Plus, the broad implications of the ruling against HIV PrEP coverage | Thursday, September 08, 2022
| | | | | | | Presented By PhRMA | | | | Axios Vitals | | By Tina Reed · Sep 08, 2022 | | Good morning, Vitals readers. Today's newsletter is 935 words or a 4-minute read. ⌚️ The latest health features in Apple's tech lineup? More advanced (and encrypted) cycle tracking for periods and ovulation, thanks in part to a new body temperature sensor on its Apple Watch Series 8, Axios' Ina Fried and Kelly Tyko report. - The watch will also be able to detect a serious car crash and automatically connect to emergency contacts and first responders.
| | | | | | 1 big thing: Court ruling on HIV meds could have sweeping implications for preventive care |  | | | Illustration: Brendan Lynch/Axios | | | | A federal court ruling that struck down required coverage of HIV prevention medication may have far more sweeping implications for whether insurers will have to continue offering a range of no-cost preventive health services, Axios' Oriana Gonzaelez, Adriel Bettelheim and I report. Driving the news: U.S. District Court Judge Reed O'Connor ruled on Wednesday that an Affordable Care Act requirement that employers cover the HIV prevention medication known as PrEP violates the Religious Freedom Restoration Act. What he's saying: The government failed to show "a compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions," O'Connor wrote. - O'Connor also said the U.S. Preventive Services Task Force violates the Appointments Clause of the Constitution, casting into doubt its recommendations about how primary and preventive care is delivered, along with which services should be paid for by insurance.
- PrEP is among the services the task force most highly recommends. Other services include screening for breast, lung, colorectal and cervical cancers, fall prevention for older adults, depression screening and certain prenatal care services and infant screening services.
What they're saying: "This is not just about PrEP. It's much broader," Katie Keith, a health law expert at Georgetown University told Axios. - "If we l0se the A or B recommendations, then any employer or plan, religious objection or not, could say we're not going to cover that anymore.
What to watch: There's still some uncertainty about the scope of the ruling, Keith said. O'Connor told both sides to file briefs addressing that by Friday. - If it does apply more broadly, experts say it would strike at the heart of the ACA's preventive services mandate and could put millions of Americans on the hook financially for some of the highest-value services.
🎙 Listen in: Axios Today podcast host Niala Boodhoo and I discuss the implications of this ruling. |     | | | | | | 2. Dems get another campaign issue |  | | | Illustration: Sarah Grillo/Axios | | | | The federal court's ruling on HIV prevention medication marks the second election cycle in a row that a Republican-appointed federal judge in Texas has given Democrats an opening to campaign on saving the Affordable Care Act. - It's an opportunity the Dems relish, Axios' Caitlin Owens writes.
Why it matters: Weaponizing the GOP's 2017 attempt to repeal and replace the ACA was hugely successful for Democrats in the 2018 midterms. Republicans have been eager to talk about anything but the ACA since then, but Judge Reed O'Connor has twice now issued decisions that put key tenets of the law at risk. Flashback: O'Connor is the same judge that sided with GOP state attorneys general in a case that argued the ACA is unconstitutional and should be struck down. What they're saying: "As extreme MAGA Republicans work to rip away life-saving drugs, Democrats are fiercely defending health freedom," House Speaker Nancy Pelosi said in a statement hours after the decision was released. Be smart: The Supreme Court's decision to overturn the federal right to abortion this summer arguably gave Democrats their most effective campaign message of the cycle, ahead of what was expected to be a red wave this fall. - Pelosi's statement suggests the party will eagerly tie that decision to yesterday's and make November's election even more about health care.
Go deeper. | | | | | | | | 3. Medicare Advantage has a marketing problem |  Data: Centers for Medicare & Medicaid Services; Chart: Kavya Beheraj/Axios Seniors are increasingly complaining about aggressive marketing tactics and other issues connected with private Medicare plans, according to CMS data shared with Axios' Victoria Knight. Why it matters: While enrollment in Medicare Advantage has risen every year since 2007, according to a KFF report, so, too, have questions about the quality of care and whether the program is becoming a haven for high-pressure sales tactics and scammers. - Senate Finance Chair Ron Wyden (D-Ore.), launched an investigation into Medicare Advantage plans' marketing tactics in August, requesting information from 15 state regulatory bodies.
- This week, House Ways and Means Health Subcommittee Chair Lloyd Doggett (D-Texas), led 30 other Democratic members in recommending changes to the program that included reining in aggressive and misleading marketing tactics.
- "Aggressive sales tactics have left vulnerable seniors and people with disabilities susceptible to being misled and unwillingly steered into Medicare Advantage plans," the House members wrote in their letter.
Yes, but: The top advocacy group for private Medicare plans, the Better Medicare Alliance, said the sector already is subject to regulatory oversight, including answering to more than 50 pages of federal guidelines. What we're watching: Medicare open enrollment season starts Oct. 15. Read the rest. | | | | | | | | A message from PhRMA | | Congress should address the system we use to pay for medicines | | |  | | | | Insurers and PBMs receive discounts on insulins from manufacturers but don't usually pass these savings directly to patients. The impact: Patients are burdened with higher than necessary out-of-pocket costs. Learn more. | | | | | | 4. Data du jour: Pediatric hospitalizations |  | | | Chart: Courtesy of Health Care Cost Institute. | | | | Nearly a third of non-newborn pediatric hospital admissions from 2016 to 2020 were linked to mental health needs, Axios' Arielle Dreher writes about a new report from the Health Care Cost Institute. Why it matters: A high rate of inpatient mental health care could be a sign of inadequate preventive care and management of mental health needs in younger populations, researchers said. - Though mental health hospitalizations in kids picked up before the pandemic, accumulating evidence continues to show how the health crisis exacerbated the problem.
Share this story. | | | | | | | | 5. Catch up quick | | 👉 An FDA panel backed a much-debated ALS drug in rare, 2nd review. (Associated Press) 🏆 Addiction treatment is increasingly offering the chance to participants to win rewards, including candy or even cash, for negative drug tests. And experts say there's some good science behind why it helps. (Associated Press) 💉 Officials say the monkeypox outbreak has slowed significantly as vaccination access has opened up. (CNBC) 🚀 President Biden will outline his plan for reducing cancer deaths and bolstering treatments in a speech next week as part of what he has called "this generation's moonshot," the White House announced Wednesday. (Axios) | | | | | | | | A message from PhRMA | | Improving access to life-saving medicine | | |  | | | | Insurance companies and PBMs don't pay full price for insulin. So why do patients? Rebates, discounts and other payments from manufacturers lower the cost of insulins by more than 80% on average — but insurers and PBMs usually don't share these discounts directly with patients. Stand up for patients. | | |  | | Why stop here? Let's go Pro. | | | | | | Axios thanks our partners for supporting our newsletters. If you're interested in advertising, learn more here.
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