Drug deja vu

It’s not easy being a health insurer these days, particularly when pharmaceutical companies come along with wonder drugs that cost a fortune.

Insurers are all about working the odds. They collect premiums from a large group of people and count on the fact that most of their customers won’t use much health care and their payments will more than offset the cost of providing coverage to those who do. New prescription drugs, however, distort the math and make it nearly impossible to rein in health care costs.

The latest story in this sad saga comes today in the Boston Globe, which reports on the struggle of families with children suffering from a rare condition called spinal muscular atrophy, which disables the nerve signals controlling muscle movements. The disease is often fatal to patients before their second birthday.

Cambridge-based Biogen Inc. has developed a new drug called Spinraza. In clinical trials, the drug has helped children afflicted with spinal muscular atrophy “to hold up their heads, sit up, stand on their own, and walk short distances,” according to the Globe.

The drug sounds promising, but Biogen is charging $750,000 for the first year of treatment and $375,000 annually thereafter. Those types of numbers would make any insurance company blanch, so Neighborhood Health Plan declined to cover the treatment for 4-year-old Kernan Farrell of Newburyport because she was suffering from a less-critical type of spinal muscular atrophy.

Farrell’s parents appealed the decision to a patient protection panel at the Massachusetts Health Policy Commission, the same agency charged with reining in state health care costs. The panel ruled that Neighborhood Health should pay for the drug, but only in Farrell’s case. Other children suffering from the same disease will have to jump through the same regulatory hoops to obtain coverage, the panel ruled.

We’ve seen this sort of pass-the-buck thinking before. Several years ago Gilead Sciences came out with a drug called Sovaldi that cured patients afflicted with the liver disease hepatitis C, which affects millions of people in the United States. Gilead was charging $1,000 a pill, or $84,000 for a typical, 12-week course of treatment. Insurers couldn’t stomach the high cost, so they initially restricted the treatment to those with advanced stages of the disease.

The public was outraged. Attorney General Maura Healey threatened legal action against Gilead. Gov. Charlie Baker said his administration would negotiate discounts with the company. But not much came of it, except that health insurance companies, including the state’s Medicaid program, eventually blinked and approved wider use of the drug.

Drug approvals are the humanitarian thing to do, but they also are the reason why health care costs, and particularly prescription costs, keep rising so dramatically.

–BRUCE MOHL


 

BEACON HILL

The population of Massachusetts grew at a faster rate than the rest of the New England region and only slightly off the national pace from July 2015 to July 2016. Suffolk County, anchored by Boston, grew the fastest in the Bay State. (Eagle-Tribune)

The Baker administration is seeking federal approval for more flexibility in the state’s Medicaid program with an eye toward expanding coverage of addiction and mental health treatment while paring back some other benefits. (The Republican)

MUNICIPAL MATTERS

Telegram & Gazette columnist Dianne Williamson takes aim at Michael Gaffney, who she describes as “a special kind of cad on this City Council, one who regularly smears his colleagues and seeks to divide the city.”

Somerville Mayor Joe Curtatone and other municipal leaders in the state vow not to back down in the face of threats from US Attorney General Jeff Sessions to “claw back” more than $4 billion in grants to sanctuary cities not fully enforcing immigration laws. (Boston Herald)  Salem prepares for a heated hearing on a sanctuary city ordinance. (Salem News)

Medfield became the second community in the state, following Westborough, to ban the sale of recreational marijuana when voters overwhelmingly approved a ballot question by a 4-1 margin Monday. (MetroWest Daily News)

Springfield Mayor Domenic Sarno says an outside audit found that the former golf pro at two municipal golf courses kept money that belonged to the city. (MassLive)

Boston police leaders say they are working hard to increase the diversity of their ranks — though the department’s patrol force has a lower percentage of minority officers today than it did in 2004. (Boston Globe)

A mason who was working nearby and tried to help save two drain workers trapped when a trench collapsed on them in Boston’s South End is still traumatized by the October tragedy that claimed their lives — and now has the drain company owner facing manslaughter charges. (Boston Herald)

WASHINGTON/NATIONAL/INTERNATIONAL

With Obamacare showing itself to be far more durable than many expected, health policy expert John McDonough sizes up where health care goes from here. (CommonWealth) Some think the Republican plan now will be to sabotage the law’s workings. (The New Republic) Lauren Stiller Rikleen, a visiting scholar at Boston College, suggests Gov. Charlie Baker could step into the health care mess in Washington and straighten things out. Like that will ever happen. (WBUR)

Here’s a take on things that would likely give President Trump and Paul Ryan some indigestion: “How Trumpcare’s Failure Sets the Stage for Single-Payer.” (The New Republic) Sen. Elizabeth Warren doesn’t think the idea is crazy. (MassLive)

A spokesman for House Intelligence Committee chairman David Nunes, a staunch Trump supporter, confirms the congressman met his source at the White House where he got the information he says shows associates of the president were inadvertently swept up in surveillance calls. (U.S. News & World Report) Democrats are calling for Nunes to recuse himself, saying his actions have compromised his ability to hold fair hearings on allegations of connections between Trump and Russia. (New York Times)

In which Peter Gelzinis gets Mike Capauno to consider the parallels between Trump and Bluto Blutarsky from Animal House. (Boston Herald)

Canada plans to legalize marijuana next year. The country expects to roll out its regulatory apparatus at about the same time as Massachusetts. (Time)

BUSINESS/ECONOMY

The Retailers Association of Massachusetts is considering placing a referendum on next year’s ballot to roll the state sales tax back to 5 percent. (State House News Service)

A majority of transgender renters faced discrimination in trying to secure an apartment in a Suffolk University study in Greater Boston. (Boston Globe)

EDUCATION

Quinsigamond Community College in Worcester selected Luis Pedraja, a college administrator from California, as its next president. (Telegram & Gazette)

Joan Vennochi says we need a full accounting of the mess at UMass Boston, including a clearer sense of what the university’s president, Martin Meehan, knew about the problems and what he did early on to address them. (Boston Globe)

HEALTH/HEALTH CARE

State regulators give a thumbs-down to a proposal to build a new rehab center in Beverly that would not accept Medicaid patients. (Salem News)

A billionaire physician-entrepreneur may have violated federal regulations by promoting on Twitter the supposed benefits an anti-cancer drug that does not yet have federal approval. (STAT)

TRANSPORTATION

Keolis, the state’s commuter rail operator, is being plagued by locomotive and passenger car breakdowns. Not all of the problems are Keolis’s fault, but T overseers are losing patience. (CommonWealth)

The MBTA is running out of options on making spending cuts — some of the bigger-ticket items on the T’s cut list have either been taken off or are slipping off the table. (CommonWealth)

MBTA odds and ends: The Orange Line prototype rail car will go on display at Boston City Hall next week. (CommonWealth)

Running the South Coast Rail through Middleboro with diesel engines would cost about $1.1 billion, roughly one-third of the estimate for the proposed electric line that would go through Stoughton, according to Department of Transportation officials. (State House News) That estimate was first revealed last week, but didn’t get much attention. (State House News)

ENERGY/ENVIRONMENT

President Trump is set to sign an executive order rolling back many of former President Barack Obama’s climate change regulations on greenhouse gases but experts say the measures are unlike to meet the administration’s promised goals of restoring coal mining jobs. (New York Times)

Worcester, which has one of the best recycling programs in the country, says its 18-gallon recycling containers are no longer big enough. (Telegram & Gazette)

Four Cape Cod towns lost an appeal of a plan by Eversource to spray herbicide along transmissions lines that the communities claim would contaminate water supplies. (Cape Cod Times)

CASINOS

Gaming Commission chairman Stephen Crosby, in a wide-ranging interview, said if online gambling is approved by the Legislature, there are “as many or more” safeguards available than in brick and mortar casinos that can be implemented to tamp down on problem gambling. (Greater Boston)

CRIMINAL JUSTICE/COURTS

A former Southbridge math teacher is sentenced to 11 years in prison for possessing child porn and soliciting live online child sex shows. (Telegram & Gazette)

Former Pittsfield police officer Jeffrey Coco gets 20 months in jail for stealing $228,000 from a police union fund. (Berkshire Eagle)

MEDIA

David Fahrenthold, the Washington Post reporter who broke stories about President Trump’s charity and his comments on “Access Hollywood,” wins the Toner Prize for political reporting. (Washington Post)

PASSINGS

Political gadfly and two-time gubernatorial candidate Christy Mihos, who became a millionaire with his convenience store chain only to squander his fortune and become embroiled in a scandalous divorce, died of cancer in Florida. He was 67. (Cape Cod Times)