on the hill
Exclusive: Senators ask Medicare for a pay bump for drugs used with scans
Sen. Marsha Blackburn (R-Tenn.) is leading a bipartisan group of senators to ask Medicare officials to bump payment for drugs paired with diagnostic scans that are used for, among other things, assessing patients' eligibility for a new class of Alzheimer's drugs, my co-author Rachel Cohrs Zhang reports.
Medicare last year relaxed restrictions that limited Medicare patients to one PET scan in their lifetimes, and only in the context of a clinical trial. Now, the group of 15 senators including Sens. Tammy Baldwin (D-Wis.), Susan Collins (R-Maine), Shelley Moore Capito (R-W.V.), Joe Manchin (D-W.V.) and Maggie Hasssan (D-N.H.), is asking Medicare to pay for the drugs used with the scans separately, instead of having them bundled in with other services.
If Medicare goes along with the plan, it would likely be a boon for health care providers. A government watchdog found in March 2021 that when providers were paid separately for Eli Lilly's radiopharmaceutical drug, they were paid significantly more than when payments were packaged.
in the courts
Next steps in the PrEP fight
A federal appeals court on Friday largely maintained the status quo in a contentious fight over whether federal panels can require insurers to cover certain preventive care without cost to patients (they can, for now). Lawyers and public health advocates who spoke to STAT described it as a "pleasant surprise" and a "reprieve," especially for sexual health services. But in the next breath, many also expressed concern about the next steps in the legal fight.
The case, Braidwood Management v. Becerra, questioned whether one advisory group, the U.S. Preventive Services Task Force, had the authority to require insurers to cover PrEP, a medicine that minimizes the risk of HIV transmission. The suit came from a Christian-owned wellness business and six individual Texans who all argued the requirement violated their religious beliefs. But a ruling against USPSTF could threaten any decision the panel has made since 2010, including no out-of-pocket payments for cancer screenings and statins.
And though the Fifth Circuit Court of Appeals opted out of challenging the panel's authority, the judges laid a roadmap for how objectors could lay a better foundation for a future case, legal experts told STAT.
This challenge is "part of a broader campaign by the conservative legal establishment to place real limits on the power and scope of the federal administrative state," said Nicholas Bagley, a University of Michigan law professor and former legal counsel to Michigan Democratic Gov. Gretchen Whitmer. "That campaign includes a lot of different things, like the Chevron Doctrine."
Chevron — a longtime legal deference to federal agencies on their industry regulations — is also in jeopardy with a Supreme Court decision that could land as early as this week. (Thoughts about that? Hit my email.)
drug policy
House panel weighs weight-loss drug coverage
The Ways and Means Committee is exploring a vote on scaled-back versions of two major health care bills that would expand Medicare's coverage of cancer screening tests and hugely popular weight loss drugs, five sources familiar with the planning told Rachel and John Wilkerson.
Full Medicare coverage for both items has broad bipartisan support, but the expansion has been hampered by the likely exorbitant price tags to the federal government, Rachel and John write. If the panel is able to scale back the measures to a more palatable price point, it could increase their chance of passage.
On the table are the Treat and Reduce Obesity Act, which would allow Medicare to cover obesity drugs, and the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act, which would allow Medicare to cover multi-cancer blood tests to screen healthy people for cancer. Read more on the state of play. 
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