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Oversight plans galore, New York hospital allies, and insurers’ Covid test conundrum

February 2, 2023
Reporter, D.C. Diagnosis Writer
Hello and happy Thursday, D.C. Diagnosis readers! I'll be hanging around at the BIO CEO & Investor Conference in New York next week. If you'll be there and want to chat about how the IRA is affecting your business or investment strategy, let me know! Reach me anytime with tips on the news or NYC dinner spots at rachel.cohrs@statnews.com.

oversight

The House GOP's unofficial oversight plan

The House Energy & Commerce Committee hasn't formally adopted an oversight plan yet, but I obtained a copy of the document describing the issues the panel's Republicans are planning to focus their efforts on this Congress. A few highlights:

  • Providers will be interested to see that their payment policies appear to be a potential target. "It is critical that the Committee identify provisions within the troves of HHS regulations contributing to dynamics — such as provider consolidation — that are increasing health care costs," the document states. 
  • Follow-up on surprise billing, Medicare drug price negotiation, and health care price transparency is also on the list.
  • Pharmacy benefit manager transparency made the agenda, but interestingly, oversight of the 340B drug discount program did not. (That doesn't mean it's definitely off the table, though.)
  • Fraud in the Medicare and Medicaid programs will be another focus.
  • As expected, the committee will also focus on fentanyl, the federal Covid-19 response, and federal research funding.

Inflation reduction act

And Republicans aren't the only ones looking at oversight…

Senate Finance Committee Chair Ron Wyden (D-Ore.) sent a letter to CMS on Wednesday asking for an update on the agency's timeline for implementing rebates that penalize drugmakers that raise their prices faster than the rate of inflation.

"The Finance Committee will be paying close attention to how the inflation rebate provisions work to lower prices for seniors and hold manufacturers accountable if they continue to raise prices beyond the rate of inflation," Wyden wrote.

There's still a bit of lead time, as Medicare Part B drugmakers will be notified of the amount of penalties they owe the federal government in September. But the agency hasn't provided as much detail about the implementation of the inflation penalties as it has with regards to the flashier drug price negotiation process.


influence

New York hospitals' dream team

Hakeem Jeffries and Chuck Schumer
ANNA MONEYMAKER/GETTY IMAGES

The Greater New York Hospital Association is very well-positioned in the new Congress now that the two top leaders of the Democratic Party are from New York, I report this morning

Senate Majority Leader Chuck Schumer (D-N.Y.) has long been an ally of the GNYHA, often pushing for more funding for teaching slots at hospitals. And new House Minority Leader Hakeem Jeffries (D-N.Y.) is another New Yorker representing a Brooklyn district, though he has a less robust record on health care. Those ties will be important, as hospitals are anxious their payments from federal health programs could be slashed amid talk of spending cuts. 

Medical education is a big industry in New York, and GNYHA bolsters their political clout with a sophisticated campaign spending strategy that you can learn more about here.



insurance

Medicare Advantage cuts on deck

It's been a busy news week on the MA beat, and luckily my colleague Bob Herman has been covering every big announcement this week. The latest: Medicare Advantage insurers could face an average 2.3% cut to baseline payments in 2024, the Biden administration said Wednesday. That could be a cut of more than $3 billion to the industry, Bob writes.

The major reason behind the proposed pay cut: Medicare officials want to update data and coding systems that are used to explain the health conditions of an insurance company's enrollees.

The document released Wednesday is just the beginning of a two-month lobbying frenzy by insurance companies. The final rule will come out by April 3. Get all the details here


addiction

Are venture capitalists turning a blind eye to addiction?

U.S. addiction deaths are hovering at all-time highs, but the venture capital world has shown remarkably little interest in developing new cures, according to a new report from the biotechnology lobbying group BIO, my colleague Lev Facher reports

V.C. firms have invested 270 times more money in the past decade into cancer cures than potential addiction treatments, according to the report. But further investment is sorely needed because the few addiction drug candidates that do reach clinical trials fail with astonishing frequency: 93% of phase 2 trials for opioid addiction drugs failed, at BIO's last count. 

There aren't exactly a lot of existing options, either. There are currently just three FDA-approved drugs to treat opioid addiction, and none to treat addiction to cocaine or methamphetamine. Given the current pipeline and investment landscape, the D.C. trade association doesn't expect that to change anytime soon. Read more here.  


covid-19 policy

Test-to-treat no more

The FDA has changed its emergency use authorization for Pfizer's Paxlovid Covid-19 antiviral, the agency announced yesterday, so that health care providers no longer have to see a positive test to prescribe the treatment. 

The agency was trying to accommodate situations in which someone might have a known, direct Covid-19 exposure and develop symptoms, but still test negative — a scenario that's particularly important if the person in question is high-risk, the FDA said. 

White House Covid-19 Coordinator Ashish Jha told Eric Topol, the founder and director of the Scripps Research Translational Institute, last week that the White House is concerned about a low rate of Paxlovid use among people over age 75, in particular. Pfizer has estimated sales of $8 billion for the drug for 2023


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What we're reading

  • 'Ill-gotten gains': FTC commissioner says GoodRx's $1.5 million fine for health data leaks should have been higher, STAT
  • Google's ex-CEO Eric Schmidt tapped for federal biotech commission that allows members to keep biotech investments, CNBC
  • KKR veteran sets records with $3.9 billion health care fund, STAT
  • Republicans break with another historical ally: doctors, Axios
  • Medicare may test policy of paying less for accelerated approval drugs, STAT

Thanks for reading! More next week,


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