House delivers hospital transparency bill

The House passed a major health care package late Monday, an end-of-year victory after the same policies had to be yanked from consideration in September because they lacked bipartisan support, Rachel Cohrs reports.

Though the package is unlikely to pass the Senate and become law as-is, its advancing through the House does make each included policy more attractive for a potential government funding deal, as lawmakers draw closer to the Jan. 19 deadline to fund the government and extend funding for certain health programs in particular.

The bill would equalize payment between hospital outpatient departments and doctors' offices for administering medicines in Medicare, rein in some practices by pharmacy benefit managers, and codify health care price transparency rules. It would also stave off pay cuts for safety-net hospitals and fund community health centers. But the most controversial part, by fair, is so-called "site-neutral" payments for medicines. Rachel explains.

gene therapy

Covering CRISPR

Now that the much-anticipated CRISPR gene-editing tool for sickle cell disease is approved, the next challenge is here: Paying for the $2.2 million exa-cel. The therapy could go to an estimated 100,000 Americans, mostly Black people. But policymakers including Sen. Bill Cassidy (r-La.), the highest-ranking member of the Senate health committee, have questioned how the health care system can grapple with the wave of costs for this and other pricey gene therapies on the horizon.

This is "one of the big questions," said Lewis Hsu, chief medical officer of the Sickle Cell Disease Association of America Inc. "The price tag is estimated to range from $2.2 to $3.1 million depending on the treatment. Who's going to pay that?"

Value-assessing groups like the Institute for Clinical and Economic Review and the University of Washington have said that the steep cost could be worthwhile for both patients and health care systems compared to lifelong treatment. But there are questions about how that value changes based on peoples' ages (ideally, children with sickle cell would get the therapy as soon as possible). One outstanding question is whether CMS would issue a national coverage determination, which can limit coverage to certain populations and require evidence-gathering by providers.

The agency didn't comment on that specifically, but a spokesperson said that current Medicare and Medicaid coverage rules apply. That means that for Medicare coverage, "an item or service must be reasonable and necessary for the diagnosis or treatment of an illness or injury for the Medicare population" and for Medicaid, "states will generally be required to cover the drug for most people."

health insurance

UnitedHealth executive to head AHIP

Mike Tuffin, executive at insurance giant UnitedHealth Group, is slated to be the next leader of the health insurance industry's largest lobbying group. He's currently UnitedHealth's senior vice president for external affairs and head of U.S. government affairs.

The announcement comes after Matt Eyles announced his retirement from the group earlier this year after a five-year tenure. Notably, UnitedHealth group is not a member of AHIP after the company left in 2015.

That said, Tuffin is also an AHIP alum: He spent nine years at the organization from 2003 to 2012. At the time, he was AHIP's executive vice president of communications and public affairs. More from Rachel.

closing the gap

Making mobile care work

There's a van brigade in New England targeting hard-to-meet patients, spurred in large part by the Covid-19 pandemic and recently expanded CMS policies. STAT intern Anika Nayak dove into the experience of hundreds of low-income and marginalized Boston residents to look closer at the aims of these on-the-go providers.

The Community Care Van program is aimed at narrowing the health disparity gap exposed by the pandemic by addressing both general health concerns and a wide range of social factors that contribute to health gaps including postpartum care, food security, and housing. The vans operate on a walk-in basis, and anyone can qualify — but operators are also looking to enroll patients in insurance.

Recent government policies may help further bolster the popularity of mobile clinics and other alternative health care delivery models. As of this October, CMS allows public and private insurers to reimburse providers of mobile medicine to homeless and unsheltered populations. More from Anika.

opioid crisis

The methadone battle you didn't expect

Today, senators will debate an addiction medicine proposal that would have been considered unthinkable just years ago: giving a select group of doctors the power to prescribe methadone directly to patients. The Senate HELP panel is marking up an extension to the SUPPORT Act that would allow certified addiction doctors to prescribe methadone to patients outside specialized methadone clinics.

Opponents, including methadone clinics, say the bill would do more harm than good, Lev Facher writes. Methadone is itself an opioid, and in rare cases it can lead to overdose when misused. Historically, methadone clinics and law enforcement groups like the DEA have strongly opposed major expansions in access to methadone.

Still, key Biden administration officials have shifted their stance in recent years, reflecting an evolving attitude towards methadone and treatment. The bill still faces significant obstacles on Capitol Hill despite the markup this week, not least of them lobbying against expanded access. Lev dives in.

in the industry

Jobs' mission accelerating cancer therapies

Not everyone has the resources that Reed Jobs has. After his father, Apple founder and icon Steve Jobs, died of complications from pancreatic cancer in 2011, he joined his mother's venture capital and philanthropy group Emerson Collective to help jumpstart cancer therapies' speed to market.

Jobs built out a health team aimed at the oft-bemoaned Valley of Death, the tenuous period between when scientists make a discovery, and when they've gathered enough preclinical data to convince drug companies or investors that it is worth developing further, he told STAT's Angela DeAngelis in extensive interviews. Within a year, Emerson Collective had launched its first science grant program and made its first biotech investment.

The group has some early wins, including investments like Grail, which earned FDA breakthrough status in 2019 for an early cancer detection device. But the cancer field has hit some snags: Investment has dropped and the landmark discovery of checkpoint inhibitors has lagged as scientists find that they work in a small subset of cancers. More from Allison.

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