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| Presented By Better Medicare Alliance |
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| Axios Vitals |
| By Tina Reed · Feb 15, 2023 |
| 🐪 Happy Wednesday, Vitals readers. Today's newsletter is 907 words or a 3½-minute read. Situational awareness: The FDA will hold its first meeting today to consider whether Narcan, a brand of the opioid overdose reversal drug naloxone, should be made available over the counter. |
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| 1 big thing: The administration's next crack at lower drug prices |
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| Illustration: Annelise Capossela/Axios |
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| The Biden administration unveiled three drug payment programs Tuesday aimed at helping reduce patients' out-of-pocket costs, including one that would potentially lower Medicare payments for promising treatments approved by the FDA before clinical trials are complete, Axios' Maya Goldman and Caitlin Owens write. Why it matters: The models wade into some of the most timely drug pricing issues of the day, and could boost President Biden's political arsenal for 2024. Driving the news: In October, Biden directed the CMS Innovation Center, which runs experiments on new ways to deliver and pay for health care, to study how it can use its authority to lower drug costs. - The executive order — and the new programs announced Tuesday — build on Medicare drug pricing reforms enacted by Congress last year. But they don't require lawmakers' blessing.
The details: The three programs focus on different classes of treatments and coverage. - One would encourage Medicare prescription drug plans to offer a standardized set of about 150 generic drugs to patients for a maximum copayment of $2 per month. The list would target drugs for chronic conditions like hypertension.
- Another would give state Medicaid agencies the option to coordinate with manufacturers and other states to test new ways to pay for gene and cell therapies based on health outcomes.
- The report specifically mentions gene therapies for sickle cell disease, two of which could hit the market this year with multi-million dollar price tags and would likely present significant affordability challenges for state Medicaid programs.
The third model would try to incentivize manufacturers to complete timely clinical trials to confirm accelerated-approval drugs work by adjusting how much Medicare pays for the products. - "Whether [payments] would go up or down — I think that's a design question that we would have to explore as we start developing the model," Innovation Center director Liz Fowler said.
Go deeper. |
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| 2. Docs prod Congress to do more on Medicare pay |
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| Illustration: Gabriella Turrisi/Axios |
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| Top doctors groups are pressing Congress to overhaul the way Medicare pays physicians just as lawmakers are getting pulled into the politically charged debate over possible cuts to entitlement programs, Axios' Arielle Dreher writes. Why it matters: The new appeals serve notice that there's a political risk if provider cuts become part of conservative-led efforts to balance the federal budget or a deal on raising the debt limit. Driving the news: The American Medical Association and nearly 100 other physician groups recently called for "long-term, substantive payment reforms," saying Medicare payments to clinicians have declined 22% from 2001 to 2021, when adjusted for inflation. Yes, but: The pleas come at a politically loaded moment, with Medicare emerging as a 2024 campaign issue and both parties vowing to save the program. - As Axios' Caitlin Owens reported, there are plenty of reforms that would reduce Medicare spending and shore up the program's solvency not by cutting seniors' benefits, but through reductions to fees paid to health industry groups.
- Republicans' relationship with the AMA has also soured over the group's positions on issues like abortion and gender-affirming care, Caitlin and Victoria Knight recently wrote.
Our thought bubble: Increasing payments involves new Medicare spending, which will be a particularly difficult ask in the current political environment. It remains to be seen if belt-tightening will negatively impact patients, as some industry groups contend. Read the rest. |
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| 3. Quote du jour: Protecting kids online |
| "Let us be clear: these are no coincidences, accidents or unforeseen consequences. They are the direct result of products designed to hook and monetize America's children. It should not take grieving parents filing lawsuits to hold this industry accountable for their dangerous and addictive product designs." — Kristen Bride, surviving parent of Carson Bride, a 16-year-old who died by suicide following cyberbullying, told the Senate Judiciary Committee about the dangers of social media. Children's safety online is back on Congress' agenda, Axios' Ashley Gold writes. |
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| A message from Better Medicare Alliance |
| Proposed Medicare Advantage cuts would hurt 30 million seniors |
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| 30 million seniors rely on Medicare Advantage for high-quality care at a lower cost. Now, the administration is proposing deep cuts, meaning higher premiums and fewer benefits. With inflation so high, seniors can't afford higher health care costs. Protect 30 million seniors and stop the cuts. |
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| 4. Private equity cuts back on ER docs |
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| Illustration: Brendan Lynch/Axios |
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| Emergency departments staffed by private equity-owned companies are saving money by cutting back and hiring fewer doctors, KHN reports. Why it matters: Private equity closed 2022 with its "second-best year," announcing or closing more than 850 deals in 2022, per data released earlier this month by market research firm Pitchbook. - Private equity has also been gaining public awareness and regulatory scrutiny for its impact on the quality of health care due to its reputation for aggressive cost-cutting from operations.
- "It's a relatively simple equation," Robert McNamara, a founder of the American Academy of Emergency Medicine and chair of emergency medicine at Temple University, told KHN.
- "Their No. 1 expense is the board-certified emergency physician. So they are going to want to keep that expense as low as possible," he said.
The other side: In a statement to KHN, one of the groups cited in the report, American Physician Partners, called the strategy a "blended model" and said it was a way to ensure all ERs remain fully staffed. Catch up quick: Biden administration has made private equity ownership of nursing homes a key focus, rolling out a rule Monday to require nursing homes to disclose more details about their ownership, including whether private equity or real estate investment trusts have a stake. - They cited research showing residents in nursing homes acquired by private equity were more likely to have a preventable emergency department visit and experience a preventable hospitalization.
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| 5. Catch up quick |
| 👉 South Dakota has become second state to ban gender-affirming care for trans youth. (Axios) 💊 A quick-acting male birth control drug shows promise in the lab. (Washington Post) 🕰 According to medical guidelines, your doctor needs a 27-hour workday. (New York Times) |
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| A message from Better Medicare Alliance |
| Why the proposed cuts to Medicare Advantage will hurt seniors |
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| The proposed cuts to Medicare Advantage are unprecedented and will drive up premiums and cut benefits for seniors at a time of high inflation. Now isn't the time for cuts. The administration must protect the stability of this vital program, which 30 million seniors rely on every day. See why. |
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| Thanks for reading, and thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for the edits. |
 | | Your personal policy analyst is here. | | |
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