Drug pricing
A redux of pharma's worst nightmare
Remember when former President Trump regularly bashed drug makers, accused them of "getting away with murder," but then failed to secure legislation cutting drug prices and haphazardly pushed through regulations that were blocked by the courts, Congress, and the Biden administration? Well, he's back at it.
My colleague John Wilkerson noticed a video that Trump put out claiming to be the "only president in modern times" to take on the drug industry. (Biden, of course, signed a law that directs Medicare to negotiate drug prices, penalizes companies that raise prices too fast, and caps seniors' pharmacy costs.)
The Republican presidential candidate is angry that "foreign socialist welfare systems" pay less for drugs than Americans, and he promised to sign another executive order guaranteeing those prices in the United States. Read more.
regulations
Hot rules summer
Beware, health policy nerds planning to take summer vacations — there may be quite a few late afternoon rule drops in the coming weeks.
My colleague Bob Herman said he's watching for rules on home health, hospital outpatient payment, and the physician fee schedule within the coming weeks. And there's a possibility that Medicare's fix to its multibillion-dollar 340B payment problem could come soon, too. Hospital groups including the American Hospital Association and the National Rural Health Association met with the White House budget office recently to make their case that the agency shouldn't take money from some hospitals to pay back others.
Medicare is also expected to release final guidance on its drug price negotiation program soon. Some of the rules about how the program will select drugs were already finalized in April, but other portions about the negotiation process itself could be changed.
And finally, the FDA is expected to decide whether to give full, traditional approval to Eisai and Biogen's Alzheimer's treatment Leqembi by July 6. Got any tips about the approval process, or any feedback on how a potential patient registry is working? Drop me a line!
providers
Fact check: consolidation edition
Lawmakers have been abuzz about the prospect of site-neutral payments this legislative session — a policy idea that would make sure Medicare pays the same for physician services regardless of where they are provided. Lawmakers have implied that higher payments for hospital outpatient departments are a driving force behind acquisitions of physician practices by larger hospitals — but that isn't necessarily true.
Here's one example from a hearing in April, from Rep. Mariannette Miller-Meeks (R-Iowa): "Hospitals are motivated to gobble up physician practices because they're able to bill Medicare roughly double the amount that private practices can."
That was true at one time, but a budget law in 2015 prevented any newly-acquired offsite practices to bill at higher rates. (Any that hospitals already had could continue billing at the higher rates.). A bill led by Sens. Maggie Hassan (D-N.H.), Mike Braun (R-Ind.), and John Kennedy (R-La.) would end the practice of grandfathering outpatient departments established before 2015.
It is true that lawmakers could save Medicare billions of dollars if they implemented site-neutral payments across the sites that are currently grandfathered into higher payments. It's also true that consolidation is pervasive in health care. But those two facts aren't necessarily driving each other in this current moment.
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