Editorial Roundup: Indiana
Indianapolis Business Journal. July 8, 2022.
Editorial: Pharmacy middlemen merit tougher regulations, scrutiny
If Indiana hasn't already launched an investigation into the less-than-transparent world of pharmacy benefit managers, it should.
These huge companies-including Express Scripts, OptumRx and CVS Caremark-operate as middlemen among pharmacies, drugmakers and health insurance plans to negotiate prescription drug prices.
They say they are saving consumers billions of dollars a year by demanding lower prices. But they are less than forthcoming about how big a slice of the pie they are keeping for themselves. And, as IBJ's John Russell reported last week, that lack of transparency has caused critics to accuse them of siphoning off billions that should go to patients as savings at the pharmacy counter.
Several states are investigating the industry or have reached settlements with a pharmacy benefit manager, also known as a PBM, which has repaid millions of dollars after being accused of overcharging state Medicaid or Medicare plans.
Trade journals such as Modern Healthcare and Fierce Pharma have reported that Indiana is among the states rumored to be investigating the industry. But Hoosiers don't know that for sure because Indiana Attorney General Todd Rokita's office hasn't responded to IBJ's request to discuss the issue.
Indiana lawmakers have attempted to regulate the industry, but their regulations haven't really taken hold.
Legislation was passed in 2020 to allow for the implementation of licensing rules and reporting requirements for PBMs. But the Indiana Department of Insurance still hasn't finalized the rules, so little oversight is actually occurring.
The Legislature also ordered the state Medicaid program to audit its pharmacy benefit manager. But that hasn't happened yet, either.
If Indiana officials would get on the stick, perhaps they could actually do something to help control the health care costs they so loudly bemoan.
Certainly, Indiana's hospital and insurance prices need to be examined, as legislative leaders already have pointed out.
A letter sent by House Speaker Todd Huston and Senate President Pro Tem Rodric Bray earlier this year asked Indiana hospital and insurance executives to come up with a plan to lower 'œout-of-control'ť health care costs. The letter noted that expenses charged by Indiana hospitals to cover their overhead and keep the doors open are the fifth-highest in the country, according to a 2020 study by the RAND Corp.
An easy first target that could immediately make a difference in lowering health care costs would seem to be the pharmacy benefit middlemen.
Several state Medicaid programs already have reached settlements with St. Louis-based insurer Centene over its PBM practices. It has agreed to pay $13.7 million to New Mexico, $27.6 million to Kansas, $88 million to Ohio and $55 million to Mississippi. The Federal Trade Commission also has launched an inquiry into the PBM industry.
Hoosier consumers and taxpayers also deserve assurances they aren't being overcharged.
That's why we urge Indiana's Republican legislative leaders to rev up regulations on PBMs and encourage their favorite attorney general to give the industry a hard look as well.
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Terre Haute Tribune-Star. July 6, 2022.
Editorial: Pence presents a fuzzy profile
Mike Pence is riding precariously along a craggy fault line in American politics.
On one side are those who once embraced Pence's hard-core religious conservatism but now are angry with him over his refusal as vice president to participate in President Trump's scheme to overturn the result of the 2020 election. On the other are those who oppose Pence's political ideology but applaud his unwillingness to buckle under Trump's pressure.
Labeling him a hero or villain depends on your perspective. And if you seek clarity or insight on the issue from Hoosiers who have watched him closely through the years, you likely won't get much help. In Indiana, Pence's legacy is, well, complicated.
When Trump plucked Pence from obscurity in 2016 to be his vice presidential runningmate, most Hoosiers greeted the news with ambivalence. Pence was serving the final year of a troubled first term as governor and was facing a tough reelection campaign. Polling showed him neck-and-neck with Democratic rival John Gregg. Incumbent GOP governors in Indiana are usually unbeatable.
Pence captured the governor's office four years earlier in a closer-than-expected race with the same Democrat who was challenging him again in 2016. As a former multi-term member of the U.S. House of Representatives, Pence was seen by political observers as using his position as governor to bolster his resume for a potential run for higher office. But a controversial first term did nothing to raise his national profile in a positive way.
He suffered a major black eye from the Religious Freedom Restoration Act, a clumsy piece of legislation he successfully pushed through the General Assembly. RFRA, as it was known, backfired spectacularly. It was seen as discriminatory against the LGBTQ community and triggered a nationwide backlash that grew in intensity against the state until the legislature and Pence amended it with assurances that no one could be discriminated against on the basis of sexual orientation.
Other Pence actions as governor did not sit well with constituents, including his slow response to an HIV epidemic in southeastern Indiana and his efforts to prevent Syrian refugees from settling in the state.
Trump saved Pence from a bruising reelection campaign. The duo then shocked the world with their unlikely Electoral College victory for president and vice president, and Pence spent the next four years as Trump's compliant wing man - at least until the closing days of the administration when Pence followed the law rather than his boss' bidding.
Pence deserves credit for shunning the attempt to subvert the democratic process. In doing so, he ensured the peaceful transfer of power in January of 2021 while making him a target of disdain and anger from Trump and his allies.
But is Pence a hero? That image of him is far from clear.
Despite Trump's ire directed at him and undemocratic actions following the election, Pence continues to praise the former president's record. That's not surprising.
It should be noted that Pence during his career has been a strong supporter of a free and independent press. Yet he stayed silent when the former president frequently attacked the news media as 'œenemies of the people.'ť
Yes, Pence's legacy is complicated. That's how it's destined to remain.
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Fort Wayne Journal Gazette. July 10, 2022.
Editorial: Indiana steps up funding, support for lead-exposed children
The Indiana Department of Health last week adopted a new rule expanding its definition of 'œelevated'ť levels of lead in a child's blood, and increased support for families with children who have high amounts of the toxin.
The Centers for Disease Control and Prevention lowered its threshold of elevated lead levels to 3.5 micrograms per deciliter from 5 micrograms in October 2021. Indiana's emergency rule on child lead levels now lines up with the federal guideline. State Health Commissioner Kris Box expects the state's lead caseloads to increase from 600 children annually to 2,000.
Matt LeBlanc, communications director for the Allen County Department of Health, told The Journal Gazette the department anticipated that change. Last month, it was awarded a state grant worth up to around $439,000 to reduce the harm of lead to children.
'œThis grant will assist in providing education, lead case management and identification of sources of lead for children under 7 and their families as we support them in making informed decisions about the health of their children,'ť said Josh Blauvelt, Vector Control and Healthy Homes program coordinator for the county health department's Environment Services Division. 'œEven at low levels, lead exposure can lead to serious health problems, which means testing and early intervention are extremely important.'ť
No level of lead exposure or lead in the body is safe, according to the CDC, but children are particularly at risk because of their size and developing brains. Lead exposure can affect every system in the body.
Even low levels in blood have shown negative effects to a child's intelligence, ability to pay attention and academic achievement.
There is some good news: Childhood lead poisoning is preventable. Allen County's state grant will be used to continue efforts to lessen the effects of lead on children and take on any new cases referred to the health department.
'œFunding is key to fighting any public health problem, and this grant allows us to continue the necessary and important fight against lead and its effects,'ť said county health department administrator Mindy Waldron.
Health care providers typically screen more than 4,000 Allen County children for lead exposure every year, LeBlanc said. About 80 of those children are then referred to the health department's Healthy Homes Program for case management services. Thirty-two children were referred to the health department in 2021, a lower number LeBlanc attributed to the COVID-19 pandemic.
Case management includes meeting with families and providing materials such as nutritional information and a developmental questionnaire. A timetable for retesting will be established and a risk assessment, which identifies home hazards such as lead-based paint, will be conducted. Case managers assess nutritional needs, make referrals for health services and determine whether child-development milestones are being met.
Homes constructed prior to 1978, when the federal government banned the use of lead-based paint, are most at risk for sources of lead.
This winter, Indiana will boost its efforts against childhood lead exposure. On January 1, 2023, the state will mandate health care providers offer universal lead screening to all children younger than 6. Until then, only children covered by Medicaid will be tested, at 12 and 24 months.
Lead is a critical issue for children in Indiana and across the nation. There are treatments, but preventing exposure to the toxin is of paramount importance. Finding and removing sources of lead from a child's environment can prevent further risk.
Kudos to the Indiana General Assembly for availing funds to increase lead testing and case management services at the county level to protect the state's most vulnerable population: its children.
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