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Is there an answer to Covid’s origins, Biden readies his budget pitch, a preview of Medicare negotiation targets?

February 28, 2023
Reporter, D.C. Diagnosis Writer
Happy Tuesday and welcome to D.C. Diagnosis, where I'm here to back Kayla's take on DCA (not IAD, please don't get confused) being the best airport. Send news, tips and travel advice to sarah.owermohle@statnews.com.

the pandemic

Will there ever be a definitive answer to Covid's origins?

The Energy Department recently concluded that the coronavirus pandemic likely originated from a laboratory leak in China, revising an undecided 2021 report and joining the FBI in their theory, albeit with "low confidence." The updated intelligence report, first reported by The Wall Street Journal this weekend, quickly reignited online debate about where the virus came from and who, if anyone, is to blame for its initial spread. 

Skeptics were quick to point out that while DoE and the FBI have leaned into the theory, other epidemiologists, the World Health Organization and at least four other federal agencies (which the government declines to identify) have separately said either that the virus started with natural transmission, likely in a Wuhan, China food market, or that there just isn't enough information yet to tell. Still, media personalities and conservative pundits took to social media to blast scientists, including former top infectious disease expert Anthony Fauci, who dismissed early lab leak claims. 

But misinformation still abounds. Harvard national security expert Juliette Kayyem, appearing on CNN Monday, said that no security agencies, nor the WHO, believe "this was purposeful bioterrorism. This report is being manipulated to suggest China was purposeful."

Regardless of federal officials' conclusions, calls to reform infectious disease research are unlikely to go away, and have already triggered talks about boosted oversight at the National Institutes of Health.


Medicaid 

Biden readies his budget pitch

President Joe Biden heads to Virginia Beach today to tout his coming budget proposal (out Mar. 9) and to blast Republicans' purported plans to cut the national debt by slashing Medicaid benefits and Affordable Care Act provisions. This comes after House Republicans under Majority Leader Kevin McCarthy already abandoned similar plans to try to shrink Medicare spending. 

That said: It's not totally clear what the GOP caucus proposal is for reducing the national deficit. While some Budget Committee members and outside Republican advisers have discussed cutting Obamacare and eliminating the premium tax credit, leadership hasn't committed to specific proposals (They're likely waiting to see what Biden proposes next week). 

Plus, while Biden in his State of the Union address promised that Medicare and Social Security cuts would be non-starters in budget negotiations, it's unclear whether he's ready to go as hard-line for Medicaid and ACA provisions. "What you'll hear him say … is that we need to continue to protect and build on progress we've made strengthening the Affordable Care Act and Medicaid," White House deputy communications director Kate Berner told reporters. 


Drug pricing

A crystal ball for drug price negotiation

The Journal of Managed Care & Specialty Pharmacy has two new studies out that may pique the interest of drug pricing wonks, my co-author Rachel Cohrs writes. 

  • Wall Street's favorite parlor game has been guessing which drugs Medicare will negotiate under the Inflation Reduction Act's new program. West Health Policy Center's Sean Dickson and University of California San Diego associate professor Inmaculada Hernandez published a new paper on the drugs most likely to make that list in the program's first three years. They've got a rundown of the drugs that likely won't be eligible, too. 

  • Researchers at Tufts University analyzed how much commercial insurers are actually incorporating ICER decisions into their coverage policies. Health plans imposed restrictions in 61% of coverage decisions for drugs assessed by ICER compared with 38% of decisions for drugs not assessed by ICER. But plans only cited ICER in 2.4% of eligible coverage decisions in 2020.

in the fda

FDA's neuro chief departs as Alzheimer's drug controversy continues

The neurologist Billy Dunn, who presided over the agency's polarizing approval of Alzheimer's drug Aduhlem, is retiring to "explore other opportunities," as STAT's Adam Feuerstein and Damian Garde reported. Teresa Buracchio, deputy director of the office of neuroscience, has been named acting director to replace Dunn, according to an internal FDA email.

Dunn, who joined the agency 15 years ago, was mainly a behind-the-scenes bureaucrat until the controversial Aduhelm decision pushed him and his office into the spotlight. After the FDA overrode a panel of experts in 2021 to approve the Biogen drug on limited evidence, it came out that Dunn had an off-the-books meeting with Biogen's head scientist several years earlier, sparking a close collaboration that has since spurred federal investigations and congressional probes. At least one report, from the Office of the Inspector General, is expected next year.

Outside of the Aduhelm approval (and two more Alzheimer's drug decisions that followed), Dunn oversaw a number of major firsts for rare diseases and new therapies, like the first cannabis-derived drug. But first, read more on his retirement and on how he came to be Biogen's big believer from Adam, Damian and Nick Florko. 



at the agencies

Antitrust officials eye allowing more physician-owned hospitals 

Some government antitrust regulators are hinting at their support for expanding physician-owned hospitals amid some congressional calls for the same – and amid increasing Biden administration scrutiny of health industry consolidation.

A pair of Biden officials from the Justice Department and the FTC wrote a paper with a few other experts arguing that the administration needs to roll back an Obamacare provision that keeps physician-owned hospitals from getting Medicare and Medicaid payments, in a bid to slow down consolidation and control prices. It's an interesting stance for Biden folks to take, my colleague John Wilkerson writes, because Democrats have typically supported the effective ban on doctor-owned hospitals. 

Republican lawmakers, however, have fought the limits for a long time. House Republicans last year included a repeal of the ban as part of their Healthy Future Task Force's report, and on Wednesday, GOP Sens. James Lankford (Okla.) and Bill Cassidy (La.), both doctors, introduced a bill to rescind the ban. Read more from John, here


More around STAT
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What we're reading

  • FDA is petitioned to boost enforcement of trial sponsors that fail to register studies or report results, STAT
  • Idaho dropped thousands from Medicaid early in the pandemic. Which state's next? Kaiser Health News/NPR
  • How Eric Lander's sharp elbows spurred MIT's Nancy Hopkins to start a gender revolution, STAT
  • Life After Food? A diabetes drug has become an off-label appetite suppressant, The Cut
  • Why one state's plan to unwind a Covid-era Medicaid rule is raising red flags, Politico

Thanks for reading! More on Thursday,


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