State highlights: States and drug prices; Ariz. limiting Sovaldi for patients; L.A. boosts uninsured care by $61 million

Oct 8 2014

A selection of health policy stories from Oregon, Arizona, California, Pennsylvania, North Carolina, New York, New Mexico and Minnesota.

Stateline: Q&A: States And Drug Prices
Because of its high cost, some state Medicaid programs and prison systems are refusing to provide Sovaldi to any but the sickest patients. Most recently, Oregon last month threatened to limit access to the drug unless it can get Sovaldi at a deeply discounted price. But Sovaldi is only the beginning. Expensive new treatments for certain cancers, rheumatoid arthritis and other conditions also have rattled Medicaid officials, patients and health care providers. What can states do to hold down drug costs? Drug pricing is a complicated and opaque process. Here are some of the basics (Ollove, 10/6).

The Associated Press: Arizona Medicaid Program Limits Coverage For Drug
Arizona's Medicaid program is joining some other states in limiting which patients can receive an effective but expensive new drug for hepatitis C. Arizona's program recently told a legislative oversight committee that it costs taxpayers $80,000 to $150,000 per patient to provide Sovaldi to people enrolled in the program, the Arizona Capitol Times reported. The Arizona Health Care Cost Containment System has thousands of patients diagnosed with hepatitis C, but so far the program is providing coverage of Sovaldi for only 180 people under a stringent screening process. Under the state's criteria, people provided coverage for the $1,000-per-pill drug must be in late stages of liver scarring from hepatitis and must be drug free (10/6).

Los Angeles Times: L.A. County Offers $61-Million Health Plan For Those Still Uninsured
Los Angeles County will provide access to a primary care doctors for nearly 150,000 uninsured Los Angeles County residents, including many who are ineligible for Obamacare coverage because they lack legal immigration status. My Health L.A., as the $61-million program for the uninsured is called, will assign uninsured patients to a "medical home" at one of around 150 community clinics, said Dr. Mitchell Katz, director of the county's Department of Health Services (Brown, 10/6).

The Wall Street Journal: Philadelphia Schools Cancel Teachers Union Contract
In a surprise move Monday, the commission that governs the financially troubled Philadelphia public-school system canceled the teachers union contract and decided educators must contribute to their health insurance for the first time to free up money for classrooms (Calvert, 10/6). 

The Associated Press: Philadelphia Teachers Irate After Struggling District Cancels Contract, Imposes Health Costs
Philadelphia teachers vowed to fight a sudden move by the district Monday that cancels their union contract and forces them to start paying health premiums of as much as $140 a month. The teachers union, with about 15,000 members, accused the state-led School Reform Commission of ratcheting up its "war on teachers." However, district leaders said there was nothing else to cut after years of funding woes that have prompted nearly $1 billion in cuts that includes the loss of 5,000 positions and the closure of 30 schools. Many Philadelphia schools operate without a nurse or librarian on duty (Dale, 10/6).

North Carolina Health News: Lawmakers Get Long Look At Other States' Medicaid Programs
In a committee meeting Monday, state lawmakers heard from the Medicaid directors of three other states in an attempt to get a handle on how states that have some similarities to North Carolina organize and pay for Medicaid services. But if lawmakers were looking for a road map of how to proceed with reorganizing and reforming North Carolina's system, they didn't get any clear directions. Medicaid directors from Ohio, Florida and Virginia presented an array of examples (Hoban, 10/7).

Los Angeles Times: Wal-Mart Teams With Directhealth To Lift Health Care Sign-Ups At Stores
Wal-Mart Stores Inc. is launching expanded healthcare sign-ups at many of its stores, including hundreds of locations in California. The retail giant said Monday that it has partnered with DirectHealth.com, an insurance agency and online comparison site. DirectHealth agents will be staffed inside 2,700 stores, including 29 in Los Angeles County and 212 across California (Khouri, 10/6).

The New York Times: From A Father's Anguish Comes A Plan To Help Mentally Ill Inmates
By his count, Francis J. Greenburger has built or owned more than 20,000 apartments over the past 50 years. Starting out at age 19 with a five-story brick rental on Barrow Street, Mr. Greenburger built one of the city's largest co-op conversion businesses in the 1970s and 80s ... Yet for all of his 20-million-square-foot empire, the project Mr. Greenburger may be most excited about -- certainly the one he is most determined to build -- is a 25-bed center to treat convicts with mental illnesses (Chaban, 10/6). 

Los Angeles Times: L.A.-Area Restaurants Adding Health Care Surcharge To Cover Workers
Diners are discovering an unfamiliar new item when the bill comes for the truffled lobster Bolognese at Melisse and for the crunchy Spanish fried chicken and waffles at AOC -- a 3 percent surcharge for employees' medical insurance. The charge first appeared at one Los Angeles-area restaurant late last year; by early September, more than a dozen mainly high-end eateries followed suit. The added cost has given some diners heartburn and thrust the restaurants' owners unwillingly into the debate over the Affordable Care Act (Li, 10/4). 

The Associated Press: NY Bureau Probes Consumer Medical Issues
The Health Care Bureau in the New York Attorney General's Office reports investigating and resolving 13,000 consumer complaints and saving or returning $12.5 million to nearly 2,500 New Yorkers since 2011. The report tracks calls to the bureau's free help line and investigations into complaints like denied services, rejected insurance claims and medical overbilling (10/7). 

The Associated Press: Medical Pricing Website Proposed In New Mexico
New Mexico could help make health care more affordable by establishing a website to provide consumers with information about the cost of medical procedures and quality of care at hospitals, according to a report by an independent think tank. Think New Mexico plans to push for the proposal when the Legislature meets next year for a 60-day session (Massey, 10/6).

StarTribune: Mental Health Relief -- Without Having To Wait
Even on her worst days, Shirley Thompson used to have to wait weeks to see her psychiatrist to get help with her bipolar disorder. "You can't put a date on your depression," she said. It's a problem shared by millions of mental health patients across the country. In Minnesota alone, nearly 168,000 adults live with a serious mental illness and one in four experiences a mental illness of some kind in a given year. Acute shortages of mental health professionals fuel growing delays for appointments. But now, Thompson finally has a way to get help. Fast. Instead of waiting weeks for her next scheduled appointment, she can stop in at a moment's notice to see her psychiatrist at the Hennepin County Mental Health Center. The center is on the cutting edge of a movement to deliver mental health care quickly and conveniently -- mirroring the minute-clinic model for flu and colds (Shah, 10/6).

Georgia Health News: Grady Appeals To Public In Battle Over Contract
Many negotiations between insurers and health systems go down to the last minute, but they are typically resolved in the nick of time. For example, Blue Cross reached a contract with Northeast Georgia Health System in Gainesville late last month, right before a cutoff deadline. If an agreement is not reached, though, patients with Blue Cross insurance would face higher out-of-pocket costs at Grady Memorial Hospital and its clinics because they would be in the "out of network" category (Miller, 10/6).