Center for American Progress proposes plan to improve and expand Medicare
by Diane Archer - JustCare - February 28, 2018
In a sign that the Clinton-Obama wing of the Democratic party has moved left, last week the Center for American Progress proposed Medicare Extra, universal national health insurance for everyone without health insurance and everyone else who would prefer it to the coverage they have. Unlike the Sanders plan, CAP proposes a multi-payer plan that allows everyone with insurance to keep what they have if they like it. The plan has many advantages over more modest Medicare for all proposals, but it allows commercial for-profit health plans to remain in the mix, driving up costs and threatening the traditional Medicare-like plan it proposes.
Medicare Extra is an enhanced version of Medicare, filling most of its gaps and providing significantly more coverage. Much like Sanders’ Medicare for All plan, in addition to the standard Medicare benefits, this government plan would cover vision, hearing and dental care as well as long term care supports and services. The coverage would be automatic for anyone without health insurance, everyone turning 65, and everyone at birth; and, it is available to everyone else who chooses it over the coverage they currently have.
To its credit, CAP recognizes that we cannot rely on commercial health insurers to guarantee good affordable coverage in America. It further appreciates that we cannot rely on states to ensure access to care for their residents. And, it relies on the federal government to regulate prices for its Medicare Extra plan because “competition” cannot and has not reined prices in. These are all important lessons learned from the Affordable Care Act.
Like the Sanders plan, Medicare Extra (essentially traditional Medicare with expanded benefits) is administered by the federal government. But, CAP does not go as far as Sanders to eliminate commercial insurance. Rather, CAP attempts to do a better job of leveling the playing field between commercial insurance and the government plan, a Sisyphisian task. And, likely, the CAP plan’s Achilles heel.
As we have seen over the decades and most recently with the ACA, if given any latitude, commercial health insurers will always design their health plans to avoid enrolling people with costly conditions, keeping their networks free of centers of excellence and top specialists. They will never reveal the value of their coverage for people who develop complex conditions, such as heart disease, cancer, stroke or diabetes. Moreover, government has never been able to oversee them effectively or prevent them from committing fraud, wrongly denying care and otherwise keeping the public in the dark about what they offer their members. CAP envisions reining the commercial health plans in significantly more than Medicare Advantage plans, but it is hard to understand how it will be enough.
Unlike Sanders, CAP also allows people with employer coverage and Medicare to keep the coverage they currently have if they so choose. People with Medicaid would be enrolled in Medicare Extra. And, everyone enrolled in Medicare Extra has the choice of this government-administered traditional-Medicare-like plan or Medicare Choice, essentially a commercial Medicare Advantage plan with expanded benefits. It goes without saying that the added administrative costs of all these options are considerable, especially if there is appropriate oversight of the commercial plans.
CAP has yet to model the financing for its proposal, which relies on wealthier Americans to pay more and provides free coverage to people under 150 percent of the federal poverty level. But, CAP expects that Americans earning more than 500 percent of the federal poverty level, just over $60,000 a year for an individual ($104,000 for a couple), would spend 10 percent of their after-tax income for their health insurance, as well as about 20 percent coinsurance, which is likely to make it unaffordable to many.
If you want Congress to improve and expand Medicare for all, please sign this petition.
http://justcareusa.org/center-for-american-progress-proposes-plan-to-improve-and-expand-medicare/?
Nurses Applaud Keith Ellison as New Sponsor of Medicare for All Bill
Welcome New Chapter in Movement for
Guaranteed Health Care for All
National Nurses United today commended Congressman Keith Ellison after he took over the lead sponsorship of HR 676, the Expanded and Improved Medicare for All Act. Ellison asked for unanimous consent to become the lead sponsor on the floor of the House of Representatives on Wednesday afternoon.
“Representative Ellison has long been a leader in the fight for a single payer, Medicare for all healthcare system, and we are looking forward to working with him to finally win guaranteed healthcare for all people living in the United States,” said Jean Ross, Co-President of National Nurses United, and a registered nurse from Minnesota.
“As registered nurses, we see the horrific impacts of our for-profit health insurance system everyday at the hospital bedside. Tens of millions of people don’t have insurance, while millions more can’t afford the costs of the deductibles and copays. As a result, too many patients go without care. We see patients everyday who can’t afford the costs of the lifesaving treatments or medications that they require, and we see the devastation that these realities cause for their families,” Ross continued.
“But there is a solution to end this unnecessary suffering. Through an improved Medicare for All system, every person living in the United States could receive the healthcare services they need. Every other industrialized nation has used a similar approach to guarantee quality healthcare for its residents, and it’s time that the United States did the same.”
Former Congressman John Conyers Jr., who resigned in December, previously introduced HR 676. The bill has received groundbreaking support in this congressional session, with 120 democratic members of congress cosponsoring the legislation.
“In the past year, the movement for a single-payer healthcare system has turned a new page,” said Bonnie Castillo, RN, Executive Director of National Nurses United. “We have seen huge growth in both public and political support for improved Medicare for All. “Our patients know that they are being short-changed by the current for-profit health insurance system, and they are demanding Medicare for All. In Congress, the movement for healthcare justice has a new champion, Keith Ellison, who shares the nurses’ values of caring, compassion and community. NNU looks forward to working with Rep. Ellison, and with everyone who shares those values, to build a truly just healthcare system.”
National Nurses United is the nation’s largest union of registered nurses, and represents 150,000 nurses across the country. For her part, Jean Ross believes that the fight for Medicare for All is necessary for her profession, saying “as nurses, we have a duty to advocate for our patients, and we know that Medicare for All is the best solution for our patients.”
by Diane Archer - JustCare - February 28, 2018
In a sign that the Clinton-Obama wing of the Democratic party has moved left, last week the Center for American Progress proposed Medicare Extra, universal national health insurance for everyone without health insurance and everyone else who would prefer it to the coverage they have. Unlike the Sanders plan, CAP proposes a multi-payer plan that allows everyone with insurance to keep what they have if they like it. The plan has many advantages over more modest Medicare for all proposals, but it allows commercial for-profit health plans to remain in the mix, driving up costs and threatening the traditional Medicare-like plan it proposes.
Medicare Extra is an enhanced version of Medicare, filling most of its gaps and providing significantly more coverage. Much like Sanders’ Medicare for All plan, in addition to the standard Medicare benefits, this government plan would cover vision, hearing and dental care as well as long term care supports and services. The coverage would be automatic for anyone without health insurance, everyone turning 65, and everyone at birth; and, it is available to everyone else who chooses it over the coverage they currently have.
To its credit, CAP recognizes that we cannot rely on commercial health insurers to guarantee good affordable coverage in America. It further appreciates that we cannot rely on states to ensure access to care for their residents. And, it relies on the federal government to regulate prices for its Medicare Extra plan because “competition” cannot and has not reined prices in. These are all important lessons learned from the Affordable Care Act.
Like the Sanders plan, Medicare Extra (essentially traditional Medicare with expanded benefits) is administered by the federal government. But, CAP does not go as far as Sanders to eliminate commercial insurance. Rather, CAP attempts to do a better job of leveling the playing field between commercial insurance and the government plan, a Sisyphisian task. And, likely, the CAP plan’s Achilles heel.
As we have seen over the decades and most recently with the ACA, if given any latitude, commercial health insurers will always design their health plans to avoid enrolling people with costly conditions, keeping their networks free of centers of excellence and top specialists. They will never reveal the value of their coverage for people who develop complex conditions, such as heart disease, cancer, stroke or diabetes. Moreover, government has never been able to oversee them effectively or prevent them from committing fraud, wrongly denying care and otherwise keeping the public in the dark about what they offer their members. CAP envisions reining the commercial health plans in significantly more than Medicare Advantage plans, but it is hard to understand how it will be enough.
Unlike Sanders, CAP also allows people with employer coverage and Medicare to keep the coverage they currently have if they so choose. People with Medicaid would be enrolled in Medicare Extra. And, everyone enrolled in Medicare Extra has the choice of this government-administered traditional-Medicare-like plan or Medicare Choice, essentially a commercial Medicare Advantage plan with expanded benefits. It goes without saying that the added administrative costs of all these options are considerable, especially if there is appropriate oversight of the commercial plans.
CAP has yet to model the financing for its proposal, which relies on wealthier Americans to pay more and provides free coverage to people under 150 percent of the federal poverty level. But, CAP expects that Americans earning more than 500 percent of the federal poverty level, just over $60,000 a year for an individual ($104,000 for a couple), would spend 10 percent of their after-tax income for their health insurance, as well as about 20 percent coinsurance, which is likely to make it unaffordable to many.
If you want Congress to improve and expand Medicare for all, please sign this petition.
http://justcareusa.org/center-for-american-progress-proposes-plan-to-improve-and-expand-medicare/?
Nurses Applaud Keith Ellison as New Sponsor of Medicare for All Bill
Welcome New Chapter in Movement for
Guaranteed Health Care for All
National Nurses United today commended Congressman Keith Ellison after he took over the lead sponsorship of HR 676, the Expanded and Improved Medicare for All Act. Ellison asked for unanimous consent to become the lead sponsor on the floor of the House of Representatives on Wednesday afternoon.
“Representative Ellison has long been a leader in the fight for a single payer, Medicare for all healthcare system, and we are looking forward to working with him to finally win guaranteed healthcare for all people living in the United States,” said Jean Ross, Co-President of National Nurses United, and a registered nurse from Minnesota.
“As registered nurses, we see the horrific impacts of our for-profit health insurance system everyday at the hospital bedside. Tens of millions of people don’t have insurance, while millions more can’t afford the costs of the deductibles and copays. As a result, too many patients go without care. We see patients everyday who can’t afford the costs of the lifesaving treatments or medications that they require, and we see the devastation that these realities cause for their families,” Ross continued.
“But there is a solution to end this unnecessary suffering. Through an improved Medicare for All system, every person living in the United States could receive the healthcare services they need. Every other industrialized nation has used a similar approach to guarantee quality healthcare for its residents, and it’s time that the United States did the same.”
Former Congressman John Conyers Jr., who resigned in December, previously introduced HR 676. The bill has received groundbreaking support in this congressional session, with 120 democratic members of congress cosponsoring the legislation.
“In the past year, the movement for a single-payer healthcare system has turned a new page,” said Bonnie Castillo, RN, Executive Director of National Nurses United. “We have seen huge growth in both public and political support for improved Medicare for All. “Our patients know that they are being short-changed by the current for-profit health insurance system, and they are demanding Medicare for All. In Congress, the movement for healthcare justice has a new champion, Keith Ellison, who shares the nurses’ values of caring, compassion and community. NNU looks forward to working with Rep. Ellison, and with everyone who shares those values, to build a truly just healthcare system.”
National Nurses United is the nation’s largest union of registered nurses, and represents 150,000 nurses across the country. For her part, Jean Ross believes that the fight for Medicare for All is necessary for her profession, saying “as nurses, we have a duty to advocate for our patients, and we know that Medicare for All is the best solution for our patients.”
Letter to the editor: Worker health coverage needs rethinking
by Dan Bryant - Portland Press Herald - March 7, 2018
The recent contract negotiations between union workers and Hannaford provides an opportunity to examine the health care model.
Employment-based health insurance, now covering 56 percent of the nonelderly population, was introduced during World War II to help employers avoid wage controls. The issue of health care coverage in the recent contract negotiationsbetween United Food and Commercial Workers Local 1445 and the company that operates the South Portland Hannaford distribution center provides an opportunity to examine that persisting model. When we do, several problems leap out.
• Employers are saddled with the unpredictable cost and hassle of insuring workers, while remaining vulnerable, as in the Hannaford case, to the threat of strikes. (A 2003 strike over health care benefits in Southern California cost three grocery chains over $2 billion.)
“In most labor negotiations during the past 30 years, more time and effort has probably been spent on the health care plans provided by labor agreements than on any other contract provisions, including pensions,” attorney Arthur Smith Jr. wrotein HR Magazine in 2013.
• Workers can’t see what they’re paying for health insurance within overall labor costs, have no guarantee that their plan or network will remain the same and risk losing coverage if they leave for any reason (the average worker has 11.9 jobs from age 18 to age 50, according to the Bureau of Labor Statistics). An employer’s retention advantage can be an employee’s job lock.
• When commercial insurers insure employees, they are cherry-picking the healthiest demographic, leaving the poorest, sickest and oldest pool to be funded by increased taxes and cost-shifting. And sometimes blamed (“state patients”).
The possibility of another strike at a Hannaford distribution center may not be as newsworthy as assault weapons or Russian meddling, but it should serve to remind us, when we get back to the issue of health care reform, that we should not let outdated conventions and entrenched interests keep us from rethinking the relevance of today’s workplace to today’s health care.
Daniel Bryant
Cape Elizabeth
Quebec doctor embarrassed by pay hikes to colleagues
by Susan Schwartz - Montreal Gazette - March 2, 2018
Embarrassed. That’s how Dr. Arnold Aberman feels about pay increases for doctors in a system where many health care employees are overworked to the point of exhaustion and patient access to needed services is often severely limited.
By noon on Friday, 648 Quebec doctors, including the Beauharnois-based general practitioner, had signed an open letter made public Feb. 25 by Médecins Québécois pour le régime public (MQRP) demanding that a series of pay increases negotiated on their behalf by their professional associations be cancelled, and calling for a better distribution of resources “for the good of health care workers and to assure health services that the Quebec public deserves.”
The letter is critical of, among other things, a lack of access to services for patients in light of “draconian cuts” in recent years by Quebec, abysmal working conditions for nurses and other health care workers, and the wresting of power from such local establishments as hospitals and its centralization with the provincial health ministry.
“I signed the letter because I think the health care system has been deteriorating for the past 15 or 20 years,” said Aberman. At 68, he has worked at the CLSC de Beauharnois for his entire career, since completing his residency in 1976. He and the 500 doctors, residents and medical students who belong to the MQRP feel the money paid to doctors could be used elsewhere to improve the system.
“You look at all the cutbacks, at the situation of nurses and all the other employees, including the maintenance and kitchen staff in hospitals, and how the conditions are deteriorating. And the doctors are getting paid more. There has to be a difference in salary. But I think the differences are extreme.”
Aberman cited a 2017 report from Quebec’s Institut de recherché et d’informations socioeconomiques, which found that in France, the average revenue for doctors is three times what it is for the average worker; in the United Kingdom it is four times the average — and, in Quebec, 7.6 times the average salary.
Doctors spend many years studying and training, often incurring significant debt, and on the job they shoulder a tremendous amount of responsibility for the care, even the lives, of others. They are also relatively well paid. In a 2017 document, the Canadian Institute for Health Information reported that the average annual salary for Quebec doctors in 2015 was $325,000. Surgeons’ salaries, on average, are higher: In Quebec, the figure was $381,000 for medical specialists, and $456,000 for surgical specialists. The average for general practitioners, or family doctors, was $255,000. These figures were slightly higher or slightly lower than those for doctors in other provinces, but generally comparable.
According to an agreement in principle made public Feb. 16 by the Liberal government, Quebec’s 10,000 specialists will get an 11.2 per cent increase spread over eight years at a cost of $511 million to the province. They are also entitled to certain retroactive increases intended in part to address the fact they were historically paid less than their counterparts in other provinces. Last fall, Quebec’s family doctors voted in favour of an eight-year deal featuring a pay raise of an average of about 14.7 per cent at the end of the contract in 2023.
Raises for doctors, the MQRP open letter says, are particularly egregious in light of stressful work conditions for nurses like forced overtime and unacceptably heavy patient loads. And the announcement of pay hikes for specialists barely two weeks after a cri de coeur on Facebook by an overworked young nurse in the Eastern Townships had gone viral and following weeks of public denunciations by nurses from across Quebec of overwork in hospitals seems to indicate an insensitivity to the prevailing winds of public opinion.
http://montrealgazette.com/news/local-news/quebec-doctor-embarrassed-by-pay-hikes-to-colleagues
Quebec doctor embarrassed by pay hikes to colleagues
by Susan Schwartz - Montreal Gazette - March 2, 2018
Embarrassed. That’s how Dr. Arnold Aberman feels about pay increases for doctors in a system where many health care employees are overworked to the point of exhaustion and patient access to needed services is often severely limited.
By noon on Friday, 648 Quebec doctors, including the Beauharnois-based general practitioner, had signed an open letter made public Feb. 25 by Médecins Québécois pour le régime public (MQRP) demanding that a series of pay increases negotiated on their behalf by their professional associations be cancelled, and calling for a better distribution of resources “for the good of health care workers and to assure health services that the Quebec public deserves.”
The letter is critical of, among other things, a lack of access to services for patients in light of “draconian cuts” in recent years by Quebec, abysmal working conditions for nurses and other health care workers, and the wresting of power from such local establishments as hospitals and its centralization with the provincial health ministry.
“I signed the letter because I think the health care system has been deteriorating for the past 15 or 20 years,” said Aberman. At 68, he has worked at the CLSC de Beauharnois for his entire career, since completing his residency in 1976. He and the 500 doctors, residents and medical students who belong to the MQRP feel the money paid to doctors could be used elsewhere to improve the system.
“You look at all the cutbacks, at the situation of nurses and all the other employees, including the maintenance and kitchen staff in hospitals, and how the conditions are deteriorating. And the doctors are getting paid more. There has to be a difference in salary. But I think the differences are extreme.”
Aberman cited a 2017 report from Quebec’s Institut de recherché et d’informations socioeconomiques, which found that in France, the average revenue for doctors is three times what it is for the average worker; in the United Kingdom it is four times the average — and, in Quebec, 7.6 times the average salary.
Doctors spend many years studying and training, often incurring significant debt, and on the job they shoulder a tremendous amount of responsibility for the care, even the lives, of others. They are also relatively well paid. In a 2017 document, the Canadian Institute for Health Information reported that the average annual salary for Quebec doctors in 2015 was $325,000. Surgeons’ salaries, on average, are higher: In Quebec, the figure was $381,000 for medical specialists, and $456,000 for surgical specialists. The average for general practitioners, or family doctors, was $255,000. These figures were slightly higher or slightly lower than those for doctors in other provinces, but generally comparable.
According to an agreement in principle made public Feb. 16 by the Liberal government, Quebec’s 10,000 specialists will get an 11.2 per cent increase spread over eight years at a cost of $511 million to the province. They are also entitled to certain retroactive increases intended in part to address the fact they were historically paid less than their counterparts in other provinces. Last fall, Quebec’s family doctors voted in favour of an eight-year deal featuring a pay raise of an average of about 14.7 per cent at the end of the contract in 2023.
Raises for doctors, the MQRP open letter says, are particularly egregious in light of stressful work conditions for nurses like forced overtime and unacceptably heavy patient loads. And the announcement of pay hikes for specialists barely two weeks after a cri de coeur on Facebook by an overworked young nurse in the Eastern Townships had gone viral and following weeks of public denunciations by nurses from across Quebec of overwork in hospitals seems to indicate an insensitivity to the prevailing winds of public opinion.
http://montrealgazette.com/news/local-news/quebec-doctor-embarrassed-by-pay-hikes-to-colleagues
by Susan Schwartz - Montreal Gazette - March 2, 2018
Embarrassed. That’s how Dr. Arnold Aberman feels about pay increases for doctors in a system where many health care employees are overworked to the point of exhaustion and patient access to needed services is often severely limited.
By noon on Friday, 648 Quebec doctors, including the Beauharnois-based general practitioner, had signed an open letter made public Feb. 25 by Médecins Québécois pour le régime public (MQRP) demanding that a series of pay increases negotiated on their behalf by their professional associations be cancelled, and calling for a better distribution of resources “for the good of health care workers and to assure health services that the Quebec public deserves.”
The letter is critical of, among other things, a lack of access to services for patients in light of “draconian cuts” in recent years by Quebec, abysmal working conditions for nurses and other health care workers, and the wresting of power from such local establishments as hospitals and its centralization with the provincial health ministry.
“I signed the letter because I think the health care system has been deteriorating for the past 15 or 20 years,” said Aberman. At 68, he has worked at the CLSC de Beauharnois for his entire career, since completing his residency in 1976. He and the 500 doctors, residents and medical students who belong to the MQRP feel the money paid to doctors could be used elsewhere to improve the system.
“You look at all the cutbacks, at the situation of nurses and all the other employees, including the maintenance and kitchen staff in hospitals, and how the conditions are deteriorating. And the doctors are getting paid more. There has to be a difference in salary. But I think the differences are extreme.”
Aberman cited a 2017 report from Quebec’s Institut de recherché et d’informations socioeconomiques, which found that in France, the average revenue for doctors is three times what it is for the average worker; in the United Kingdom it is four times the average — and, in Quebec, 7.6 times the average salary.
Doctors spend many years studying and training, often incurring significant debt, and on the job they shoulder a tremendous amount of responsibility for the care, even the lives, of others. They are also relatively well paid. In a 2017 document, the Canadian Institute for Health Information reported that the average annual salary for Quebec doctors in 2015 was $325,000. Surgeons’ salaries, on average, are higher: In Quebec, the figure was $381,000 for medical specialists, and $456,000 for surgical specialists. The average for general practitioners, or family doctors, was $255,000. These figures were slightly higher or slightly lower than those for doctors in other provinces, but generally comparable.
According to an agreement in principle made public Feb. 16 by the Liberal government, Quebec’s 10,000 specialists will get an 11.2 per cent increase spread over eight years at a cost of $511 million to the province. They are also entitled to certain retroactive increases intended in part to address the fact they were historically paid less than their counterparts in other provinces. Last fall, Quebec’s family doctors voted in favour of an eight-year deal featuring a pay raise of an average of about 14.7 per cent at the end of the contract in 2023.
Raises for doctors, the MQRP open letter says, are particularly egregious in light of stressful work conditions for nurses like forced overtime and unacceptably heavy patient loads. And the announcement of pay hikes for specialists barely two weeks after a cri de coeur on Facebook by an overworked young nurse in the Eastern Townships had gone viral and following weeks of public denunciations by nurses from across Quebec of overwork in hospitals seems to indicate an insensitivity to the prevailing winds of public opinion.
http://montrealgazette.com/news/local-news/quebec-doctor-embarrassed-by-pay-hikes-to-colleagues
Hundreds of Canadian doctors demand lower salaries
Amy B Wang, The Washington Post • March 8, 2018
In a move that can only be described as utterly Canadian, hundreds of doctors in Quebec are protesting their pay raises, saying they already make too much money.
As of Wednesday afternoon, more than 700 physicians, residents and medical students from the Canadian province had signed an online petition asking for their pay raises to be canceled. A group named Medecins Quebecois Pour le Regime, which represents Quebec doctors and advocates for public health, started the petition Feb. 25.
“We, Quebec doctors who believe in a strong public system, oppose the recent salary increases negotiated by our medical federations,” the petition reads in French.
The physicians group said it could not in good conscience accept pay raises when working conditions remained difficult for others in their profession — including nurses and clerks — and while patients “live with the lack of access to required services because of drastic cuts in recent years.”
A nurses union in Quebec has in recent months pushed the government to address a nursing shortage, seeking a law that would cap the number of patients a nurse could see. The union said its members were increasingly being overworked, and nurses across the province have held several sit-ins in recent months to push for better working conditions.
In January, the situation was encapsulated in a viral Facebook post by a nurse in Quebec named Emilie Ricard, who posted a photo of herself, teary-eyed, after what she said had been an exhausting night shift. Ricard said she had been the only nurse to care for more than 70 patients on her floor; she was so stressed that she had cramps that prevented her from sleeping, she added.
“This is the face of nursing,” Ricard wrote, criticizing Quebec Health Minister Gaetan Barrette, who had deemed recent health care system changes a success.
“I don’t know where you’re going to get your information, but it’s not in the reality of nursing,” the nurse wrote. She later added: “I am broken by my profession, I am ashamed of the poverty of the care that I provide as far as possible. My Health system is sick and dying.”
Ricard’s post has since been shared more than 55,000 times.
“There’s always money for doctors, she says, but what about the others who take care of patients?” said Nancy Bedard, president of Quebec’s nurses union, according to Global News.
Meanwhile, in February, Quebec’s federation of medical specialists reached a deal with the government to increase the annual salaries of the province’s 10,000 medical specialists by about 1.4 percent, or from $4.7 billion currently to $5.4 billion in 2023, Canadian Broadcasting Corp. News reported. The average salary for a specialist in Quebec is already high — $403,537 annually — compared with $367,154 in neighboring Ontario, according to CBC.
“The only thing that seems to be immune to the [health-care system] cuts is our salaries,” the petition by Medecins Quebecois Pour le Regime, the doctors group, stated. “Contrary to the Prime Minister’s statements, we believe that there is a way to redistribute the resources of the Quebec health system to promote the health of the population and meet the needs of patients without pushing workers to the end.”
The petition ended by asking that the salary increases be canceled and the money be redistributed throughout Quebec’s health care system.
It is unclear what will become of the petition. Barrette, the health minister, addressed the issue shortly after the petition was started.
“If they feel they are overpaid, they can leave the money on the table,” he said Feb. 26, according to CBC. “I guarantee you I can make good use of it.”
Barrette also said that the issue of working conditions for medical personnel such as nurses was something “that has to get our total attention,” according to the Toronto Star.
“We have the money to address that,” he told the newspaper. “That doesn’t mean we have infinite amounts of money, but we have the capacity to resolve that issue once and for all.”
Taxpayers — not Big Pharma — have funded the research behind every new drug since 2010
by Alexander Zaitchick - Social Security Works - March 2, 2018
Something odd happened when the Trump administration submitted the original version of its latest pro-corporate budget: Big Pharma didn’t like it.
The problem wasn’t a tax hike or new regulations: the problem was that the budget included deep cuts to the budget of the National Institutes of Health.If those cuts had gone through, they would have exposed one of the biggest lies told about Big Pharma: that the current system of patents and price-gouging is just an unfortunate necessity to cover the cost of all their brave and noble R&D work.Trump’s original spending proposal for fiscal year 2019, released last month, included major cuts to not just to the NIH, but the National Science Foundation as well. It is those two publicly funded entities — not Big Pharma — that support the bulk of the country’s basic research into diseases and pathways to new treatments.
That’s why the cuts were especially unwelcome in the executive suites of drug and biotech companies. Their business models depend on Washington subsidizing expensive, high-risk basic research, mostly through the vast laboratory network funded by the NIH.
Just how important is our publicly funded research to Big Pharma and Biotech? According to a new study by a small, partly industry-funded think tank called the Center for Integration of Science and Industry (CISI), it is existentially important. No NIH funds, no new drugs, no patents, no profits, no industry.
The CISI study, underwritten by the National Biomedical Research Foundation, mapped the relationship between NIH-funded research and every new drug approved by the FDA between 2010 and 2016. The authors found that each of the 210 medicines approved for market came out of research supported by the NIH. Of the $100 billion it spent nationally during this period, more than half of it — $64 billion — ended up helping the development of 84 first-in-class drugs.
But the NIH doesn’t get to use the profits from these drugs to fund more research, the way it might under a model based on developing needed drugs and curing the sick, as opposed to serving Wall Street. Instead, publicly funded labs conduct years of basic research to get to a breakthrough, which is then snatched up, tweaked, and patented (privatized) by companies who turn around and reap billions with 1,000-times-cost mark-ups on drugs developed with taxpayer money.
Those companies then spend the profits on executive bonuses and share buybacks, and lavish mass marketing campaigns to increase sales of amphetamines, benzos, opioids, and dick pills.
And with what’s left over, they lobby to keep threats to this massive scam at bay, all while scooping up more NIH-funded breakthroughs and starting the process anew.
This scam is worth a lot of money and is not easily messed with, as sacred as federal research benefiting military contractors. After Trump reversed his proposed research cuts last month, Bloomberg published an investor-soothing excuse article with the title, “The NIH appears Trump-proof.” The reporter, Max Nisen, explained, “NIH funds [are] a backbone of the research ecosystem on which [biotech and drug companies] depend. The better the NIH does, the better they do.”
The new CISI study was actually designed and written to reinforce this status quo: By showing federal research to be crucial to the current drug-pipeline, its authors hoped to provide ballast against Trump’s proposed cuts, which threatened the development of new drugs.
The study stops there, but for those not committed to the current system of patents and profit, its findings provide a leaping-off point to bigger questions. Such as:
If government-funded science is doing such a great job at basic research, why not provide additional funding for the development and testing of drugs?
If private industry isn’t doing basic research, and continues to gut long-flat-lined R&D budgets, what the hell are they spending their money on? (That one has an answer; see graph below)
Why are we allowing drug companies to gain proprietary control over taxpayer-funded research, then turn around and price-gouge those same taxpayers to literal death?
These are the questions driving a growing Drug Access movement that seeks to replace the current monopoly-patent paradigm with open science collaborations, generic license regimes, and a “NASA for drugs” focused on developing critical, life-saving medicines and ensuring they remain affordable.
For advocates of this new paradigm, the CISI data amplifies what they’ve been saying for years.
“The CISI study is further evidence of a broken system where taxpayers fund the riskier part of drug development, then once the medicines show promise, they are often privatized under patent monopolies that lock in exorbitant prices for 20 years or longer,” says Bryn Gay, Hepatitis C Project Co-Director at the Treatment Action Group.
As an example, Gay points to new hepatitis C drugs that have become a global rallying cry for an end to drug patent monopolies. After the NIH funded $62.4 million for the basic science behind the breakthrough drug sofosbuvir, it was purchased by the firm Gilead for $11 billion. Gilead then turned around and priced at up to six-figures, even though a 12-week treatment course of costs less than $100 to produce.
“Companies have raked in profits of over $70 billion from hep C medicines, yet companies like Gilead and Janssen have walked away from additional hep C research, such as for a preventative vaccine,” says Gay. “The impact of NIH-funded research again demonstrates that we need to increase government funding for infectious and neglected diseases. We can’t rely on Pharma to set R&D agendas shaped by how much profit can be generated.”
Dean Baker, an economist at the Center for Economic and Policy Research, believes a publicly funded system is possible. A start-to-finish government drug pipeline, he estimates, would result in an 80 percent drop in the $450 billion Americans currently spend on prescription drugs. He estimates that the government could fund the development and testing of new drugs for an additional $50 and $80 billion a year — roughly the amount of money drug corporations have made from the hep C treatment alone.
“The industry wants us to believe the government can fund good basic research, but is incapable of developing and testing new drugs,” says Baker. That is, of course, not true. “[The CISI] analysis shows the enormously important government role in developing new drugs. We should start asking questions about how the government can see the process through so [new drugs] could be sold at generic prices the day they are approved by the FDA.”
Baker also notes a government-run drug pipeline would likely result in safer drugs as well as cheaper drugs, as all clinical tests would be made fully public as a condition of funding.
The lords of the current paradigm fear rigorous and transparent clinical trials almost as much as paying for their own R&D. Last year, when the industry and its political allies drafted the 21st Century Cures Act, everybody cheered its cancer “moonshot” funding, but few noticed the section weakening the rules and regulatory oversightaround clinical trials.
In other words, the same people getting rich off your taxes are willing to risk your life and a slap on the regulatory wrist for a slightly faster route from NIH-funded science to the bank.
https://other98.com/taxpayers-fund-pharma-research-development/
US cancer network recommending expensive drugs based on weak evidence, study finds
by Jessica Glenza - New York - March 7, 2018
Guidelines for American oncologists often recommend expensive and harmful cancer drugs for patients based on “weak evidence”, according to a new study in the British Medical Journal.
The BMJ research looked at drugs recommended for conditions not approved by the US Food and Drug Administration, a practice called “off-label” prescribing.
Off-label prescribing, or using a drug for purposes that may be well known but not approved by a regulatory agency, is common, especially in oncology. But recently approved cancer drugs can cost hundreds of thousands of dollars and have severe side-effects.
“They’re not your grandpa’s old cytotoxic drugs,” said Vinay Prasad, an oncologist at the Oregon Health and Sciences University, referring to early cancer drugs. “They are $100,000 drugs. They bring $1bn per year to the drugmakers.”
Prasad, the study’s lead author, said: “It would be one thing if we were talking about drugs that were cheap and have no side-effects.” He added that many recently approved cancer drugs “have risk-benefit analyses that are just tilted toward benefit. [But] you can get to a net harm condition.”
Prasad’s study looked at the US National Comprehensive Cancer Network, a body that publishes guidelines developed by oncologists. The NCCN’s recommendations influence treatment decisions and determine which cancer drugs insurers are required to pay for.
Medicare, a US public health insurance program for 55 million elderly and disabled Americans, is required to pay for all conditions NCCN recommends. Many private insurers follow suit. The NCCN’s role is similar to that of the National Institute for Health Care Excellence (Nice) in the United Kingdom.
In oncology, between 50% and 75% of current prescriptions are off-label, according to some estimates. It is illegal for drugmakers to advertise drugs for off-label uses.
Prasad’s study focused on 47 new drugs approved by the FDA between 2011 and 2015. The FDA approved those drug for 69 different indications. However, the NCCN recommended those drugs for 113 indications, 44 more indications than the FDA approved.
Only a minority of those additional recommendations were based on either randomized controlled trials (23%), considered the gold standard, or advanced-level phase three trials (16%). The team also followed up after 20 months on whether the FDA eventually approved medications for those 44 additional indications NCCN recommended. Only 14% were eventually approved by the FDA.
The study concluded that the research “raises concern that the NCCN justifies the coverage of costly, toxic drugs based on weak evidence”.
The report comes after recent research that found 90% of the researchers and physicians who helped develop the NCCN received money from the pharmaceutical industry.
“It’s clear with cancer drugs, one has to be very judicious about using them beyond where they’ve been studied,” said Prasad.
His advice to patients who might be trying new treatments is to ask about existing evidence.
“If you’re a cancer patient, I think it is so easy to get drawn into a discussion where the doctor starts to tell you of how a treatment should work,” said Prasad. “Patients have to force doctors to change the conversation from ‘how might this help me’, to ‘what is the evidence this drug helps patients like me?’”
Robert Carlson, the chief executive of the NCCN, said the guidelines rely on the “strongest scientific evidence available”.
“[The] NCCN’s 1,355 panel members come from 27 leading academic cancer centers in the United States,” he said. “Their expertise allows them to evaluate complex circumstances based on all available data, in order to come to a consensus about what constitutes optimal care.”
- This article was amended on 8 March 2018 to correct a misquote.
- https://www.theguardian.com/science/2018/mar/07/us-cancer-guidelines-study-british-medical-journal?
Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8
by Robert Pear - NYT - February 24, 2018
WASHINGTON — As consumers face rapidly rising drug costs, states across the country are moving to block “gag clauses” that prohibit pharmacists from telling customers that they could save money by paying cash for prescription drugs rather than using their health insurance.
Many pharmacists have expressed frustration about such provisions in their contracts with the powerful companies that manage drug benefits for insurers and employers. The clauses force the pharmacists to remain silent as, for example, a consumer pays $125 under her insurance plan for an influenza drug that would have cost $100 if purchased with cash.
Much of the difference often goes to the drug benefit managers.
Federal and state officials say they share the pharmacists’ concerns, and they have started taking action. At least five states have adopted laws to make sure pharmacists can inform patients about less costly ways to obtain their medicines, and at least a dozen others are considering legislation to prohibit gag clauses, according to the National Conference of State Legislatures.
Senator Susan Collins, Republican of Maine, said that after meeting recently with a group of pharmacists in her state, she was “outraged” to learn about the gag orders.
“I can’t tell you how frustrated these pharmacists were that they were unable to give that information to their customers, who they knew were struggling to pay a high co-pay,” Ms. Collins said.
Alex M. Azar II, the new secretary of health and human services, who was a top executive at the drugmaker Eli Lilly for nearly 10 years, echoed that concern. “That shouldn’t be happening,” he said.
Pharmacy benefit managers say they hold down costs for consumers by negotiating prices with drug manufacturers and retail drugstores, but their practices have come under intense scrutiny.
The White House Council of Economic Advisers said in a report this month that large pharmacy benefit managers “exercise undue market power” and generate “outsized profits for themselves.”
Steven F. Moore, whose family owns Condo Pharmacy in Plattsburgh, N.Y., said the restrictions on pharmacists’ ability to discuss prices with patients were “incredibly frustrating.”
Mr. Moore offered this example of how the pricing works: A consumer filling a prescription for a drug to treat diabetes or high blood pressure may owe $20 if he uses insurance coverage. By contrast, a consumer paying cash might have to pay $8 to $15.
Mark Merritt, the president and chief executive of the Pharmaceutical Care Management Association, which represents benefit managers, said he agreed that consumers should pay the lower amount.
As for the use of gag clauses, he said: “It’s not condoned by the industry. We don’t defend it. It has occurred on rare occasions, but it’s an outlier practice that we oppose.”
However, Thomas E. Menighan, the chief executive of the American Pharmacists Association, said that such clauses were “not an outlier,” but instead a relatively common practice. Under many contracts, he said, “the pharmacist cannot volunteer the fact that a medicine is less expensive if you pay the cash price and we don’t run it through your health plan.”
A bipartisan measure that took effect in Connecticut this year prohibits the gag clauses. It was introduced by the top Democrat in the Connecticut Senate, Martin M. Looney, and the top Republican, Len Fasano.
“This is information that consumers should have,” Mr. Looney said in an interview, “but that they were denied under the somewhat arbitrary and capricious contracts that pharmacists were required to abide by.”
Mr. Fasano said that consumers were sometimes paying three or four times as much when they used their insurance as they would have paid without it. “That’s price gouging,” he said in an interview.
The legislation, Mr. Fasano said, encountered “a lot of resistance” from large pharmacy benefit managers and some insurance companies.
In North Carolina, a new law says that pharmacists “shall have the right” to provide insured customers with information about their insurance co-payments and less costly alternatives.
A new Georgia law says that a pharmacist may not be penalized for disclosing such information to a customer. Maine has adopted a similar law.
In North Dakota, a new law explicitly bans gag orders. It says that a pharmacy or pharmacist may provide information that “may include the cost and clinical efficacy of a more affordable alternative drug if one is available.”
The North Dakota law also says that a pharmacy benefit manager or insurer may not charge a co-payment that exceeds the actual cost of a medication.
The lobby for drug benefit companies, the Pharmaceutical Care Management Association, has filed suit in federal court to block the North Dakota law, saying it imposes “onerous new restrictions on pharmacy benefit managers.”
Specifically, it says, the North Dakota law could require the disclosure of “proprietary trade secrets,” including information about how drug prices are set. “P.B.M.–pharmacy contracts typically preclude a pharmacy from disclosing to the patient the amount of a reimbursement,” the lawsuit says.
Gov. Asa Hutchinson of Arkansas, a Republican, said this past week that he would call a special session of the State Legislature to authorize the regulation of pharmacy benefit managers by the state’s Insurance Department.
He said he feared that some independent pharmacists receiving “inadequate reimbursement” from the benefit managers might go out of business, reducing patients’ access to care, especially in rural areas.
https://www.nytimes.com/2018/02/24/us/politics/pharmacy-benefit-managers-gag-clauses.html
'Needless and Ideologically-Driven Cruelty': Arkansas to Become First State to Implement Trump's Assault on Medicaid
by Jake Johnson - Common Dreams - March 5, 2018
The Trump administration is waging a vicious war on Medicaid—a program that provides life-saving healthcare to around 74 million Americans—and its effects will soon be felt in the state of Arkansas.
On Monday, Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma—who, prior to joining the Trump White House, helped craft Indiana's punitive Medicaid restrictions—hand-delivered and signed a federal waiver granting Arkansas permission to begin imposing work requirements on the state's Medicaid recipients, 60 percent of whom already work.
According to state officials, the measure will go into effect June 1, which would make Arkansas the first state to implement Medicaid work requirements.
In an article on Monday, Vox's Dylan Scott made clear that Arkansas' plan amounts to just a fraction of the broad nationwide attacks on Medicaid launched by red states, which are "putting the lifeline for millions of poor Americans at risk."
"The stakes are huge: Work requirements for food stamps have been linked to substantial drops—up to 50 percent in some isolated cases—in the program's enrollment," Scott observes. "As many as 25 million people could be subject to Medicaid work requirements if they were instituted nationwide. In a very real sense, health coverage for millions of Americans who rely on Medicaid could be at risk under the agenda Trump is advancing."
While Arkansas' Republican Gov. Asa Hutchinson insisted at a press conference that his plan "is not about punishing anyone," analysts argued that is precisely what it will do.
Citing provisions in the Arkansas waiver that will require those with disabilities to "prove" they are exempt from work requirements every two months and other forms of red tape, Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities (CBPP), argued in a blog post on Monday that the measure is "certain" to increase "the gaps in coverage, worsen health outcomes, and possibly increase state costs."
Brad Woodhouse, director of the advocacy group Protect Our Care, denounced Arkansas' plan as "draconian" in a statement following Hutchinson's announcement.
"By imposing onerous monthly paperwork requirements on working people and forcing Arkansans with disabilities to re-prove their exempt status every two months, today's Arkansas plan breaks new ground in needless and ideologically-driven cruelty," Woodhouse said.
Numerous analyses have found that paperwork requirements like those proposed by Arkansas and other states will likely lead to thousands of eligible people losing health insurance.
https://www.commondreams.org/news/2018/03/05/needless-and-ideologically-driven-cruelty-arkansas-become-first-state-implement?
In Battle Over Future of Veterans’ Care, Moderation Wins, for Now
by Nicholas Fandos and Dave Philipps - NYT - March 6, 2018
WASHINGTON — In an administration rife with intramural fights, the battle over the Department of Veterans Affairs has stood out, not only for its vitriol but also for its consequences. At stake is the future of the nation’s veterans health care system.
For now at least, it appears moderation has prevailed, with the Veterans Affairs secretary, David J. Shulkin, thwarting a pitched conservative push to drive him out.
“It’s my job as secretary to get the organization singly focused on making the V.A. work better for vets,” the secretary, a physician and holdover from the Obama administration, said in an interview on Monday, after the latest in a string of meetings with the White House chief of staff. “I’ve been making it clear to the organization that we will not be distracted as we have in the last couple weeks.”
“People need to get on board with that or need to leave,” he added.
For weeks now, Dr. Shulkin, a political moderate who was confirmed by the Senate 100 to 0, has been locked in a bitter and unusually public battle with a band of Trump administration officials who he said were out to overthrow him. The plotters included White House officials and the two men charged with safeguarding the secretary’s public image — who instead worked to undercut it, according to loyalists of the secretary.
Offstage lurked Concerned Veterans for America, part of the constellation of political groups funded by the billionaire libertarian-leaning activists Charles G. Koch and David H. Koch, in this case to push the department away from government-run veterans’ care and toward private care subsidized by the government.
Dr. Shulkin forced the fight into the open, running a one-man media operation via his own cellphone while betting that the White House would eventually offer reinforcements. On Monday, after meeting with the White House chief of staff, John F. Kelly, Dr. Shulkin signaled that his gamble had paid off.
He said in an interview that President Trump and Mr. Kelly supported his making changes at the department, including the removal of any staff members who did not support him. Mr. Kelly made no mention of finding a new secretary, Dr. Shulkin said, and the White House press secretary, Sarah Huckabee Sanders, publicly expressed her support.
Staff changes could be announced on Wednesday, Dr. Shulkin said, without providing details. Whether he can prevail in actually firing the officials — rather than just having them transferred elsewhere in the government — remains to be seen. Political appointees serve at the pleasure of the president, and it was not clear whether Mr. Kelly or Mr. Trump would back their ouster.
At the root of the dispute is a long-running battle over how to deliver health care to the nation’s veterans. The department, the federal government’s second largest, operates more than 1,200 hospitals and clinics across the country where about nine million veterans receive treatment at little or no cost. In limited cases, it pays for veterans to see private doctors.
Policymakers in both parties argue that offering veterans unrestricted choice between the public veterans health care system and private medical providers would be too expensive and lead to the dismantling of the Veterans Affairs system. They have generally favored a more measured approach that would allow the department to approve the use of private care when waiting times are too long at veterans’ hospitals or when veterans live too far from the department’s facilities.
Enter the Trump administration: Mr. Trump has promoted greater choice as a top priority and surrounded himself with several conservative advisers supportive of greater privatization. Darin Selnick, a former senior adviser to the Koch-funded group, serves as the veterans affairs adviser for the White House’s Domestic Policy Council.
Dr. Shulkin, who led the department’s health care system under President Barack Obama, has aligned himself with the more moderate position. As more conservative officials see it, that has put him out of line with the White House view on the department’s most pressing policy issue.
In addition to the two top communicators — Curt Cashour, Dr. Shulkin’s press secretary, and John Ullyot, the assistant secretary responsible for communications — Dr. Shulkin is likely to target several officials close to the White House. They are Jake Leinenkugel, the White House senior adviser on veterans affairs, and Camilo Sandoval, a former data manager for the Trump campaign who was given a political post at the department.
Mr. Leinenkugel, a former brewery executive, wrote an email to Mr. Sandoval in December outlining his falling out with Dr. Shulkin over policy issues. Mr. Leinenkugel proposed using a then-continuing inspector general investigation to oust Dr. Shulkin’s chief of staff; replacing the deputy secretary, Thomas G. Bowman, with Mr. Leinenkugel; and replacing Dr. Shulkin with a “strong political candidate” with ties to the Koch-based group.
The dispute boiled over last month when the department’s inspector general released a scathing report on a business trip that Dr. Shulkin took to Britain and Denmark last year. The report found “serious derelictions” related to the trip and concluded that the secretary spent much of it sightseeing and improperly accepted a gift of Wimbledon tickets. It also accused Dr. Shulkin’s chief of staff at the time of altering an email to justify the department’s paying the airfare of Dr. Shulkin’s wife.
Political appointees trying to wrestle away control of the department seized on the report to force the secretary’s ouster. Shortly after its release, Mr. Cashour and Mr. Ullyot called a prominent House staff member to ask for backup, according to a Republican congressional aide familiar with the call. Mr. Ullyot told the staff member, Jonathan Towers, that Dr. Shulkin would be gone by the weekend and asked if House Republicans would advocate the secretary’s removal, the Republican aide said.
Mr. Towers, who works for the chairman of the House Veterans Affairs Committee, Representative Phil Roe of Tennessee, told Mr. Ullyot “no” on the spot, the aide said, and pointed out that Mr. Roe had released a statement of support for the secretary just a day before.
Mr. Cashour and Mr. Ullyot have disputed that account. The purpose of the call, they said, was to warn Mr. Towers that doubts raised about the inspector general report by Dr. Shulkin were unfounded. Tiffany McGuffee Haverly, a spokeswoman for Mr. Roe, said on Monday that the chairman continued to have confidence in Dr. Shulkin.
Dr. Shulkin, meanwhile, disputed the report’s conclusions and went around his press office to personally reach out to the news media and publicize concerns that appointees in his office were “trying to undermine the department from within.”
There were other examples. In recent months Dr. Shulkin began to use a new, more inclusive motto for the department, changing the phrase “To care for him who shall have borne the battle and for his widow, and his orphan” so that it included female veterans, a former department official said.
Mr. Ullyot, carrying out orders from the White House, reversed the decision, and Dr. Shulkin relented.
The secretary has not spoken directly with Mr. Ullyot in three weeks, since the report’s release. His critics within the administration said he had isolated himself and become paranoid.
Allies of Dr. Shulkin have suspected that the same faction could be behind ominous-sounding reports that have appeared in the press saying that the inspector general was on the verge of releasing another damaging report, this time about Dr. Shulkin’s use of his in-house security detail — a report that could provide a final blow to the secretary. A spokesman for the inspector general did not reply to a request for comment.
Asked about Monday’s meeting, Mr. Cashour replied with a seemingly unrelated statement. “President Trump tasked Secretary Shulkin with reforming the V.A. so it could better serve the men and women who sacrificed to protect our country,” Mr. Cashour said. “Many reforms have already been enacted, many more are still needed, but nothing will distract the president, the secretary and the department from finding the best ways to provide care and benefits to our country’s heroes.”
Cigna Agrees to Buy Express Scripts in Major Health Care Deal
by Chad Bray - NYT - March 8, 2018
The health insurance giant Cigna said on Thursday that it had agreed to buy the pharmacy benefits manager Express Scripts for $67 billion in cash and stock, including the assumption of $15 billion in debt.
The transaction adds to a string of deals in the health care sector as insurers and others seek to control costs and stave off a possible challenge from Amazon. The online retail giant announced in January that it was teaming up with Berkshire Hathaway and JPMorgan Chase to form an independent health care venture to serve the three companies’ employees and to possibly revamp the industry.
The news comes a little over a year after a judge blocked a proposed $48 billion merger of Cigna and Anthem, another major health insurer. Separately, a judge blocked a $37 billion deal between the health insurers Aetna and Humana last year.
“This combination accelerates Cigna’s enterprise mission of improving the health, well-being and sense of security of those we serve, and in turn, expanding the breadth of services for our customers, partners, clients, health plans and communities,” David Cordani, the Cigna president and chief executive, said in a news release.
Anthem said in October that it planned to start its own business to manage prescription-drug plans, partnering with CVS Health, the large pharmacy benefits manager and drugstore chain. Then, in December, CVS Health said it would mergewith the health insurer Aetna in a $69 billion deal that could reshape the way health care is delivered in the United States.
And just last month, the supermarket operator Albertsons said it would buy the remnants of the Rite Aid drugstore chain, in a bet that increased foot traffic from in-store pharmacies would drive more consumers to its stores to shop for other items.
Rite Aid itself had tried to bulk up its operations by merging with Walgreens, but negotiations ended after antitrust authorities indicated that they were unlikely to approve the combination last year. Instead, Rite Aid agreed last year to sell nearly 2,000 stores and three distribution centers to Walgreens.
Express Scripts, based in St. Louis, provides services to company-provided health plans like negotiating drug prices and arranging home delivery of some prescriptions. The company reported revenue of $100.3 billion in 2016 and employed about 25,000 people.
Under the terms of the deal, Express Scripts shareholders would receive $48.75 in cash and 0.2434 of a share of the combined company. That represented a 31 percent premium to the closing price of Express Scripts on Wednesday. Express Scripts was up 14 percent in premarket trading on Thursday.
After the transaction, Cigna shareholders will own about 64 percent of the combined company, and Express Scripts shareholders would own the rest. The transaction is expected to close by the end of the year and is subject to shareholder and regulatory approval.
The combined company would be named Cigna and would be based in Bloomfield, Conn., where Cigna currently has its headquarters. Express Scripts would continue to have its headquarters in St. Louis.
Mr. Cordani would serve as president and chief executive of the combined company, while Tim Wentworth, the Express Scripts chief executive, would serve as president of the Express Scripts business.
Morgan Stanley and the law firms Wachtell, Lipton, Rosen & Katz; and Paul, Weiss, Rifkind, Wharton & Garrison are advising Cigna. Centerview Partners and Lazard Frères & Company, and the law firms Skadden, Arps, Slate, Meagher & Flom and Holland & Knight, are advising Express Scripts.
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