👀 Axios Vitals: All eyes on SCOTUS

Plus, Biden admin floats expanding health coverage to immigrants | Friday, April 14, 2023

Open in app View in browser   Presented By PhRMA   Axios Vitals By Tina Reed · Apr 14, 2023 Happy Friday, Vitals readers. Today's newsletter is 941 words or a 3½-minute read.     1 big thing: All eyes on SCOTUS for abortion pill ruling Illustration: Natalie Peeples/Axios   The Supreme Court could rule as soon as today in the legal battle over abortion pills — and could effectively override the FDA's decision-making if it doesn't turn back a ruling limiting the use of the drug mifepristone, Axios' Caitlin Owens writes. Why it matters: Until last week, such a sweeping blow against the FDA's authority would have been unprecedented. Now it's a real possibility — one that could quickly threaten access to the pill used in more than half of U.S. abortions. What to watch: Justices could decide to stay lower courts' limitations on abortion pills while the appeals process plays out, punting larger questions about the appropriate role the judicial system can play in regard to drug approvals. Or, as two federal courts have already, the high court could issue an order that effectively overrides the FDA's authority. Driving the news: The 5th U.S. Circuit Court of Appeals' partial pause of a Texas judge's ruling was still met by outrage from abortion rights proponents as well as industry groups, who argue the implications extend to the entire pharmaceutical industry. The Department of Justice said yesterday that it was appealing the ruling, which allowed the FDA's authorization to remain in place but imposed restrictions on mifepristone's use. The FDA had previously lifted those restrictions. The decision is set to take effect Saturday, which could lead the Supreme Court to act quickly. Related: Federal court rules 17 states, D.C. are not impacted by Texas abortion pill ruling     2. Emergency contraception demand spike expected Illustration: Aïda Amer/Axios   Providers of emergency contraceptives expect demand to swell as access to abortion medication is clipped, Axios' Erin Brodwin and Claire Rychlewski write. "As abortion access continues to be restricted, EC usage is very much increased," said Amanda Morrison, CEO of direct-to-consumer emergency contraceptive maker Julie. Julie recently accelerated its nationwide rollout, speeding up the availability of its single-pill drug in retail stores including CVS, CNN reported. It also introduced a new two-count pack to encourage patients to keep the pills on hand for emergencies. The big picture: Last year after a draft Supreme Court opinion overturning Roe v. Wade was leaked, women's virtual health services company Nurx saw a 300% increase in requests for emergency contraception. It's part of a bigger uptick in demand for the over-the-counter single tablet drugs which can prevent pregnancy when taken within 72 hours of unprotected sex. They do not harm an existing pregnancy. Dozens of universities have installed vending machines with emergency contraception, many within the last year. Sales of Plan B, a brand of emergency contraception, reached about 15 million units in 2022, up nearly 60% compared with 2018, an analysis from the Financial Times found.     3. Biden floats expanding health coverage to DACA Illustration: Aïda Amer/Axios   Undocumented immigrants who were brought to the U.S. as children could enroll in Medicaid, the Children's Health Insurance Program and Affordable Care marketplaces under a proposal the Biden administration submitted on Thursday, Axios' Sabrina Moreno and Adriel Bettelheim write. Why it matters: The plan could trigger a fight with conservatives who've resisted expanding Medicaid and are sharply at odds with the administration over immigration policy. The big picture: The proposal applies to individuals in the Deferred Action for Childhood Arrivals (DACA) program, which has been in place since 2012 despite litigation and the Trump administration's attempts to cut the program. The 5th Circuit Court of Appeals last October largely upheld a district court ruling that the program was unlawful, but kept it for existing DACA recipients who arrived by 2007. The administration estimates about 34% of the nearly 580,000 recipients in DACA don't have health coverage. Yes, but: The proposal could get ensnared in a dispute over the Trump administration's 2019 public charge rule, which threatened to deny visas to individuals who sought government benefits like food stamps or Medicaid. The Biden administration stopped enforcing it in March 2021. Earlier this year, Texas filed a lawsuit challenging the reversal.     A message from PhRMA Did you know that just 3 PBMs control 80% of all prescriptions?     And all three own or are owned by insurance companies. They often own your pharmacy too. This extreme market consolidation steers you toward pharmacies that make them more money — regardless of what's best or convenient for you. Haven't heard about this? That's by design.     4. EHR rule is a "bridge to nowhere" insurers say Illustration: Maura Losch/Axios   A new Biden administration effort stemming from the 21st Century Cures Act to make health data sharing more transparent is facing pushback from health insurers, Axios' Arielle Dreher writes. Why it matters: The rule from the Office of the National Coordinator for Health Information Technology aims to get providers and payers to share patient health information in a more seamless way. But health plans say it's a "bridge to nowhere" without a requirement that EHR vendors implement electronic prior authorization. The details: Prior authorization, the process by which providers get clearance that a service is covered, often still involves time-consuming paperwork such as faxing documents. Insurance companies will have to begin the process of modernizing the prior authorization process due to other rules the Centers for Medicare and Medicare is finalizing this spring. But they say it will be all be for naught without a parallel requirement for EHR vendors. Zoom out: CMS' rule aims to digitize the prior authorization process in an effort to streamline negotiations between payers and providers. Insurers will have to implement electronic prior authorization for Medicare, Medicaid and Affordable Care Act exchange plans.     5. Catch up quick 🏛 Ex-CEO of Outcome Health, once valued at $5.5 billion, found guilty of fraud. (Axios) 👉 DeSantis signs Florida's 6-week abortion ban into law. (Axios)     6. Dog of the week Buster. Photo: Lindsey Segal   Meet Buster, who is named after former San Francisco Giants catcher Buster Posey (of course!), writes her human Lindsey Segal. "She is eight pounds but thinks she is a 200-pound alpha male," Segal writes. "Her loves include lying in the sun, human food, and sitting with her head in (yes, in) the steering wheel of the car." Do you have a dog to nominate for Vitals' Dog of the Week? Reply to this email and attach a photo and details. Your pup may be featured in a future newsletter!     A message from PhRMA The 3 largest PBMs denied coverage to over 1,150 medicines last year     And all three own or are owned by insurance companies. They often own your pharmacy too. That includes medicines that could lower your costs at the pharmacy. Pharmacy benefit managers (PBMs) are putting their profits before you. Haven't heard about this? That's by design.   Thanks for reading, and thanks to senior health care editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. Dive deeper into the future of health care Axios Pro is your personal health care industry analyst, here to help you make the news actionable and anticipate future outcomes. Subscribe today.   Axios thanks our partners for supporting our newsletters. Sponsorship has no influence on editorial content. Axios, 3100 Clarendon B‌lvd, Arlington VA 22201   You received this email because you signed up for newsletters from Axios. To stop receiving this newsletter, unsubscribe or manage your email preferences.   Was this email forwarded to you? Sign up now to get Axios in your inbox.   Follow Axios on social media: