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Is pasta healthy? What we have wrong on Medicare Advantage, & PhRMA takes stock of its IRA loss

February 21, 2023
Reporter, D.C. Diagnosis Writer

Happy Tuesday, D.C. Diagnosis readers! I hope you had a good long weekend and it's nice to see you. Send news, tips, and thoughts on D.C. etiquette to sarah.owermohle@statnews.com.  

food industry

Cereal, pasta, pickle lobbies: Meet people where they are

The FDA is looking to implement reform that wouldn't let companies label foods as healthy unless they contain a certain amount of fruits and veggies along with limited sugar, salt and saturated fats. Unsurprisingly, the industry groups for cereal, pasta, and more have *thoughts* — and they want the agency to slow down on regulations that could alienate consumers from their brands, STAT's Nick Florko writes.

Companies including the Barilla, General Mills, and Kellogg's logged their concerns in public comments on FDA's proposal that spanned from telling the agency that pasta consumers are more healthy anyway (citing industry sponsored research) or that "if the food does not taste good, people will not buy it," as frozen-aisle staple Healthy Choice argued. The Consumer Brands Association has suggested it may sue over FDA's proposal, announced in September.

While some say the pushback is "baffling," others acknowledge that the stringent rules proposed won't be workable in the U.S. market. "Hardly anything would qualify, so of course food manufacturers don't like the idea," said Marion Nestle, and emeritus professor of nutrition and public health at New York University, who added the FDA's regulation "automatically excludes the vast majority of heavily processed foods in supermarkets, as well as a lot of plant-based meat, eggs, and dairy products," from bearing the healthy claim. Read more.


Medicare

What's really happening with Medicare 'cuts'?

The conversation around Medicare and particularly Medicare Advantage costs is missing the point on prices and seniors' benefits – intentionally – my stalwart health business colleague Bob Herman argued last week in a must-read thread on the political dialogue around the programs' reform. 

There's a heated debate about proposed Medicare Advantage payment rates in 2024, with health insurers and Republicans arguing the changes are a cut, and one that could raise seniors' costs and cull their benefits. The Biden administration insists these aren't cuts, (but nevertheless says the changes could save the program $3 billion next year.) 

"To the actual 2024 proposals: They do indeed decrease payments to MA insurers. But you need to think of it as a decrease in *overpayments* insurers have been getting for more than a decade." Read more from him on the Medicare Advantage audits to come and the latest on the program's growth


Drug pricing

PhRMA's lessons learned from its IRA defeat

On the latest Readout LOUD podcast with our biotech colleagues, new PhRMA board chair and Novartis CEO Vas Narasimhan reflected on the brand-drug lobby's new approach to advocacy following its stinging lobbying loss last year with the passage of Democrats' drug pricing law, my D.C. Diagnosis co-author Rachel Cohrs writes. A couple highlights:

  • On what went wrong during the IRA debate: "I think in retrospect, we need to get better [at shaping] legislation, even if we don't like it, to try to be sensible [about] pro-innovation policies that support the industry. If we sit on the sidelines then these things will happen on their own and we may not like the result."
  • On how PhRMA's approach could change: "I think the biggest learning is we need to be more proactive as an industry in offering solutions to the challenges that constituents are putting forward to policymakers. And I think if we can get sharper at that, do better at that, hopefully we can get better policy in place."
  • On whether PhRMA is going to sue: "Certainly I think if the industry perceives that [CMS guidances] aren't sensible, we'll have to look at what actions we can take. I think that it's still early days to really determine that."

Read the full interview transcript here



drug pricing

Copay assistance cuts spell disaster for cystic fibrosis patients

Vertex Pharmaceuticals' decision to slash financial assistance for pricey cystic fibrosis medicines this year immediately exposed a coverage gap, as some patients' costs soared from a few hundred dollars a year to tens of thousands, leaving them scrambling to find insurance plans that could cushion the cost, Ed Silverman reports.

How'd this happen? The story begins with copay assistance programs, which drug companies have offered for years to help patients afford their most costly medicines by paying down out-of-pocket costs, Ed writes. Notably, Moderna last week promised that its Covid-19 vaccine would be free for all, in part through a program just like this.  

But these programs have served as insurers' nemeses, as plans argue they encourage patients to go for higher-cost drugs, and have set up counter-programs known as copay accumulators that have doused drug companies' efforts. Caught in the crosshairs are patients with few options, left to mitigate sudden prices of drugs like Vertex's Orkambi. Read more here from Ed on the devastating impact for some families.


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What we're reading

  • A device restored hand movement for two stroke survivors. Researchers want to take it mainstream, STAT
  • Opinion: Biology is dangerously outpacing policy, The New York Times
  • Government watchdog calls for stronger oversight of for-profit research review boards, STAT
  • Infected in the first wave, they navigated long Covid without a roadmap, Reuters 
  • First non-immunosuppressive drug approved for a rare and deadly kidney disease, STAT

Thanks for reading! More on Thursday,


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