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What does a drug price negotiation win look like?

July 30, 2024
Reporter, D.C. Diagnosis Writer

Hello and happy Tuesday, D.C. Diagnosis readers! I confess (to the horror of my coworkers sometimes) that I've never watched The Simpsons, but this recent dive into the archives from VP Harris was fun. Send news, tips and your favorite Simpsons clips to sarah.owermohle@statnews.com.

drug pricing

Hard bargain or hardly a bargain?

prices

The deadline for Medicare to announce negotiated prices on the first round of drugs is fast approaching. If you're wondering how to tell whether the Biden administration drove a hard bargain, my colleague John Wilkerson has some tips.

Judging the negotiated prices is not straight forward, but there are at least four ways to get at it. Do they save taxpayers money? Do they save seniors' money? Are they appropriately priced for the value they provide? Are we still paying more than other countries?

The international price comparison might be the easiest approach, and the most tempting. But don't hold your breath for lower prices here than abroad, according to KFF Executive Vice President for Health Policy Larry Levitt.

"That's an important political goal," Levitt said. "But the drug pricing provisions in the Inflation Reduction Act ended up being much more modest than advocates had hoped."

More from John.


hospital regs

Fixing site neutral's rural hospital problem

Based on casual hallway interviews with lawmakers, one of the hospital industry's most persuasive arguments against equalizing payments in Medicare regardless of where a service is provided is that the policy could hurt rural hospitals, my co-author Rachel Cohrs Zhang reports. 

Rachel discussed this topic, known as site-neutral policy, with health policy experts from the American Enterprise Institute, the Brookings Institution, Paragon Health Institute, and the Center for American Progress, including how to ensure that rural hospitals wouldn't be harmed if the policy is implemented. Ben Ippolito from the American Enterprise Institute said that rural hospitals do face financial challenges, but to overpay all hospitals in America to fix the issue is "so backwards that it's like we've completely lost the point." 

The policy could save money by reducing payments for some services like x-rays and office visits in hospital outpatient departments, and the most aggressive form of the policy could save Medicare more than $100 billion. Ippolito suggested using some of the savings to just give money to rural hospitals. He also said that it's also unlikely that rural hospitals are the big drivers of purchasing physician practices.

Loren Adler of the Brookings Institution suggested using the savings to provide slightly higher Medicare payments for rural hospitals, or providing a financial incentive for doctors to practice in rural areas. 


FOod fights

White House prepares for a 'healthy' dose of lobbying

The regulatory wonks over at the White House Office of Management and Budget are about to get very familiar with the food industry's feelings on what is, and isn't "healthy," my colleague Nick Florko reports. The White House regulatory office has officially begun scheduling meetings about the FDA's attempt to redefine that term.

There's no telling yet what the FDA's regulation on labeling food as "healthy" says. The agency submitted the rule to the White House earlier this month. OMB must now review the regulation and meet with stakeholders before it is ultimately released. A draft of the regulation, which was released in 2022, proposed that foods could be labeled healthy if they contained a certain amount of healthy food groups, like vegetables and fruits, and were limited in harmful nutrients like sodium and added sugar. The regulation was criticized by food manufacturers as overly restrictive. 

The change to FDA's definition of healthy could have major financial implications for food manufacturers – especially those who literally have the word "healthy" in their names. So, the White House is likely to schedule dozens, if not hundreds, of meetings with food makers in the coming weeks. But, interestingly enough, the first groups to get the White House's ear aren't the frozen food lobby, or the folks behind Healthy Choice  – it's tea companies who have been trying to get tea called out as healthy within the FDA's regulation. Lipton Tea met with the White House last week, according to public records, and the Tea Council of the U.S.A. is slated to meet with officials on Friday.

Got good goss on tea makers lobbying in Washington? Spill the tea to Nick at nicholas.florko@statnews.com.



k street

Grindr taps into health care lobbying

LGBTQ dating app Grindr has hired a well-known Washington lobbying firm amid legislative and court battles over reproductive health care access.

The "Global Gayborhood" called in a former senator's K Street shop, to lobby on "HIV prevention; LGTBQ family formation challenges including surrogacy and IVF," according to federal disclosures filed last week.

Grindr's foray into lobbying is notable for the platform; no other popular dating apps have registered to lobby on health care issues, according to STAT's review of federal disclosures. Match Group, which owns the popular dating apps Tinder and Hinge, spent $650,000 last quarter lobbying on digital privacy issues. More from Nick and me on Grindr entering the fray and who they've picked for the fight.


medicare policy

Telehealth providers brace for potential coverage cliffs

Scores of telehealth companies popped up during the Covid-19 response to provide remote care. But with Medicare telehealth coverage set to expire at the end of 2024, some are wondering: Will Congress extend coverage in time? And if they don't, what happens to care?

Several companies are drawing up plans to notify patients that their services soon won't be covered by Medicare and others are wondering how their businesses might survive, STAT's Mario Aguilar reports. 

CMS has also pressed for Congressional action to extend telehealth flexibilities. But if lawmakers don't pass some kind of legislation before the agency issues a final payment rule in November, the agency may not have time to reflect those changes, Mario writes. More on the telehealth dilemma


behavioral health

America's mental health care, and coverage, still in crisis

Nearly a quarter of Americans reported mental illness in the past year, and receiving affordable care remains a top issue, according to a new report by nonprofit Mental Health America that assembled data from federal and state health agencies.

More than 60% of uninsured adults with anxiety and depression were not receiving care in 2022, in large part because they couldn't afford it, MHA found. Nine of the 10 states reporting the highest amounts of uninsured adults with mental illness that year are also holdouts on expanding Medicaid. MHA also traced the impact of recent Medicaid expansion on access to care: Between 2018 and 2019, for instance, uncompensated care costs rose 6% across all states but fell 14% in Virginia and Maine, the two states that expanded the program during that time.

There are also still barriers for people on insurance to receive behavioral health care, because while the ACA required coverage on small employers' health plans, state laws vary on what large employers must cover. Read the whole report.


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What we're reading

  • Could cow vaccines help halt the spread of bird flu in U.S. herds? Experts are divided, STAT
  • Iowa now bans most abortions after about 6 weeks, before many women know they're pregnant, Associated Press 
  • In a big step for liquid biopsy, FDA approves a blood screening test for colorectal cancer, STAT

  • Kamala Harris' call for 'reproductive freedom' means restoring Roe, Politico 

Thanks for reading! More on Tuesday,


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