2vW&R&vW7@f"FRvW7B֖6R6'G2#BRfvVB'FRrB֖FFR֖6P6'G2RRB"R&W7V7FfVǒ( ĆvWfW"bFW6RFfGV06FVRFWW&V6Rv'W&FVWBЦb6WBB&V֗V7VFr( FPWF'266VFVB( &WV"7V'7FF&WfW'6bFR4vVBW7V6ǐ&"Br֖6RW&62( ФV&V֗V7VFr7&V6V@"W&6VBFRgV6RB&6P7B6'ǒFRvW"֖6Rw&W#"RFRvW7B֖6Rw&WFP6&VBWBb6WBW2&V֗VЧ7VFrFV7&V6VB( 3bRखFRgV6RBFRvW7BЦ6Rw&WFRFG2bW6V@7VFr&RFW&6VBbFPf֖ǒ6RWBb6WB67G2FRЦ7&V6VBFG2&F2%f"V6खFR֖FFR֖6Rw&WFW&Rv07&V6RFRFG2bv'W&FV&V֗V7VFr##6W&6W366( 2'&VfrV'#2#vFvƆFW 2V7FVERWBWBb6WB7VFrB&V֗V6G&'RЧF2gFW"VVFFbFRff&F&R6&R7BFW&VB#V'#"WV"VBb&EФVW"76&V@VF6&R7VFp&6W2FvW7B@#`66&FrFV&W'B'FPVF6&R67B7FGWFR44VW"76&VBVF6&R7VFp&#