Axios Vitals: Costly mistake

Plus, drug law brings value into price equation | Friday, October 14, 2022

Open in app View in browser   Presented By PhRMA   Axios Vitals By Tina Reed · Oct 14, 2022 Happy Friday, Vitals readers. Today's newsletter is 869 words or a 3-minute read. 💩 1 fun thing: There was apparently a "Ryan Reynolds effect" on the number of colonoscopies scheduled last month. Appointment booking platform Zocdoc says 36% more appointments were booked per day after the release of Reynolds' "Lead from Behind" PSA than were booked per day in the 100 days prior.     1 big thing: The Biden administration's next challenge is paying for discount drug mistakes Illustration: Sarah Grillo/Axios   Four months after it lost a high-profile dispute at the Supreme Court, the Biden administration has yet to figure out how it will reimburse hospitals for as much as $10 billion in unlawful cuts to Medicare outpatient drug payments, Axios' Maya Goldman writes. Why it matters: Congress may have to step in and authorize billions in new spending to make the facilities whole if the government decides to claw back already allocated funds. Flashback: The Centers for Medicare and Medicaid Services in 2018 began cutting payments to safety-net providers in the federal 340B discount drug program by nearly 30% after research indicated some hospitals were profiting excessively from the program. CMS applied the $1.96 billion in savings from the reimbursement cut by raising Medicare payments to all hospitals for non-drug items and services.  But the Supreme Court ruled in June that the rate adjustments for 2018 and 2019 were illegal because HHS didn't first conduct a survey of hospitals' acquisition costs. State of play: CMS this summer proposed policy changes and sought feedback on how to compensate the affected hospitals. Repaying them without tapping into new funds would have a ripple effect and result in lower Medicare payments to 80% of all hospitals next year, according to an Avalere study.  Further complicating matters, a lower court ruled last month that CMS had to stop discount drug program payment cuts for 2022.   What we're hearing: Hospitals say that new federal spending should be used to rectify the improper cuts.  But CMS hasn't said whether it agrees with that argument. And it's unclear if Congress would approve such a payment fix while it sorts through a passel of other year-end health care funding requests. What we're watching: CMS could finalize a solution in early November as part of its Medicare outpatient payment rule for 2023. Emily Cook, a partner at law firm McDermott Will & Emery, thinks CMS will move forward with a solution that requires some clawbacks of already authorized funds.  Yes, but: Health care providers are already asking Congress for relief from several other Medicare payment cuts. Read the rest.     2. New drug law attempts to marry prices to value Illustration: Aïda Amer/Axios   Democrats' new law giving Medicare the authority to negotiate some drug prices attempts to do something critics say is often lacking in today's market: Tying what the government pays to the treatments' value, Axios' Caitlin Owens writes. Yes, but: The law lists multiple factors that will be used to determine a drug's price, but it's unclear how those factors will be defined and weighted, experts say. The big picture: Medicare will be able to negotiate the prices of certain drugs that have been on the market for several years but don't have competition from generics. Instead, it lists multiple factors for the government to consider when coming up with its negotiated price proposal. These include things like R&D costs, production and distribution costs and how the drug compares to alternative treatments. The bottom line: The way Medicare determines these prices could drastically impact the pharmaceutical industry. "It's going to change the market," said Avalere's Michael Ciarametaro, one of the authors of a white paper on the topic. "The thing is, manufacturers are going to have to adapt to it. It's something that is going to start small, most likely, and will build over time." Read the rest.     3. CDC: Latinos with HIV report discrimination Illustration: Natalie Peeples/Axios   Latinos with HIV are facing stigma and discrimination due to their diagnosis, making it harder for them to receive adequate care, according to CDC data released Thursday, Axios' Sabrina Moreno writes. Why it matters: The shame associated with disclosing HIV status or fearing that doctors won't listen to their needs could lead Latinos to avoid testing or treatment — a decision that could be fatal. The report comes as Latino men are among the most likely to be impacted by monkeypox, a disease where similar stigma, language barriers and lack of access to care have contributed to disparities reminiscent of those in the HIV epidemic. Details: The CDC analyzed roughly 2,700 responses from Hispanic adults with HIV and broke down reports of stigma and health care discrimination by race, gender and limited English proficiency. Women, Latinos from the Caribbean and those who identified as American Indian or Alaska Native reported the highest levels of stigma-related concerns over their HIV status. Nearly 30% of Black Latinos reported experiencing health care discrimination compared to 21% of white Latinos.     A message from PhRMA How insured Americans navigate unclear insurance coverage     According to new findings, insured Americans favor policy solutions that improve their ability to navigate and access their care while lowering their out-of-pocket costs. An example: Tackling the barriers introduced by insurers and middlemen like pharmacy benefit managers. Read more.     4. Data du jour: Long COVID rates Data: CDC Household Pulse Survey Nearly a third of Americans who know they've had COVID say they've also experienced the often disabling aftereffects known as long COVID, according to recent CDC data. The rate of those reporting long COVID symptoms was highest in West Virginia (49%), compared to the state with the lowest rate of people reporting long COVID: Vermont (22%). Be smart: A study published this week in JAMA Network Open found long COVID could set individuals back the equivalent of a decades' worth of aerobic fitness, the Washington Post reported.     5. Dog of the week Theo and Teddy. Photo: Sabrina Moreno/Axios   Meet Theo and Teddy, two adorable "brothers" from Richmond, Virginia. They were submitted by Axios' Sabrina Moreno, who says Theo is 6-foot-2 standing on his hind legs, but "scared of literally everything" while Teddy loves to "dance" to Bad Bunny songs. Have a good story tip on health care equity? You can reach Sabrina by email or on Twitter.     A message from PhRMA Americans want policy reforms that improve their insurance     Did you know 39% of insured Americans say they don't understand what's covered by their insurance? Health insurance coverage should be predictable and transparent, and insured Americans agree. Learn more from PhRMA's latest Patient Experience Survey report.   Thanks for reading, and thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. Please ask your friends and colleagues to sign up. Why stop here? Let's go Pro. Join the thousands of professionals reading Axios Pro: Health Tech Deals to better understand the forces shaping their industry.   Axios thanks our partners for supporting our newsletters. If you're interested in advertising, learn more here. Sponsorship has no influence on editorial content. Axios, 3100 Clarendon B‌lvd, Arlington VA 22201   You received this email because you signed up for newsletters from Axios. Change your preferences or unsubscribe here.   Was this email forwarded to you? Sign up now to get Axios in your inbox.   Follow Axios on social media: