Healthcare Costs and Policy Issues

A new study conducted by researchers from the Beth Israel Deaconess Medical Center found that rural living may pose a risk to consumers’ heart health. Their work showed that consumers who live in rural areas may struggle to get access to medical care for serious cardiovascular issues. 

“Although public health and policy efforts to improve rural health have intensified over the past decade, our findings highlight that large gaps in clinical outcomes for cardiovascular conditions remain in the United States,” said researcher Dr. Rishi K. Wadhera.

“These disparities suggest that rural adults continue to face challenges accessing the care they need for urgent conditions, an issue that has likely been magnified by the rapid rise in rural hospital closures over the last decade.” 

Identifying risks for rural consumers

For the study, the researchers analyzed data from more than two million consumers on Medicare. All of the participants were over the age of 65 and had been hospitalized with heart issues between 2016 and 2018. 

The researchers identified several concerns with rural health care, but especially with emergency health care in rural areas for cardiovascular patients. For starters, the study showed that mortality rates in rural hospitals were higher than in urban hospitals. The researchers also found that patients are less likely to receive typical procedures given to those having a heart attack or stroke in rural hospitals.

Despite these concerning findings, the study also revealed one positive outcome. 

“One bright spot is that we found that the subgroup of older adults who present to rural hospitals with a very severe type of heart attack – known as ST elevation myocardial infarction, or STEMI – experience similar outcomes as their urban counterparts,” Dr. Wadhera said. “This is good news, and suggests that concerted public health initiatives over the past decade, like regional systems of care and transfer protocols, have helped eliminate the rural-urban gap in outcomes for the most emergent type of heart attack.” 

What is different in rural areas? 

The researchers point to several different reasons for disparities in health care for patients in rural areas. They explained that many hospitals in these regions aren’t as well-staffed as hospitals in more populated areas. This can make it difficult for follow-ups, scheduling rehabilitation sessions, or even discharging patients following a cardiovascular issue. 

The researchers also found that rural hospitals aren’t as well-equipped for cardiovascular patients because they may lack the tools and resources necessary to properly treat these serious conditions. Additionally, the team explained that many hospitals in rural areas have closed in recent years. This adds the burden of travel to high-risk patients who require emergency care, which can make it difficult for them to receive treatments in a timely fashion. 

Moving forward, the researchers hope these findings emphasize the need for even stronger public health efforts geared towards emergency medical care in rural areas.  

“Our findings highlight that ongoing public health, policy, and clinical efforts are needed to close the gaps in outcome for urgent cardiovascular conditions, such as heart attacks and stroke,” said researcher Dr. Emefah C. Loccoh. 

The U.S. Food and Drug Administration (FDA) is working with various state governments to track down the origin of two new E. coli outbreaks. 

At this point, the agency says there are a lot of unknowns. What is known is that the illnesses have been caused by Shiga toxin-producing E. coli O157:H7 (STEC).

“We do not know what food is causing people to get sick or whether it involves an FDA-regulated food product,” said  Frank Yiannas, FDA deputy commissioner for Food Policy and Response. “However, we have seen similar recurring, emerging or persistent strains of E. coli in recent outbreaks.” 

“E. coli O157:H7 can contaminate many foods, and we cannot assume that the current outbreaks are linked to historically associated foods like romaine and other leafy greens,” the agency added. “There is no information currently to indicate that people should avoid any specific food.”

One of the E. coli outbreaks is being caused by a strain that is genetically related to a strain that caused the 2019 STEC outbreak linked to romaine grown in the California Central Coast Salinas growing region. To date, health officials have documented 23 cases and no deaths.

The second outbreak is being caused by a strain that is genetically related to a larger, diverse genetic cluster including the strain that caused the 2018 STEC outbreak linked to romaine and environmental isolates from the Yuma, Arizona growing region. To date, 21 cases and one death have been reported.

‘Transparency and early communication’

"We are issuing this update early in our investigation as part of our continued commitment to transparency and early communication,” Yiannas said. “We are also working toward making a new resource available soon on our website to provide early updates on new and active investigations.

Because the origin of the two outbreaks is still a mystery, consumers should take precautions when consuming uncooked produce. Produce should be carefully and thoroughly washed before serving. The FDA offers these guidelines for safe storage and preparation of produce.

The 2019 E. coli outbreak finally ended in January of this year, an outbreak linked to California-grown romaine lettuce. In total, 167 people across 27 different states were infected by tainted products. Of that number, 85 consumers were hospitalized and 15 developed hemolytic uremic syndrome, which is a type of kidney failure. Luckily, there were no deaths linked to the outbreak. 

While the risk of kids contracting scarlet fever hasn’t been a serious concern in nearly 80 years, a new study conducted by researchers from the University of Queensland found that the highly contagious infection has reemerged in recent years. Their work revealed that clones of the bacteria that cause scarlet fever are at the root of this resurgence, and keeping kids healthy is of the utmost importance. 

“The disease had mostly dissipated by the 1940s,” said researcher Dr. Stephen Brouwer. “After 2011, the global reach of the pandemic became evident with reports of a second outbreak in the U.K., beginning in 2014, and we’ve now discovered isolate outbreaks here in Australia.” 

“This global re-emergence of scarlet fever has caused more than a five-fold increase in disease rate and more than 600,000 cases around the world.”  

Bacterial clones

Because scarlet fever has been dormant for so long, the researchers were interested in discovering how the infection has reappeared in recent years. They began studying the Streptococcus pyogenes bacteria, which is what causes scarlet fever. They learned that copycat bacteria had evolved and added new toxins that produce an even greater immune response. 

“The toxins would have been transferred into the bacterium when it was infected by viruses that carried the toxin genes,” said researcher Mark Walker. “We’ve shown that these acquired toxins allow Streptococcus pyogenes to better colonise its host, which likely allows it to out-compete other strains. These supercharged bacterial clones have been causing our modern scarlet fever outbreaks.” 

The researchers explained that scarlet fever is spread the same way most bacterial infections are spread -- by an infected person coughing or sneezing near an uninfected person. Because young children are most susceptible to the virus, it can spread rather quickly. Case numbers have been low recently because of measures currently in place to protect consumers against COVID-19; however, the researchers worry about how that will change as children go back to school and social distancing protocols begin to ease up. 

“We need to continue this research to improve diagnosis and to better manage these epidemics,” said Walker. “Just like COVID-19, ultimately a vaccine will be critical for eradicating scarlet fever -- one of history’s most pervasive and deadly childhood diseases.” 

A new study conducted by researchers from Boston University School of Medicine found that consumers could be bringing toxic contaminants from work into their homes. 

The researchers say this trend is certainly a cause for concern, as the exposure to such chemicals could become a public health hazard. 

“Although OSHA [Occupational Safety and Health Administration] does regulate some key workplace exposures that can become take-home exposures, such as asbestos, lead, and pesticides, often regulations are not up to date or enforced enough to be protective at the family level,” said researcher Dr. Diana Ceballos. 

Affecting the household

Dr. Ceballos drew on her previous work with the Centers for Disease Control and Prevention (CDC), as well as several other studies that have evaluated the impacts of take-home exposures, to better understand how these chemicals can affect more than just the workers themselves. 

The researchers explain that regulations are put in place that are designed to protect workers, and ultimately the people they come into contact with after work hours. However, they found various cases in which these strategies didn’t hold up. The researchers found that systemic inequalities often make it difficult for workers to avoid potentially dangerous working conditions, as those who work in direct contact with contaminants can’t afford to lose their jobs by speaking up. 

This issue becomes compounded when workers live in buildings that are also contaminated with similar chemicals, as those who live there are getting double the exposure. Children are particularly vulnerable to such contaminants, as it takes lower levels of exposure for them to experience the side effects that come with these chemicals. 

Tighter regulations needed

While the researchers are calling for tighter regulations for all workers, they also explained that work needs to be done on all fronts, including improving housing units to ensure that workers aren’t putting themselves or their loved ones at risk. 

“To prevent the chronic, low-level, take-home exposures that are particularly harmful for developing children, a multi-tier intervention approach including interventions at the workplace, home, and community levels are needed,” said Dr. Ceballos. 

A California lawsuit has produced testimony that seems to confirm what many health insurance policyholders have long suspected.

In a deposition for a suit filed by a college student, the former medical director for Aetna revealed that he never looked at a patient's medical records before deciding whether to approve care.

The plaintiff in the case, 21 year-old Gillen Washington, said he was denied coverage for an infusion of intravenous immunoglobulin, which is used to treat a severe immune disorder. He is suing the health insurer in California state court.

CNN, citing a transcript from the case, quotes Dr. Jay Ken Iinuma, who served as Aetna's medical director for Southern California, as saying he always followed Aetna's training in these matters, which he said called for nurses to review the records and make recommendations to him.

California Insurance Commission investigating

However, that policy may not meet the standards of the state of California. CNN said it provided the deposition transcript to California Insurance Commissioner Dave Jones, who reacted by launching an investigation.

“If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California—and potentially a violation of law,” Jones told CNN.

According to the network, the court testimony also revealed that Iinuma knew little about the medical condition for which treatment was sought and was unaware of how best to treat it.

Company response

In a statement to CNN, Aetna said it looks forward to explaining its clinical review process for California regulators. It said its medical directors take their responsibilities seriously but also “work collaboratively with our nurses.”

Health insurance policies generally state the coverage they provide, spelling out what they cover. However, the insurance companies have discretion when the treatment is deemed "a medical necessity" rather than a covered benefit.

According to FamilyDoctor.org, a medical necessity is something the patient's doctor believes is necessary, whether it's covered or not.

Gillem's suit claims the requested treatment was covered by his Aetna policy and alleges the company's "reckless withholding of benefits almost killed him." Aetna denies that charge, saying Washington did not comply with its request for new blood work before it approved the treatment.

In an effort to reduce the rising tide of opioid-related deaths and addictions, pharmacy chain CVS has announced policy changes that will limit the supply of drugs consumers can access, expand its drug disposal program, and increase funding for drug abuse and support services.

Starting in February 2018, all commercial, health plan, employer, and Medicaid clients who are new to therapy will be limited to a seven-day supply for acute prescriptions, unless they choose to opt out. Daily dosages will also be limited based on their strength, and immediate-release formulations will be required before extended-release opioids can be dispensed.

CVS will also work with its pharmacists to more closely examine opioid prescriptions and contact physicians if the amount of medication seems excessive. Pharmacists and CVS employees will also provide community education and counseling services on subjects like prescription drug abuse, addiction, and how to dispose of unused medication.

“As America’s front door to health care, with a presence in nearly 10,000 communities across the country, we see firsthand the impact of the alarming and rapidly growing epidemic of opioid addiction and misuse,” said CVS Health President and CEO Larry J. Merlo.

“Today we are announcing an expansion of our enterprise initiatives to fight the opioid abuse epidemic that leverages CVS Pharmacy’s national presence with the capabilities of CVS Caremark, which manages medications for nearly 90 million plan members.”

Expanding disposal program and community services

On top of limiting access to opioids, CVS announced that it will be expanding its Medication Disposal for Safer Communities Program to include 1,550 kiosks and 750 additional disposal units across the country.

These locations – starting in states like Florida, Massachusetts, North Carolina, Pennsylvania, South Carolina, and Washington D.C. – will ensure that “people can safely dispose of unwanted medications” to curb cases of misuse and abuse, according to Richard Baum, acting director of the National Drug Control Policy.

As the last part of its initiatives, the CVS Health Foundation has agreed to invest an additional $2 million in federally-qualified community health centers that deliver medication-assisted treatment, addiction recovery, and prevention services.

Part of a larger effort

Merlo said that CVS’ newest initiatives are part of a larger effort by all healthcare stakeholders to address the opioid crisis in the U.S.

“Without a doubt, addressing our nation’s opioid crisis calls for a multi-pronged effort involving many health care stakeholders; from doctors, dentists and pharmaceutical companies to pharmacies and government officials,” he said.

“With this expansion of our industry-leading initiatives, we are further strengthening our commitment to help providers and patients balance the need for these powerful medications with the risk of abuse and misuse.”

Different companies have different policies when it comes to sick days and family leave. Some are more generous than others.

While debate continues in Washington over potential federal policies, various cities and states have moved ahead, putting their own policies into place.

Last year, Chicago passed a provision requiring employers in the city to provide paid sick days to their employees. A few months later, Cook County, Illinois adopted a similar policy.

A growing number of states also have paid sick leave policies, with Arizona becoming the most recent state to adopt one. It took effect last month and applies to both full and part-time employees, as well as contract workers. Interestingly, it does not apply to people who work for the federal and state governments.

Broad coverage

Most of the laws and ordinances are fairly broad. Employees generally can use sick days for themselves or to care for family members.

The types of illnesses eligible for the time off include any physical or mental illness, injury, or health condition; injuries caused by sexual violence, stalking, abuse, or domestic violence; or any sickness resulting from a public health crisis.

Here is a complete list of cities and states that have sick leave statutes and what those statutes require.

According to the Department of Labor, federal law does not require employers to provide paid sick leave. If the company you work for does provide it, the firm is not required to compensate you for unused sick leave if you take another job.

Family and Medical Leave Act

Federal law does require employers to provide up to 12 weeks of unpaid leave under the Family and Medical Leave Act (FMLA).

FMLA applies to all public employers and companies with 50 or more employees. The leave can be used to recover from a serious health condition, or to care for a family member.

NPR reports paid sick leave policies are beginning to gain some traction in a Republican-controlled Congress, mainly because companies are finding the growing number of state and municipal policies confusing.

One proposal would set a minimum amount of paid sick leave employers could voluntarily offer. By meeting that minimum, the employer would not be governed by state or local regulations.

Consumers are increasingly being exposed to potential serious injury when they take the wrong medication, in the wrong combinations, and in the wrong amount.

Researchers from the Center for Injury Research and Policy and the Central Ohio Poison Center studied 13 years worth of incident reports at poison control centers around the U.S.

They found serious medication errors per 100,000 residents surged 100% from 2000 to 2012. Rates increased for all age groups, with the exception of children younger than six years-old, a decrease likely attributable to a decline in the use of cough and cold medicines.

The study found that the areas where medication errors were most likely to occur were in the administering of cardiovascular drugs, analgesics, and hormones.

Not surprisingly, medical errors involving analgesics overwhelmingly involved acetaminophen and opioids. Cardiovascular and analgesic medications together accounted for the majority of all fatalities in the study.

“Drug manufacturers and pharmacists have a role to play when it comes to reducing medication errors,” said Henry Spiller, a co-author of the study.

Room for improvement

Spiller says there is room for improvement in product packaging and labeling. He says dosing instructions could be clearer, "especially for patients and caregivers with limited literacy or numeracy.”

The Food and Drug Administration (FDA) is working to reduce the number of medication errors in the U.S. Its Division of Medication Error Prevention and Analysis reviews medication error reports sent to MedWatch, evaluates causality, and analyzes the data to come up with solutions.

It also reviews proprietary names, labeling, packaging, and product design prior to drug approval to help prevent medication errors.

The Center for Injury Research and Policy study found that overall, medication errors typically involved taking or giving the wrong medication or incorrect dosage, or accidentally taking the same medication twice.

Among children, dosing errors were common, as was inadvertently taking or giving somoneone else’s medication.

To reduce errors, the researchers suggest writing down dosing instructions, including when and how much medication should be taken. They also urge patients to ask questions of doctors and pharmacists and to always use child-resistant packaging for medication.

Concerns over what experts call an opioid epidemic are continuing to grow in the U.S. Regulators and policymakers are taking a hard look at prescribing practices to mitigate the damage, but a new study shows that special attention should be paid to one vulnerable subsection of consumers.

Researchers from the University of Michigan and the Geisel School of Medicine at Dartmouth have found that out of the 115 million prescriptions written for opiates each year in the U.S., 60 million go to adults with some sort of mental illness or mood disorder, such depression or anxiety.

"Despite representing only 16 percent of the adult population, adults with mental health disorders receive more than half of all opioid prescriptions distributed each year in the United States," said lead author Matthew Davis, an assistant professor at the U-M School of Nursing.

Vulnerable patients

Further findings of the study show that a sizable chunk of the Americans who have been diagnosed with a mental health disorder are prescribed opioid drugs every year.

Out of 38.6 million Americans with such a diagnosis, more than 7 million receive a prescription (18%). That’s more than triple the number of adults without a mental disorder who are likely to get an opioid prescription (5%).

Study co-author Brian Sites says that these prescribing practices are extremely dangerous because people with mental illnesses are more likely to become dependent on opioid drugs. He recommends that officials re-assess current practices to better align with the best available therapies.

"Because of the vulnerable nature of patients with mental illness, such as their susceptibility for opioid dependency and abuse, this finding warrants urgent attention to determine if the risks associated with such prescribing are balanced with therapeutic benefits," he said.

The full study has been published in the Journal of the American Board of Family Medicine.

The Agriculture Department's Food Safety and Inspection Service (FSIS) has issued a public health alert regarding approximately 424 pounds of raw veal imported from the Netherlands by MRW Food Brokers in Owings Mills, Md.

The raw boneless veal may be contaminated with Non-O157 Shiga toxin-producing Escherichia coli (STEC) O103.

There have been no confirmed reports of illnesses due to consumption of the recalled products.

The veal was derived from calves slaughtered on March 8, 2017, and March 9, 2017, and further processed and packaged on March 9, 2017 and March 13, 2017.

The following products are covered by the alert:

• Boxes of chilled “Boneless Veal Cap” with case code of Londbos05597422 and lot code 0001.
• Boxes of chilled “Boneless Veal BHS” with case code of Londbos05597426 and lot code 0005.
• Boxes of chilled “Boneless Veal Inside” with case code of Londbos05597439 and lot code 0006.
• Boxes of chilled “Boned In Veal Rack Chop” with case code of SELEDEL05593535 and lot code 0012.

The recalled items were shipped to a distributor, and shipped to restaurants and grocery stores in Florida and Massachusetts.

What to do

Customers who purchased the recalled products should not to consume them, but throw them away or return them to the place of purchase.

A condition that causes life-threatening heart damage is quietly taking the lives of Americans, and less than 1% of all consumers who are infected are being treated for it.

Chagas disease, called the “silent killer” by researchers, affects nearly 300,000 people in the U.S., according to estimates from the Centers for Disease Control and Prevention (CDC). It is caused by a parasite called the triatomine bug, which can be found throughout North, South, and Central America. Around 30% of those who are infected go on to develop serious cardiac, digestive, and neurological disorders, and a recent study suggests that prevention efforts need to be stepped up to deal with the threat.

"Without treatment many Chagas patients are at risk of a ‘silent death’ due to heart failure. Our study ... underscores the critical importance of early detection and treatment to tackle this public health challenge in the US," said lead author Dr. Sheba Meymandi, director of the Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center.

Affects consumers nationwide

The study examined 4,755 Latin American-born residents of Los Angeles County to see how pervasive Chagas disease is in a select population; the disease is one of the leading causes of heart disease in Latin America. The researchers found that 1.24% of the participants tested positive for the condition.

Although the tests were focused on Latin American-born residents in a specific area, Meymandi and her colleagues believe that as many as 30,000 people may be infected in the greater Los Angeles area, which corroborates findings from the CDC which estimates that 300,000 people are infected nationwide. The team cites the need for further research to determine exactly how pervasive the disease is in certain areas of the country.

"The bugs that transmit Chagas disease live in 27 states -- the whole southern half of the country, and we know they sometimes infect people, but we need further research to determine how often this takes place," said researcher Colin Forsyth.

Few treatment options

Beyond the United States, statistics for Chagas disease are no less unsettling. Experts estimate that there are 5.7 million infected people worldwide, many of which hail from 21 Latin American countries.

The CDC says that Chagas disease usually comes with an acute or chronic stage immediately after infection that may last anywhere from a few weeks to several months. However, infections may be mild or asymptomatic and usually include fever and swelling around the site where the parasite entered the skin. In severe cases, inflammation of the heart muscle or the lining around the brain may also be present.

Currently, there are two drugs that are known to kill the parasites called benznidazole and nifurtimox. However, despite being available for over 40 years, the researchers say that neither has been registered for use in the U.S. by the Food and Drug Administration (FDA). They believe that providing access to these drugs and developing newer and better treatments will be vital towards curbing incidence rates.

The full study has been published in Clinical Infectious Diseases.

Kentucky Fried Chicken (KFC) has announced that, by the end of 2018, all of its chickens will be raised without the use of antibiotics medically important in human medicine.

That qualifier is important, drawing a distinction between drugs used to treat animals and those that treat humans. Still, it addresses a major consumer among health policymakers.

The Antimicrobial Resistance Learning Site at Michigan State University points out that many antibiotics are used both on animals and humans, and when it happens, it can hurt efficacy. For example, eating a lot of chicken or beef treated with human antibiotics might make that same drug less effective when it is administered to the person to treat an infection.

Complex change

"Making this change was complex and took a lot of planning,” said Kevin Hochman, president and chief concept officer for KFC U.S. It required close collaboration with more than 2,000 farms, most of them family-owned and managed, in more than a dozen U.S. states where they raise our chickens."

Both environmental and public health groups have long advocated eliminating antibiotics used by humans from the food chain. Lena Brook, food policy advocate at the National Resources Defense Council (NRDC) calls the KFC move “a game-changer” for the fast food industry's relationship with public health.

"The market is responding to consumer demand for better meat,” Brook said. “This commitment from the nation's most iconic fast food chicken chain will have a major impact on the way the birds are raised in the U.S. and in the fight against the growing epidemic of drug-resistant infections."

Sending ripples through the industry

In fact, when a fast food chain operating on a massive scale makes a decision like this, it has a way of sending ripples throughout the chicken industry. Last year, when McDonald's and several other large enterprises pledged to move to cage-free eggs, egg producers had to begin major changes to meet the anticipated demand.

Food sourcing has become a major issue for restaurants because it has become a big issue for consumers. As we reported last year, small companies taking a holistic approach to food production have begun to shake up the industry, and the large players have been forced to react.

In addition to its announcement about antibiotics, KFC pledged that by the end of next year, artificial colors and flavor will be gone from all core products. As of today, the company says all chicken, and most of its menu, is free of food dyes.

Federal agencies have been grappling with how to handle the increasing abuse of prescription opioid drugs. Last year, the FDA began an opioid drug policy review to address the drug approval process and prescribing policies, and the CDC released guidelines in the hopes of curbing the number of prescriptions.

While efforts such as these have gone a long way towards reducing dependence on opioids, a new study shows that the drugs still present a real danger – especially to children.

A study conducted by the Center for Injury Research and Policy and Nationwide Children’s Hospital shows that there were over 188,000 calls made to poison control centers between January 2000 and December 2015 for children who were exposed to opioids; that’s an average of 32 calls per day, or one call every 45 minutes.

"The opioid crisis which has been affecting our adult population has now trickled down to our children," said study author Dr. Marcel Casavant. "When adults bring these medications into their homes, they can become a danger to the children that live there.

Exposure to young children and teens

The researchers note that most opioid exposures (60%) were experienced by children aged 5 years and younger; teenagers were exposed approximately half as often (30%), but the severity of the exposure varied by age. The drugs that led to the most calls to poison control included hydrocodone (29%), oxycodone (18%), and codeine (17%).

For the youngest children, most instances of exposure occurred in the home and were managed by caregivers without serious medical outcomes. However, while these exposures were generally unintentional, over two-thirds of teens who were exposed to opioids did so intentionally.

This is a worrying statistic when taken with some of the other study findings. In particular, the researchers say that there was a 50% jump in opioid-related suspected suicides among teens during the 16-year study period. Teens were also more likely to be admitted to health care facilities for serious medical outcomes than other groups.

Casavant states that most teens get opioids from friends and family, so it is important to make sure all medications are kept in a safe place. “It is important that these medications are stored up, away and out of sight of kids of all ages, in a locked cabinet is best," he said.

Striking a balance

Physicians have long stated that restricting opioids is a tricky proposal, since so many consumers depend on them for pain relief. However, senior study author Dr. Gary Smith says that finding a solution is imperative going forward.

"As physicians, we need to find a balance between making sure that we are helping our patients manage their pain, and making sure we don't prescribe more or stronger medication than they need," he said.

"While overall rates of exposure to opioids among children are going down, they are still too high. We need to continue to examine our prescription practices and to increase education to parents about safe ways to store these medications at home to keep them out of the hands of children."

The full study has been published in Pediatrics.

While attention in Washington is focused on Obamacare, and whether or not to repeal it, a pharmacy management company says drug prices need attention too.

Express Scripts says rising prescription drug prices are taking a toll on government health programs. It has issued a study urging policymakers to adopt changes that would make it easier to hold down price hikes.

"Our country is engaged in an important dialogue about how best to provide millions of Americans with much needed pharmacy care, and how to deliver that care in the most affordable and sustainable way," said Dr. Glen Stettin, chief innovation officer at Express Scripts.

He says the company has identified several areas where policymakers should act to curb high prices and wasteful spending.

Medicare and Medicaid

The study found Medicare Part D plans, which provide prescription drug coverage, paid for more of the cost of drugs last year, reducing patients' out-of-pocket costs. It says the average out-of-pocket cost for a 30-day prescription last year was $8.35.

Pharmacy spending on Medicaid plans rose 5.5% last year, mainly because of a 4.3% increase in unit costs for drugs. The study attributes that to a combination of brand price inflation and formulary management limitations.

The study says drug spending under Obamacare plans jumped 14% in 2016, attributable to both the cost of the drugs and the extent of their use. It notes that people with Obamacare policies tend to use more specialty drugs for chronic diseases, which cost more. The study says specialty drugs accounted for nearly half of all pharmacy spending.

At the same time, it found that these Exchange policies were able to limit the out-of-pocket costs to patients. The average out-of-pocket cost for a 30-day prescription last year was just over $12, up slightly from 2015.

EpiPen price hike

The study said the price hike for the EpiPen autoinjector also had an impact last year. Spending for young patients on anaphylaxis therapy drugs jumped 18.8%, it said. Mylan Pharmaceutical, which makes the EpiPen, has blamed part of the price hike on pharmacy managers.

"While rising drug prices challenged all payers throughout 2016, not all had the flexibility to take needed action," said Stettin.

Policy recommendations

As far as policy recommendations, the study authors say Congress needs to look closely at brand-name biologic medications that have little competition while studying novel new drugs for chronic diseases that come to market and charge "whatever the market will bear."

The study also concludes that lawmakers should pay attention to "aggressive" price increases for older drugs that have no competition and the abuse of Food and Drug Administration incentives to squash competition.