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Congress refilled its Medicare piggy bank

December 21, 2023
Reporter, D.C. Diagnosis Writer

Hello, and happy Thursday! It's winter solstice today, the darkest day of the year — which means it only gets lighter from here. It's also the last issue of D.C. Diagnosis for 2023, so I'm wishing you all a wonderful holiday break. But always feel free to pop into my inbox anytime at rachel.cohrs@statnews.com.

cannabis

Medical marijuana companies take a page from pharma's book

Medical_Marijuana_Stat_FinalEROS DERVISHI FOR STAT

The largest medical marijuana companies have taken to hiring teams of sales reps and patient advocates to promote their products to doctors, even offering physicians personalized swag and Topgolf parties. Sound familiar?

But the issue with the medical marijuana industry is that it isn't regulated by the federal government, my colleague Nick Florko writes in a new investigation. Gifts from pharma companies to physicians are closely tracked, and the industry can't advertise medical benefits that aren't backed up with data. That's not necessarily the case with medical marijuana, which is left to often ill-equipped states instead.

Nick's full story is worth your time, including some juicy fact-checks of companies' claims (including one that a smokable cannabis product would clear out your lungs), dishy details about the gifts companies dole out to docs, and eye-popping details about dripping water and insulation issues in cultivation facilities. 


the hill

Congress refills its Medicare piggy bank

Usually, there's not much health care policy in the National Defense Authorization Act. This year is different.

Lawmakers are facing down a Jan. 19 deadline to renew a variety of expiring health care programs, so they just tucked away an extra $1.8 billion in a Medicare reserve fund in the NDAA, a Senate aide confirmed. They achieved the savings by extending the Medicare sequester's end date, and then used some of the funds to pay for World Trade Center Health Program policies to support 9/11 survivors and first responders.

The additional savings went to the Medicare piggy bank, formally known as the Medicare Improvement Fund, referred to in wonky circles as the MIF. Lawmakers will be able to pull from the MIF early next year as they weigh how to fund community health centers and stave off pay cuts to safety-net hospitals. It's not a fortune, but it's also nothing to sneeze at, given hospitals are panicked about the prospect of a payment policy passing that would save the federal government $3.7 billion over the next decade. It also gives them some wiggle room if they need to do another short-term extension of the programs.


drug pricing

Schumer's 2024 insulin resolution

Groundhog Day isn't until February, but Senate Majority Leader Chuck Schumer was already back on Wednesday with another promise to extend a $35 monthly insulin copay cap to the commercial market next year. 

For those of us old enough to remember when he promised to hold a floor vote on the issue shortly after Easter recess in 2022, the schtick is tired. 

He describes "large progress" as being made "in a bipartisan way" on the proposal and other issues. However, he still has made no public indication what legislative language he actually supports amid disagreement in his own caucus. And the outlook isn't much better in the House, where a key committee chair has panned the idea



 

Insurance

Copay assistance in the spotlight

Copay accumulators may not be the sexiest issue in the world, but Sens. Tim Kaine (D-Va.) and Roger Marshall (R-Kansas) managed to corral 17 of their colleagues to call for HHS to ban them.

When insurers use copay accumulators, copay assistance from drug makers doesn't count toward patients' deductibles or out-of-pocket limits, which means it takes longer for patients to reach those milestones. The senators in a letter are asking for the Biden administration to drop its appeal of a court decision against the use of copay accumulators and enforce a ban on their use. 

Generally, the pharmaceutical industry opposes the use of copay accumulators. The lawmakers said Congress is working on legislation, too.


analysis

HSA sticker shock

Republicans love to hype up expanding Health Savings Accounts as a health care policy they support, but a new CBO report shows the price tag for the policy is hefty, to say the least.

Analysts estimated that Rep. Beth Van Duyne's (R-Texas) bill to expand HSA eligibility and increase contribution requirements would increase the deficit by $58 billion (yes, with a "b").


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What we're reading

  • After 'SNL' skit on sickle cell CRISPR therapy, advocates cite errors and stereotypes, STAT
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  • U.S. government spent more on health care in 2022 than six countries with universal health care combined, STAT
  • A new test could save arthritis patients time, money, and pain. But will it be used? KFF Health News

Thanks for reading! More on Thursday,


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