Axios Vitals: Cancer deaths drop

Plus, FDA weights OTC birth control | Tuesday, May 09, 2023

Open in app View in browser   Presented By PhRMA   Axios Vitals By Tina Reed · May 09, 2023 Happy Tuesday, Vitals readers. Today's newsletter is 1,094 words or a 4-minute read. Situational awareness: Arkansas posted an update on its Medicaid redeterminations this week, reporting the overwhelming majority of terminations in coverage are because of procedural denials such as renewal forms not being turned in. Roughly 40% of those dropped from Arkansas' Medicaid rolls are newborns or kids, their data shows.     1 big thing: FDA experts weigh OTC birth control amid agency staff skepticism Illustration: Shoshana Gordon/Axios   FDA advisers today will weigh whether to make daily birth control pills available over-the-counter for the first time amid concerns from agency staff that patient misuse could cause more unintended pregnancies, Axios' Oriana González writes. Why it matters: Expanded availability of the pills could deliver more options for more than 19 million women living in areas with health centers that don't offer a full range of birth control methods. Driving the news: Two expert advisory committees to the FDA on Tuesday and Wednesday will discuss and vote on whether to make HRA Pharma's contraceptive pill Opill available without a prescription, which would put the onus on patients to follow instructions on the drug label. HRA Pharma, part of consumer products giant Perrigo, submitted its application last July, and advisers were originally set to meet to discuss the pill in November. However, the FDA postponed the meetings to review more information. Zoom in: FDA staff, in briefing documents, said that over-the-counter birth control "is expected to reduce barriers" to contraceptive access but expressed concern about consumers' ability to take the drug in a timely way. Taking the pill around the same time every day is "essential" for the pill's efficacy, the staff noted. FDA staff also urged the expert panels to discuss whether women with health conditions like breast cancer that might make them inappropriate candidates for the pills would be able to conclude that the product might not be right for them. What they're saying: The American College of Obstetricians and Gynecologists argues data shows "people in need of contraception are capable of using self-screening tools to determine whether hormonal contraception is right for them." The other side: Some anti-abortion groups in November sent a letter to the FDA opposing over-the-counter birth control, arguing patients should make reproductive health decisions with their providers.     2. FDA's new abortion catch-22 Illustration: Sarah Grillo/Axios   Abortion rights advocates are trying to force the FDA to expand access to medication abortion — even if that winds up undercutting the agency's rulemaking discretion, Oriana writes. The big picture: The FDA's regulatory powers over drugs that terminate pregnancies are being challenged by both abortion rights and anti-abortion groups in a way that creates a "dangerous path" for the agency to make independent scientific decisions, legal experts say. Catch up quick: A federal court ruling in Texas ordering the FDA to suspend its approval of the widely-used abortion pill mifepristone was temporarily blocked by the Supreme Court. Meanwhile, a different federal judge in Washington state barred the FDA from curtailing access to the drug in 17 states and the District of Columbia. Now, abortion clinics are asking a third federal court in Virginia to do away with FDA regulations that limit who can dispense mifepristone in Kansas, Montana and Virginia. What we're hearing: "I think we're on a dangerous path as a nation when partisans on both sides are using the courts to challenge FDA scientific determination," said Lawrence Gostin, a law professor at Georgetown University. Details: The Center for Reproductive Rights on Monday sued the FDA on behalf of abortion clinics in Kansas, Montana and Virginia to maintain and expand access to medication abortion in those states. The lawsuit argues that the FDA must "follow the science" and get rid of mifepristone's "burdensome" dispensing restrictions limiting prescribing to those certified by the FDA to to expand access to a drug that has been deemed "safe and effective." Share this story.     3. Major companies snap up primary care docs Insurers and other health care providers are on a buying spree for primary care practices, driven by the promise of some $4oo billion in Medicare Advantage spending, the New York Times writes. "That's the big pot of money everyone is aiming at," Erin Fuse Brown, director of the Center for Law, Health & Society at Georgia State University, told the Times. "It's a one-stop shop for all your health care dollars." Why it matters: More than half of Americans eligible for Medicare opt for MA plans administered by insurers. A robust primary care footprint can allow companies to steer patients to related lines of business and get a bigger cut. Driving the news: Among the latest examples is CVS' $10 billion acquisition of Medicare-focused primary care operator Oak Street Health. CVS owns one of the largest insurers with Aetna, as well as one of the largest pharmacy benefit managers with CVS Caremark. It follows Amazon's purchase of primary care company One Medical. And UnitedHealth Group subsidiary Optum now has about 70,000 doctors. Our thought bubble: This is "vertical integration" in which a single company buys up different segments of the same industry, rather than "horizontal" mergers in which a company buys direct competitors. The buyers say mergers allow them to better coordinate care and align incentives around providing higher value, lower-cost care by keeping patients healthy — what's known as value-based care. But it's also become a type of consolidation that's largely escaped much anti-trust scrutiny and that can concentrate control of the sector to a handful of big players. What we're watching: The FTC's increasing interest in enforcement in health care's vertical mergers, particularly after ordering gene sequencing company Illumina to unwind its acquisition of cancer test developer Grail last month.     A message from PhRMA PBMs control your health care     Middlemen like PBMs are charging fees tied to the price of medicines, which means they make more money when the price of a medicine goes up. This business model allows PBM profits to soar and can lead to higher costs for patients. What else are they hiding?     4. Data du jour: Cancer by congressional district Data: American Cancer Society; Note: Death rate is computed as the average of the male and female rates; Map: Erin Davis/Axios Visuals Cancer deaths are on the decline in every congressional district, typically between 20% and 45% among males and a 10% and 40% among females, over the past quarter century, according to a study published today in the journal Cancer. But health disparities remain. Details: Researchers used county-level cancer death counts and population data from the National Center for Health Statistics at common causes of cancer death dating back to 1996. By the numbers: Lung cancer saw the biggest drops among men, declining between 21%–72% since 1996. Districts located in the Midwest and South which generally have weaker tobacco control policies saw the smallest declines, the authors noted. Female breast cancer deaths dropped between 14% and 58% depending on the district. Prostate cancer deaths dropped between 25% and 68% depending on the district. Yes, but: The study found "substantial" disparities. For instance, the decline of cancer deaths was steepest among Black men, but overall cancer mortality is substantially higher among Black people. What they're saying: "While the overall declines in cancer death rates show progress against cancer, the study shows how critical public policy interventions are to reduce persistent disparities nationwide," said Lisa Lacasse, president of American Cancer Society Cancer Action Network.     5. Catch up quick 👀 Carbon Health, Anthem BCBS publicly spar over contract negotiations. (Fierce Healthcare) 🏛 Walgreens faces a trial on class claims involving Theranos fraud. (Bloomberg Law) 🏥 Atlanta shooting highlights risk of violence in medical facilities. (WSJ)     A message from PhRMA Middlemen say they want lower prices     Yet they often deny or limit coverage of lower-cost generics and biosimilars while giving preferential coverage to medicines with higher prices. This might be good for PBMs' bottom line, but it can lead to higher costs for patients. What else are they hiding?   Thanks for reading, and thanks to senior health care editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. Dive deeper into the future of health care Axios Pro is your personal health care industry analyst, here to help you make the news actionable and anticipate future outcomes. Subscribe today.   Axios thanks our partners for supporting our newsletters. Sponsorship has no influence on editorial content. Axios, 3100 Clarendon B‌lvd, Arlington VA 22201   You received this email because you signed up for newsletters from Axios. To stop receiving this newsletter, unsubscribe or manage your email preferences.   Was this email forwarded to you? Sign up now to get Axios in your inbox.   Follow Axios on social media: