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Erica Carbajal – Becker’s Healthcare – Jan. 31, 2022

A month into 2022, drug makers have raised the list prices for medications in the U.S. by an average of 6.6%, compared to the 7.0% overall consumer inflation rate, The Wall Street Journal reported.

While companies kept most increases in the single digits for another year as Congress explores measures to curb high costs, they boosted list prices on cancer, diabetes and other prescription medicines.

The news outlet cited an analysis from Rx Savings Solutions, which makes software to find prescription drug savings which found that about 150 drug makers raised prices on 866 products through Jan. 20.

Here are five details from the analysis: 

1. Drug makers raised prices by an average of 4.5% on 893 drugs during the same period last year. Drug price increases hit a peak in 2015 and 2016, when some drugs saw increases higher than 10%, according to The Wall Street Journal.

2. The 2022 analysis showed prices rose for some of the top-selling medications in the U.S., including AbbVie’s Humira, an anti-inflammatory, which saw a 7% increase. The price of Bristol-Myers Squibb and Pfizer’s Eliquis, an anticoagulant, rose by 6%, and Trulicity, Eli Lilly’s diabetes drug, rose by 5%. 

3. Political pressure and other drug-pricing measures in recent years have made price hikes less profitable for drug companies, the Journal reports. Many pharmacy benefit managers, for example, have negotiated price increase caps that require drug makers to pay rebates on product sales that have price increases above certain thresholds. 

4. The Biden administration has also proposed drug-pricing provisions in its Build Back Better bill, including one that caps price increases at the overall inflation rate across federal and private health insurance programs. 

5. Pfizer, which raised prices by an average of 3.2% on 219 drugs, shared the following statement with The Wall Street Journal: 

“For the past three years, our net prices — the prices we actually receive for our medications — has fallen due to higher rebates and discounts paid to insurance companies and pharmacy benefit managers.”

Greg Says has previously noted that retail prices for Rx drugs in the US have skyrocketed over the past 10 years.  In 2020, Medicare Part D covered over 3,500 drugs with total spending of $188 billion which was 54% of the total Rx drug spending in the US of $348 billion.  Congress needs to act to stem the rising cost of Rx drugs in the US.  One step in that direction would be for Congress to allow Medicare to negotiate drug prices with the pharmaceutical industry like the VA and private insurers can.

By Becky Upham – Life Extension Magazine

In 1900, life expectancy in the United States was 47.3 years; in 2017, it was 78.6. Here’s why the numbers have gone up, plus advice from medical experts on how to add more healthy years to your own life. In 2017, nearly 25 out of 100 people in the United States lived to celebrate their 90th birthday. Have you ever wondered how old you’ll be when you die? Even if it was just to estimate how much you should put away in your 401(k) or how much time you have to pay off your student loans?

Life expectancy represents the average number of years that someone can expect to live depending on the year they were born. For anyone born in the United States in 2017, life expectancy is 78.6 years, according to the Centers for Disease Control and Prevention (CDC). Another way that experts measure life expectancy involves considering the percentage of people who live to specified ages.

Both those calculations are based on averages of the entire population and include all sexes, races, and parts of the country. How long each individual lives is determined by many factors, says Qi Sun, MD, a doctor of science and an associate professor at the Harvard T.H. Chan School of Public Health. He explains that life expectancy is influenced by genes, environment, and lifestyle choices: “We can look at how the life span has increased over the last 100 years and see that it’s modifiable,” he says.

Read on for commonly asked questions about life expectancy and what you can do to live longer and healthier.

Do the ages that my parents or grandparents died make a difference in figuring out my life expectancy?

Family history is a big predictor of longevity. “If you look at parents’ life span and compare it with their offsprings’, you’ll find certain correlations because sometimes they share the same genes,” says Dr. Sun. If some of those genes lead to certain diseases, it may shorten life span. “On the other hand,” he adds, “families that have good genes may live longer.”

Some similarities in health patterns that may seem genetic could also be due to common habits and location. Family members often share the same environment, especially when children are young and still live at home. “Families eat a similar diet and have the same access to medical care, which are both factors that impact longevity,” Sun says.

You just need to look at data from 100 years ago and compare it with current life expectancy to see that there’s more to longevity than simply genetics. According to the CDC, the life expectancy of someone who was born in 1900 was only 47.3 years. 

“Genetics wouldn’t really explain this jump,” Sun says, adding that a lot of things combined to cause this increase, including improved medical care and hygiene.

Why do women live longer than men?

Women tend to live longer than men, and that’s been the case for at least the past century, says Robert Anderson, PhD, chief of the mortality statistics branch of the CDC. “Before that, a very high maternal mortality pulled down the average life expectancy for women,” he says.

Ever since medical improvements led to a huge decrease in the number of women dying during childbirth, life expectancy for women has gone up. According to the latest CDC data, women in the United States live close to five years longer than men, on average. “Some experts argue that there’s a genetic component, while others theorize that it has to do with differences in risk-taking,” says Dr. Anderson.

Why do some races have a shorter life expectancy?

On average, black Americans have a shorter life expectancy than white Americans, and Hispanic people living in the United States have the longest life span of all three groups. About 76 out of 100 Hispanic Americans will live until at least 75 years of age, compared with about 70 white Americans and approximately 60 black Americans.

It’s not clear why black Americans die sooner. “We haven’t identified any real genetic component that would cause this difference,” says Anderson. It could be due to culture and diet, and there may be significant environmental factors that contribute.

As a group, a higher percentage of black Americans have heart disease than white Americans, according to the American Heart Association. Although the gap in life expectancy between black and white populations has begun to close — it decreased by 2.3 years from 1999 to 2013, according to the CDC — but it still exists. Stress, more limited access to health care, and cultural factors all play a role, says Anderson.

Hispanic Americans may have the longest life span because they are less likely to die from a number of health conditions, including cancer, heart disease, chronic lower respiratory diseases, stroke, diabetes, and suicide, according to the CDC.

Is U.S. life expectancy increasing?

The long-term increase in life expectancy over the past century is largely due to two factors. “From 1900 until 1950 and then from 1950 to 2000, there was a fairly dramatic increase in life expectancy, primarily due to control of infectious diseases,” says Anderson, citing significant discoveries in antibiotics and vaccines and improvements in sanitation.

Since 1950, gains in longevity are mostly due to advances in the prevention and treatment of chronic diseases, mainly heart disease and stroke. “There’s also been an improvement in the cancer death rates beginning in the mid-1990s,” Anderson says. Cardiovascular disease and cancer are the two leading causes of death in the United States, accounting for about 40 percent of total deaths.

Life expectancy has actually declined slightly over the past three years, according to the CDC. Although the CDC says the trend is largely driven by drug overdose and suicide, there is another, more significant factor: the obesity epidemic.

“I think it’s fair to say that we are already seeing the impact of obesity on life expectancy,” Sun says. “A lot of people out there blamed the opioid crisis or drug overdose for the decrease in life expectancy, but the obesity problem is much bigger.”

What are the most important factors that determine how long you live?

“Basically any factor that influences mortality also contributes to life expectancy, because mortality is how life expectancy is calculated,” says Sun. Blood pressure, cholesterol levels, body mass index, and diabetes are established risk factors for chronic diseases like heart disease and stroke, and people who have those diseases have a shorter life expectancy.

Okay, I haven’t had the healthiest lifestyle, and now I’m over 50. Am I doomed?

“It’s never too late to adopt a healthier lifestyle,” says Sun. If a person has spent decades eating an unhealthy diet or being physically inactive, they may or may not have developed certain chronic conditions like diabetes or heart disease. Still, “If those individuals move their diet and exercise habits from the unhealthier end of the spectrum to the healthier side, they can improve their life span,” Sun says. “Just follow common sense: no smoking, avoid alcohol or drug abuse, eat a healthy diet, engage in physical activity, ensure proper healthcare coverage, and try to stay positive and optimistic.” 

If you need more incentive to make lifestyle changes, consider this: Research shows that older adults are enjoying themselves more than just about everyone else. According to a survey of 1,546 Californians ages 21 to 99, people in their nineties were the most content. The research, published in August 2016 in The Journal of Clinical Psychiatry, found that older people were happier and less depressed, and had less anxiety than younger people.

By Harry Wilmerding, Contributing Editor – THE DAILY CALLER

The American Association of Retired Persons (AARP) raked in massive profits in 2020, mostly from royalties on branded health insurance policies, not memberships, according to company financial documents.

AARP’s 2020 Form 990 shows that the organization reported $1.6 billion in revenue, with roughly $1 billion, or over 60%, from royalty revenue. Meanwhile, membership dues contributed under 20% of total revenue.

AARP’s 2019 Form 990 reported $1.72 billion in revenue, with royalties making up nearly 56% of revenue while membership dues contributed just 17%.

“The organization’s business effectively overcharges seniors who purchase insurance coverage from the organization – including Medicare supplemental policies, called Medigap insurance — to fund its own operations,” Juniper Research Group Founder and Chief Executive Chris Jacobs wrote in an August 2020 American Commitment report.

AARP is designated a 501(c)(4) nonprofit organization by the IRS, but the company has consistently made large profits due to the group’s marketing practices, according to the report.

“AARP functions less as a membership organization than as a marketing conglomerate with a liberal advocacy group on the side,” Jacobs told the Daily Caller News Foundation. “It charges so little for membership because it makes most of its money selling products to its members and taking a percentage of the cut – starting with insurance products sold by UnitedHealth.” The largest contributor to AARP’s royalty revenue is UnitedHealth Group, Jacobs told the DCNF.

AARP reported $283.7 million in revenue from UnitedHealth in 2007, around 57% of total revenue from royalties that year, according to the report. In 2017, AARP collected over $627 million from the health care giant, almost 70% of AARP’s royalty income that year.

UnitedHealth sells three separate health insurance policies using the AARP brand: Medicare Advantage, Medicare Part D, and Medigap, Jacobs told the DCNF. UnitedHealth pays AARP a “royalty fee” because it uses the organization’s brand to sell insurance.

The Medigap policies bring in the most revenue for AARP, earning it 4.95% of premiums paid on every dollar, Jacobs said. On the other hand, members using Medicare Advantage and Medicare Part D plans pay UnitedHealth, which then gives AARP only a flat licensing fee.

“For every additional dollar seniors pay in premiums, AARP adds more to its bottom line. This commission-type arrangement gives AARP every incentive to sell its members products they don’t want or need, just to make more money itself – the opposite of the way a supposedly consumer-based organization should be acting,” Jacobs said.

AARP did not respond to the DCNF’s request for comment.

AARP has been sued four times in the last four years by its members over its royalty fee structure, according to court documents. Courts ruled in favor of AARP in three of these lawsuits.  

Most recently, plaintiffs Jeremy Nichols and Leon Wilde led a class action claiming AARP and UnitedHealth made millions of dollars by illegally charging royalty fees to California senior citizens.

Specifically, the plaintiffs claimed that AARP mischaracterized fees paid by UnitedHealth as “royalty fees” to avoid taxes on income generated through the sale of insurance policies.

“Calling the commission a ‘royalty’ is merely a fiction created by Defendants to further their illegal scheme,” the plaintiffs said.

The House Ways and Means Committee investigated AARP in 2011, generating a report which was submitted to the IRS. The report highlighted key issues with AARP’s structure, including its royalty fee system.

“As this report has shown, AARP may be in violation of a number of the requirements imposed on organizations operating under a federal tax exemption,” the report stated.

“In particular, one might question whether AARP is primarily operating to promote the common good and general welfare given the fact the AARP has become increasingly dependent on hundreds of millions of dollars in royalty revenue from insurance companies,” the report read.

To be designated a 501(c)(4) organization, one must “not be organized for profit and must be operated exclusively to promote social welfare,” according to the IRS.

Although Greg Says acknowledges the appeal that the AARP brand has with seniors, it should never eliminate the need for due diligence when evaluating the suitability of an insurance product.

Nov. 2, 2021

By Amy Norton HealthDay Reporter

Nearly one-third of older U.S. adults visit at least five different doctors each year — reflecting the growing role of specialists in Americans’ health care, a new study finds.

Over the past 20 years, Americans on Medicare have been increasingly seeing specialists, researchers found, with almost no change in visits with their primary care doctor.

On average, beneficiaries saw a 34% increase in the number of specialists they visited each year. And the proportion of patients seeing five or more doctors rose from about 18% in 2000, to 30% in 2019.

Is the trend good or bad? “It’s probably both,” said Dr. Michael Barnett, the lead researcher.

On one hand, he noted, medicine has grown by leaps and bounds in recent decades — yielding a deeper knowledge of various health conditions and more options for diagnosing and treating them. “There are a lot more things that a specialist can do now, and that’s good,” said Barnett, a primary care doctor and an assistant professor at the Harvard T.H. Chan School of Public Health in Boston.

However, managing all of those medical appointments, various prescriptions and information from different providers can be “maddening,” Barnett pointed out. “If nothing else,” he said, “transportation to those appointments is a big issue for older adults.”

So the broader question of how all this specialist care is affecting older Americans’ quality of life is a complicated one, according to Barnett. What is clear, he said, is that the American health care system is “very specialist-oriented.”

Back in 1980, Americans aged 65 and older mostly saw primary care providers. About 62% of their medical appointments were with a primary care doctor, while 38% were with specialists, according to Barnett’s team. But by 2013, those figures had flipped.

That makes the United States different from many other developed health systems in the world, which put more emphasis on primary care. And, the Harvard researchers said, studies suggest those systems provide better care at lower costs.

The new findings — published Nov. 1 in the Annals of Internal Medicine — are based on claims data from Americans on Medicare between 2000 and 2019. Over time, the average beneficiary saw more specialists and had more visits to specialists, the investigators found. But there was no real change in their number of annual visits to primary care providers. By 2019, Medicare recipients saw two specialists, on average. But many saw more: That included the 30% of beneficiaries who saw five or more doctors.

Alice Bonner is a geriatric nurse practitioner and senior advisor to the nonprofit Institute for Healthcare Improvement. She agreed that the trend toward more — and pricier — specialist care is neither good nor bad, but more complex than that. “It could be that it’s helping people, or it could be that it’s wasteful,” Bonner said. “It’s so dependent on the individual situation.”

One question, she noted, is whether older adults are becoming “more assertive” in asking to see specialists. Visits to a busy primary care provider can be brief, Bonner pointed out. “If people are not having their concerns addressed,” she said, “they may seek care elsewhere.”

Like Barnett, she said that seeing multiple doctors can add a layer of complexity that burdens older adults — from transportation to managing medications. “It’s not uncommon for patients to be on nine or more medications,” Bonner noted.

Ideally, health care should be helping older adults live not only longer but better, and understanding “what matters” to any one patient is key, according to Bonner. “Most older people tell us they don’t want their lives overmedicalized,” she said. “If they’re busy traveling from doctor to doctor, they may have less time for doing what matters to them.”

Barnett made a similar point, saying primary care doctors should “help patients do what matters most to them.” In some cases, Barnett said, that might mean “pulling back” on some specialist care — though, he noted, the general culture of the health care system is to add care rather than take away. So patients may need to ask. “It’s always reasonable for patients to ask their primary care doctor whether any care they’re receiving is still necessary and needs to continue,” Barnett said.

Specialist care also adds complexity to the job of primary care providers, who are supposed to be coordinating it all, Barnett pointed out. In the current system, that may or may not be happening smoothly. Since doctors are mainly paid per service they provide during an office visit, any time spent coordinating patients’ care is uncompensated. That system, the researchers said, is a “disincentive.”

A high-carb diet, and the attendant high blood sugar, are associated with cognitive decline.

By Olga Khazan – The Atlantic

In recent years, Alzheimer’s disease has occasionally been referred to as “type 3” diabetes, though that moniker doesn’t make much sense. After all, though they share a problem with insulin, type 1 diabetes is an autoimmune disease, and type 2 diabetes is a chronic disease caused by diet. Instead of another type of diabetes, it’s increasingly looking like Alzheimer’s is another potential side effect of a sugary, Western-style diet.

In some cases, the path from sugar to Alzheimer’s leads through type 2 diabetes, but as a new study and others show, that’s not always the case.

A longitudinal study, published in the journal Diabetologia, followed 5,189 people over 10 years and found that people with high blood sugar had a faster rate of cognitive decline than those with normal blood sugar – whether or not their blood-sugar level technically made them diabetic. In other words, the higher the blood sugar, the faster the cognitive decline.

“Dementia is one of the most prevalent psychiatric conditions strongly associated with poor quality of later life,” said the lead author, Wuxiang Xie at Imperial College London, via email. “Currently, dementia is not curable, which makes it very important to study risk factors.”

Melissa Schilling, a professor at New York University, performed her own review of studies connecting diabetes to Alzheimer’s in 2016. She sought to reconcile two confusing trends. People who have type 2 diabetes are about twice as likely to get Alzheimer’s, and people who have diabetes and are treated with insulin are also more likely to get Alzheimer’s, suggesting elevated insulin plays a role in Alzheimer’s. In fact, many studies have found that elevated insulin, or “hyperinsulinemia,” significantly increases your risk of Alzheimer’s. On the other hand, people with type 1 diabetes, who don’t make insulin at all, are also thought to have a higher risk of Alzheimer’s. How could these both be true?

Schilling posits this happens because of the insulin-degrading enzyme, a product of insulin that breaks down both insulin and amyloid proteins in the brain – the same proteins that clump up and lead to Alzheimer’s disease. People who don’t have enough insulin, like those whose bodies’ ability to produce insulin has been tapped out by diabetes, aren’t going to make enough of this enzyme to break up those brain clumps. Meanwhile, in people who use insulin to treat their diabetes and end up with a surplus of insulin, most of this enzyme gets used up breaking that insulin down, leaving not enough enzyme to address those amyloid brain clumps.

According to Schilling, this can happen even in people who don’t have diabetes yet – who are in a state known as “prediabetes.” It simply means your blood sugar is higher than normal, and it’s something that affects roughly 86 million Americans. Schilling is not primarily a medical researcher; she’s just interested in the topic. But Rosebud Roberts, a professor of epidemiology and neurology at the Mayo Clinic, agreed with her interpretation.

In a 2012 study, Roberts broke nearly 1,000 people down into four groups based on how much of their diet came from carbohydrates. The group that ate the most carbs had an 80 percent higher chance of developing mild cognitive impairment – a pit stop on the way to dementia – than those who ate the smallest amount of carbs. People with mild cognitive impairment, or MCI, can dress and feed themselves, but they have trouble with more complex tasks. Intervening in MCI can help prevent dementia.

Rebecca Gottesman, a professor of neurology at Johns Hopkins, cautions that the findings on carbs aren’t as well-established as those on diabetes. “It’s hard to be sure at this stage, what an ‘ideal’ diet would look like,” she said. “There’s a suggestion that a Mediterranean diet, for example, may be good for brain health.”

But she says there are several theories out there to explain the connection between high blood sugar and dementia. Diabetes can also weaken the blood vessels, which increases the likelihood that you’ll have ministrokes in the brain, causing various forms of dementia. A high intake of simple sugars can make cells, including those in the brain, insulin resistant, which could cause the brain cells to die. Meanwhile, eating too much in general can cause obesity. The extra fat in obese people releases cytokines, or inflammatory proteins that can also contribute to cognitive deterioration, Roberts said. In one study by Gottesman, obesity doubled a person’s risk of having elevated amyloid proteins in their brains later in life.

Roberts said that people with type 1 diabetes are mainly only at risk if their insulin is so poorly controlled that they have hypoglycemic episodes. But even people who don’t have any kind of diabetes should watch their sugar intake, she said.

“Just because you don’t have type 2 diabetes doesn’t mean you can eat whatever carbs you want,” she said. “Especially if you’re not active.” What we eat, she added, is “a big factor in maintaining control of our destiny.” Roberts said this new study by Xie is interesting because it also shows an association between prediabetes and cognitive decline.

That’s an important point that often gets forgotten in discussions of Alzheimer’s. It’s such a horrible disease that it can be tempting to dismiss it as inevitable. And, of course, there are genetic and other, non-nutritional factors that contribute to its progression. But, as these and other researchers point out, decisions we make about food are one risk factor we can control. And it’s starting to look like decisions we make while we’re still relatively young can affect our future cognitive health. “Alzheimer’s is like a slow-burning fire that you don’t see when it starts,” Schilling said. It takes time for clumps to form and for cognition to begin to deteriorate. “By the time you see the signs, it’s way too late to put out the fire.”