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President Joe Biden delivers the State of the Union address before a joint session of Congress on February 7, 2023

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President Joe Biden used the pulpit during his State of the Union address this week to call for a universal price cap on insulin for all diabetes patients, but the proposal is highly unlikely to pass the current Congress.

Biden’s signature legislative achievement, the Inflation Reduction Act, capped insulin prices for Medicare beneficiaries at $35 a month, but the law doesn’t protect younger diabetic patients with private insurance or no insurance from higher prices.

“Let’s finish the work this time. Let’s cap insulin costs to $35 for everyone,” Biden told Congress Tuesday night.

As the President spoke, Sen. Jeanne Shaheen, DN.H., called on Congress to pass the Insulin Act that would extend the $35 price cap to those with private insurance. Shaheen co-sponsored the bipartisan legislation with Sen. Susan Collins, R-Maine, last July.

According to a report by Rand Corp. from 2021, the average price of insulin in the US in 2018 was 10 times higher than the average price in other wealthy countries.

While there is some bipartisan support for a universal price cap on insulin, the proposal will face an uphill battle and is unlikely to pass in a tightly divided Congress, where Democrats hold a slim majority in the Senate and Republicans weakly hold the House of Representatives represent.

Even when Democrats controlled both houses last summer, Senate Republicans managed to stop a measure that would have capped insulin prices for people with private insurance at $35 a month. Should the Senate pass the insulin bill, it would still face a House that is now in the hands of the GOP.

Rep. Cathy Rodgers of Washington, the Republican chair of the House Energy and Commerce Committee, wasted no time in real-time rejecting Biden’s proposal and sweepingly condemning state insulin price caps as “socialist” and a “federal mandate” that encourages competition harms .

“It’s time for the president to abandon his socialist pricing schemes and work to make insulin products more affordable without jeopardizing insulin competition and innovation,” Rodgers said in a statement released during the president’s address Tuesday night.

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Lisa Murdock, chief policy officer at the American Diabetes Association, acknowledged that extending the insulin price cap to those with private insurance will be an uphill battle in the ongoing Congress. However, Murdock noted that in the previous Senate, seven Republicans had voted for the cap.

“We’ve seen Republicans come forward and champion this measure, so I don’t want to say we think it’s out of reach — we’re still very committed to working with members on both sides of the aisle to do so.” that,” Murdock said.

The insulin market is dominated by Eli Lilli, Novo Nordisk And Sanofi. Industry reaction to Biden’s proposal was mixed.

Lilly supports expanding the $35 price cap to all Americans, spokeswoman Kristiane Bello said. The company has a program to provide insulin to patients regardless of their insurance status for $35 or less a month, Bello said.

Sanofi also supports a universal price cap of $35 for insulin and is already offering the drug at that price to the uninsured through a savings program, a company spokesman said.

Novo Nordisk fears that government drug price fixing will eventually limit patient access to new therapies, spokeswoman Nicole Araujo said.

Stephen Ubl, CEO of Pharmaceutical Research and Manufacturers of America, called insulin cost caps “a patch on a broken system that’s forcing people to pay more for drugs than health insurers and pharmacy benefit managers are paying.”

Last month, California sued insulin manufacturers and pharmacy service administrators CVS Caremark, Cigna’s Express scripts And Optum by United Health They claim they are using their market power to overcharge patients.

CNBC has reached out to pharmacy performance managers for comment on the president’s remarks.

According to the American Diabetes Association, about 40% of people with diabetes have private insurance and 5% have no insurance. One in five privately insured diabetes patients pays more than $35 a month for insulin, according to a survey by the Kaiser Family Foundation.

Although insulin prices vary depending on a patient’s insurance policy, in some cases, Murdock says, people pay hundreds of dollars a month for drugs they need to survive.

According to an analysis by the Health Care Cost Institute, about 9% of people taking insulin with insurance through their employer paid more than $200 out of pocket in 2019. According to the analysis, these people spent an average of $403 per month.

According to a Harvard study published in the Annals of Internal Medicine, an estimated 1.3 million US adults will have to ration their insulin due to price in 2021. Patients rationed by skipping doses, taking less insulin, or delaying the purchase of injections to save money.

States have taken matters into their own hands in the absence of a federal price cap on insulin in all forms of insurance. So far, 22 states and Washington, DC have capped the price of insulin. The cap ranges from $25 in Connecticut for a month’s supply to $100 in other states.

Abortion pill maker GenBioPro sued Wednesday to overturn West Virginia’s abortion ban because it restricts access to a drug approved by the Food and Drug Administration.

The lawsuit, filed in federal court in West Virginia’s Southern District, argues that FDA regulations on drugs such as the abortion pill preempt state laws under the US Constitution.

Access to the pill, called mifepristone, has become a major legal battleground following the Supreme Court ruling overturning federal abortion rights last June. A dozen states, including West Virginia, have adopted near-total abortion bans that outright prohibit the use of mifepristone.

The FDA approved mifepristone as a safe and effective method of terminating an early pregnancy more than 20 years ago, despite the agency placing restrictions on how the pill is distributed and administered.

Mifepristone, when combined with misoprostol, is the most common method used to terminate a pregnancy in the United States, accounting for about half of all abortions nationwide in 2020.

The FDA has eased many of its restrictions to expand access to mifepristone. During the Covid-19 pandemic, the agency allowed patients to receive the pill in the mail. Earlier this month, the FDA allowed retail pharmacies to begin dispensing mifepristone for the first time, so long as they become certified to do so.

However, bans like the one in West Virginia conflict with FDA regulations on mifepristone, raising the question of whether federal or state laws take precedence. Although the FDA has a congressional mandate to approve drugs for use in the U.S. market, states generally license the pharmacies that dispense these drugs.

GenBioPro argues in its lawsuit that the West Virginia state ban is unconstitutional because it violates the primacy and trade clauses of the US Constitution, which give the FDA the power to regulate what drugs are sold across the country.

“The individual government regulation of mifepristone destroys the national common market and conflicts with the strong national interest in ensuring access to a government-approved drug to terminate a pregnancy, resulting in the kind of economic disruption that the Framers intended to prevent by the clause,” argued GenBioPro’s attorneys in the lawsuit.

“A state’s policing authority does not extend to the functional prohibition of an article of interstate commerce — the Constitution leaves that to Congress,” the company’s attorneys wrote.

In another case, a North Carolina doctor on Wednesday asked a federal court to overturn state restrictions on mifepristone because they go beyond FDA regulations. In North Carolina, patients must receive the pill in person from a doctor at a certified facility.

“North Carolina’s imposition of restrictions beyond those that the FDA believes to be warranted as part of its regulatory balance, including restrictions that the FDA has specifically rejected, thwarts the objectives of federal law,” the doctor’s attorneys wrote in the complaint.

Anti-abortion activists, on the other hand, are pushing for mifepristone to be completely removed from the US market. A coalition of anti-abortion doctors has asked a Texas federal court to overturn mifepristone’s more than two-decade-old approval as safe and effective.

A decision in this case could be made as early as February.

Chuiyangliu Hospital, pictured in Beijing in January 2023, has completed renovations in recent years that have allowed daily patents to increase sixfold to 5,000 a day, official estimates say.

Yin Hon Chow | CNBC

BEIJING – Health, exercise and wellness top the shopping list for anyone in their late 20s and older in China. That’s according to an Oliver Wyman poll late last year, just as China was finally beginning to end its Covid controls.

Of those who plan to spend more on this health category, 47% said they plan to spend more on health insurance in December. That’s up from 32% in October, the report said.

“After this latest wave, there are much bigger health concerns, but after the entire pandemic, there has been a surge in health awareness among Chinese consumers,” said Kenneth Chow, director at Oliver Wyman.

Even for people in their early 20s, health comes second to plans to spend more on food, the survey found. The study ranked the categories based on the percentage of respondents who said they would spend more on each item, minus the percentage who said they would spend less.

The pandemic put pressure on hospitals around the world. But China’s situation — particularly since December’s spike in Covid cases — revealed the gulf between the local public health system and the country’s global economic clout, second only to the US

According to the World Bank, the U.S. ranks first in the world in per capita healthcare spending at $10,921 in 2019. For China, the same figure was $535, similar to Mexico.

Households in China also pay for a higher proportion of their healthcare — 35.2% versus 11.3% for Americans, World Bank data showed.

Extreme pressure on public hospitals — including lack of capacity — has pushed many new patients for Covid and non-Covid treatment at facilities operated by United Family Healthcare in China, said founder Roberta Lipson. She said her company has 11 international-standard hospitals and more than 20 clinics in major Chinese cities.

“Growing awareness of the importance of secure access to health care and of UFH as an alternative provider is leading to increased demand for our services from patients who can afford self-pay care,” she said.

“This experience is also driving interest in commercial health insurance, which could cover access to private premium providers,” Lipson said. “We’re helping patients understand the benefits of commercial insurance. This will have a profound impact on the volume of demand for personal healthcare.”

New Frontier Health, of which Lipson is vice chairman, acquired United Family Healthcare from TPG in 2019.

In early December, mainland China abruptly ended its strict Covid contact tracing measures. Official data showed that infections were rising sharply, with hospitalizations hitting a peak of 1.6 million nationwide on January 5.

Between December 8 and January 12, Chinese hospitals recorded nearly 60,000 Covid-related deaths – mostly seniors, according to Chinese health officials. As of Jan. 23, the total exceeded 74,000, according to CNBC estimates from official data.

Although new deaths per day have fallen sharply from the peak, the figures do not include Covid patients who may have died at home. Anecdotes describe a public health system overwhelmed with people at the peak of the wave and long waits for ambulances. Doctors and nurses worked overtime in hospitals, sometimes while they were sick themselves.

Health insurance

Most of China’s 1.4 billion people have so-called social health insurance, which provides access to public hospitals and reimbursement for medicines that are on a government-approved list. Both employers and their employees make regular payments to the state system.

Penetration of other health plans — including commercial plans — was just 0.8% in the third quarter of 2022, according to S&P Global Ratings.

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Analyst WenWen Chen expects commercial health insurance to grow rapidly this year and next. “After Covid, we see that people are becoming more risk-aware [health insurance] Agents find it easier to pick up conversations with customers.”

Chinese health insurance industry players include ping on, PICC And AIA. Local authorities are also testing a low-cost insurance product called Huimin Bao.

Oliver Wyman’s December survey found that 62% of non-policyholders plan to purchase health insurance and 44% of existing policyholders are considering increasing their coverage.

Over the past 15 years, the Chinese government has dedicated financial and political resources to the development of the country’s public health system. The subject was an entire section of Chinese President Xi Jinping’s report to a major political meeting in October.

hospital financing

However, one of the obstacles to improving China’s public health system is its fragmented funding system, according to Qingyue Meng, executive director of Peking University’s China Center for Health Development Studies.

Health care providers in China receive funding from four sources — social health insurance, the state health budget, basic public health programs and out-of-pocket payments — each “managed by different agencies without effective coordination in budget management and allocation,” Meng wrote in The Lancet in December.

“Hospitals and clinics are reluctant to offer public health care due to the lack of financial incentives and the important number of regulations that are more divergent,” he said[s] hospitals and [specialized public health organizations such as the Centers for Disease Prevention and Control].”

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For comparison, HCA healthcare, the largest hospital operator in the US, said more than half of its revenue comes from managed care — often corporate-subsidized plans with a network of healthcare providers — and other insurers. Most of HCA’s other revenue comes from Medicare and Medicaid state-related health insurance plans.

In China, United Family Healthcare’s Lipson claimed that as a privately held company, it could respond more quickly. “We fund our own growth and can acquire talent and expertise by offering competitive compensation packages, so we can also customize beds to the level of care required.”

“After observing the course of pandemic waves in other countries and our patients being paid privately, we were able to order sufficient stocks of medicines, PPE, etc. when we started to see the number of Covid cases increasing in China,” said called her.

Her company had excess capacity early in the pandemic, having opened four hospitals in the past two years, Lipson said, noting that the public system had added 80,000 intensive care unit beds in the past three years but was struggling to fill demand to cover the increase in Covid cases.

lack of specialists

Ultimately, the shock of the pandemic presents an opportunity for broader industry changes.

The healthcare payment system has no direct impact on China’s hospitals, as most are under direct government supervision, said George Jiang, consulting director at Frost&Sullivan.

But he said macro events could drive necessary systemic changes, such as B. Triple the capacity of the intensive care unit in one month.

China’s tiered medical system has forced doctors to compete for some advanced ICUs only in the largest cities, leading to shortages of qualified ICU doctors and beds, Jiang said. He said the recent changes mean smaller cities now have the capacity to hire such specialized doctors – a situation not seen in China in the past 15 years.

Now with more ICU beds, he expects China will need to train more doctors to this level of care.

There are many other factors behind the development of healthcare in China and why local people often go abroad for medical treatment.

However, Jiang noted that increased use of the internet for payments and other services in China compared to the US means the Asian country has the potential to become the most advanced medical digitization market.

Chinese companies already active in this space include JD Health and WeDoctor.

— CNBC’s Dan Mangan contributed to this report.

Correction: This story has been updated to reflect that Roberta Lipson is the Founder of United Family Healthcare and Vice Chair of parent company New Frontier Health.