EpiPen maker settles suit for $456 million, $9 million to Florida

Mylan Inc. settled allegations for $465 million it knowingly underpaid rebates owed to the Medicaid program for EpiPen products, officials said Friday.

Florida’s share is more than $9 million, Attorney General Pam Bondi said about the settlement that includes the federal government and states.

The products involve injections containing epinephrine, a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe or sometimes life-threatening conditions including low blood pressure, wheezing, severe skin itching, hives and other symptoms of an allergic reaction.

EpiPen’s makers have been under fire for price increases of more than 450 percent for medicines that children and others need.

The settlement arises from False Claims Act litigation involving, among other parties,  Ven-a-Care of the Florida Keys Inc.


No Trumpcare cuts to Medicaid? AARP says this ‘cut really is a cut’

Counselor to President Donald Trump Kellyanne Conway says GOP health plans “are not cuts to Medicaid” but a slowing of growth, but an AARP analysis says “this cut really is a cut.”

Kellyanne Conway

An AARP  policy blog post says the Senate bill “will lead to major, harmful reductions in both federal and state Medicaid spending.”

The Congressional Budget Office says Medicaid spending under the Senate’s Better Care Reconciliation Act would be 26 percent lower in 2026 than compared to keeping current law, and the gap would widen to about 35 percent in 2036.

Florida GOP Sen. Marco Rubio tweeted before the July 4 break that reporting on Medicaid “cuts”  is often misleading about states including Florida that did not expand Medicaid.  As long as the amount of federal money that goes to the state is “fair,” he said “no one currently on or eligible for Medicaid should lose coverage.”

The Senate is expected to resume work on the bill after the holiday break.

But groups already getting care from Medicaid in Florida stand to lose under a plan that caps federal Medicaid spending with a formula pegged initially to medical inflation and later general inflation, AARP figures.

According to an analysis from the AARP Public Policy Institute, reductions in  projected Medicaid spending as a result of the per capita caps in the Senate bill could be as much as 41 percent in 2036 across all populations. This includes older adults, adults with disabilities, and non-disabled children under age 19.

Medicaid covers 4 million Floridians, including half the childbirths, 70 percent of seniors in nursing homes and 41 percent of Palm Beach County’s children.

In the long run, CBO said, “states would continue to need to arrive at more efficient methods for delivering services (to the extent feasible) and to decide whether to commit more of their own resources, cut payments to health care providers and health plans, eliminate optional services, restrict eligibility for enrollment, or adopt some combination of those approaches.”

Medicaid fight hits 41% of Palm Beach Co. kids, up to 64% nearby

A battle in Washington over money for Medicaid affects 41 percent of Palm Beach County children, or more than 116,000, research released Wednesday says.

It’s an even bigger share in rural counties. For example, Medicaid covers 64 percent of the children in Okeechobee County, according to research announced by Georgetown University, the University of North Carolina and the Florida Policy Institute.

“When Florida children and families have health insurance coverage, the whole state benefits,” said Joseph F. Pennisi, executive director of the Lake Mary-based Florida Policy Institute. “Providing greater access to care can equate to fewer visits to emergency rooms, less uncompensated care and more people getting—and staying—healthy.”

The American Health Care Act passed by the House would cut more than $800 billion from Medicaid over a decade compared to leaving the Affordable Care Act intact. The Senate is considering the biggest legislative issue of President Trump’s early term now.

U.S. Rep. Brian Mast, R-Palm City, faced mostly hostile questions about the AHCA in a town hall meeting in Stuart Monday. He told questioners Medicaid spending will still rise and that what are called reductions include a winding down of Medicaid expansion that Florida chose not to pursue in the first place: “This is not a cut.”

Critics of the House bill counter that Floridians on Medicaid —  who also include 70 percent of the seniors in nursing homes — stand to lose if Medicaid funding is capped and handed to the states in block grants.

If Florida’s Medicaid money from the U.S. government had been capped to grow no more than the inflation rate from 2001 to 2011, the state would have received 17 percent less money than it actually did, an analysis by the Kaiser Family Foundation  found in March. That’s not precisely the formula the House bill would use, but the analysis highlighted the challenges of getting a capped amount right in a state where a lot of new people tend to move in, or live longer, or need more services than forecast. That would have left Florida among the 10 states hit hardest with billions of dollars in shortfalls, the analysis said, forcing tough choices to cut coverage or services, slash other spending or raise taxes.

“Medicaid provides critical access to life-saving treatment and protection from rising health care costs to many children and families living in small towns and rural America,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “Cuts to Medicaid and other health care programs would take those protections away from many and risk financial ruin, denial of health care, or both.”

By 2015, the share of Palm Beach County’s children covered by Medicaid grew to 41 percent from 27 percent six years earlier, officials said. In the same span, the number of children lacking insurance in Palm Beach County was almost cut in half to 24,480, the research showed.

Overall, 57 percent of children in Florida’s small towns and rural areas receive Medicaid coverage and 44 percent do so in urban areas, the research found.

Children on Medicaid

County / Number / % of co. children on Medicaid

Palm Beach  116,570    41%

Martin          9,470        35%

St. Lucie     34,450       54%

Indian River   13,110    49%

Okeechobee  6,090      64%

Hendry         6,750        61%

Broward     179,900     43%

Miami-Dade 293,300  50%

Notes:  2014-5 data

Source:  Georgetown University Center for Children and Families, University of North Carolina Rural Health Research Program, Florida Policy Institute

Florida shares in Pfizer $784 million drug settlement

prescription medsWyeth, owned by Pfizer Inc., has agreed to a $784 million settlement involving claims it underpaid Medicaid rebates for drugs that inhibit stomach acid, officials said Tuesday.

Florida will received $9.3 million as part of the settlement, the Florida Attorney General’s Office said.

The settlement, which arises from whistleblower cases in Massachusetts, involves the drugs Protonix Oral and Protonix IV. Government officials alleged the company avoided its obligation to pay Medicaid rebates to states.