capitol hill
A wrench in the House?
While a hospital and PBM transparency bill sailed through the House Energy & Commerce Committee earlier this year, it remains to be seen whether the Ways & Means Committee, its well-known rival on health care issues, will assert its jurisdiction. The panel has held health care hearings on competition and affordability but hasn't marked up a competing legislative package.
Republicans on the panel are meeting today to discuss health care issues, three hospital lobbyists told me, after which it could become clear whether the committee will throw a wrench into E&C's plans to get its package to a floor vote quickly. Sound like surprise billing to anyone else?
supply chain
Where is Congress on drug shortages?
The House Energy and Commerce Committee marks up today pandemic-preparedness legislation that is well-suited to drug shortage reforms, but my colleague John Wilkerson reports that Congress might let that opportunity pass it by.
Everyone agrees drug shortages have reached a crisis point. In the Senate, neither party is proposing drug shortage reforms in the reauthorization of the Pandemic All-Hazards Preparedness Act. In the House, Democrats want to give the FDA more authority over the drug supply chain. House Republicans are wary of giving the agency more power, and the FDA has yet to take advantage of authorities that Congress provided three years ago, but it's unclear exactly how Republicans want to fix the problem.
"What we're seeing is disagreement on what the right vehicle and timeline for addressing shortages is," said Soumi Saha, senior vice president of government affairs at Premier, a group purchasing organization.
alzheimer's
The unanswered question about Leqembi coverage
Medicare coverage expanded for the new Alzheimer's drug Leqembi last week when the FDA gave the drug full, traditional approval — but there's still a big lingering question out there.
Medicare is still weighing how it's going to cover PET scans that help physicians see whether patients have the amyloid plaques in their brains that the medication is supposed to clear. But right now Medicare only covers one of them in a patient's lifetime, which is sufficient to determine the presence of the plaques, but wouldn't allow physicians to see whether the drug is actually working. Neurologists I spoke with about the rollout were anxious to learn more about the coverage policy.
Medicare was supposed to issue a proposed coverage policy in December, but they've blown through that deadline. A CMS spokesperson said the agency would be issuing a proposed decision "soon." Out-of-pocket costs for the scans can run more than $5,000. Stay tuned!
local politics
A bellwether hospital defeat
As hospitals face down potential transparency measures and payment reforms in Congress, New York lawmakers Chuck Schumer and Hakeem Jeffries will be key decision-makers about whether any of that gets across the finish line. Schumer, in particular, is well-known as a friend of the industry.
However, transparency advocates recently won a policy fight in New York City over the protests of the state's powerful hospital lobby. Mayor Eric Adams signed a hospital price transparency measure that also created an Office of Health Care Accountability to examine pricing practices, which will post prices for procedures online.
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