| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | Presented by 340B Health | | | | | | 
An HSS funding hike in the fiscal 2024 spending package fails to keep pace with inflation. | Alastair Pike/AFP via Getty Images | HERE’S THE DEAL — Congress is poised to finish its fiscal 2024 spending package, which includes HHS funding, in the days to come — albeit nearly six months late. The process cost former House Speaker Kevin McCarthy his job in October and was often ugly, though this time, lawmakers will likely avoid any prolonged shutdowns that could lead to significant furloughs at federal health agencies. Here are Ben’s top takeaways from the yet-to-be-approved deal: HHS gets a boost, but … Debt ceiling deal constraints contributed to HHS getting a funding increase that fell well short of inflation — growing less than 1 percent overall despite a $955 million boost to $117 billion-plus. Despite McCarthy’s ouster, his deal will still have an impact on spending levels. But Democrats got a win, too, as they’re poised to avert a 1 percent cut across the board from going into effect April 30. Consternation in compromise: PEPFAR, a longtime bipartisan global AIDS program, got a one-year reauthorization instead of its traditional five-year deal, a compromise that left few happy. Republicans had claimed President Joe Biden uses the program to back abortion rights, which the administration and outside experts deny. The situation reflects the new state of affairs post-Dobbs. Controversial riders get the boot: Republicans’ push for anti-abortion riders ultimately failed, with no new ones added to the package. This year’s fiscal battle went much further than before, with abortion-related language in almost all parts of the appropriations process. The longstanding Hyde Amendment banning federal funding for abortion will remain. Alzheimer’s in focus: Alzheimer’s disease was a priority for appropriators. The deal “notes disappointment” with CMS’ move to limit coverage for new but pricey Alzheimer’s treatments and calls on the agency to change its decision. It also gives a $100 million boost for Alzheimer’s research, making up a third of the NIH’s increase in funding. Gear up for year’s end: As expected, pharmacy benefit manager, transparency and site-neutral payment reforms weren’t included in the package despite bipartisan interest from key committee leaders. Expect that battle to play out later this year when advocates will likely target an end-of-year package for their priorities. The future of telehealth and hospital care at home will also be a major policy question that lawmakers have to address by the end of the year. What’s next: Lawmakers face a midnight deadline tonight to avert a shutdown. The House is expected to vote on the package today. WELCOME TO FRIDAY PULSE. We’re in awe of what some people seem to think is under the Capitol — and we’re all for making it happen. Get me a shovel! Reach us and send us your tips, news and scoops at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.
| | | | A message from 340B Health: Support the 340B PATIENTS Act The 340B PATIENTS Act eliminates harmful big pharma restrictions on 340B savings that are vital for expanding health care and support for patients and rural communities in need. By restricting 340B pharmacy partnerships, drugmakers have siphoned billions from the health care safety net solely to bolster their profits. The 340B PATIENTS Act stops this damaging behavior. We call on Congress to support this vital legislation. Learn more. | | | | | | | 
Medicare will cover weight-loss drug Wegovy for certain patients at risk for heart attack or stroke. | Novo Nordisk/AP | A GAIN FOR WEIGHT LOSS? Medicare plans can cover weight-loss drug Wegovy, but there’s a catch, POLITICO’s Robert King reports. For patients on private Part D drug plans, the drug must be prescribed for the purpose of mitigating heart attack risk, according to coverage guidance CMS released Thursday. The FDA approved the Novo Nordisk blockbuster drug this month for reducing the risk of heart attack and stroke as well as obesity. A 2003 law bars Medicare plans from covering weight-loss drugs. The move bolsters the market for Wegovy and means other drugs could get a similar boost. In states, Medicaid must cover Wegovy but only to reduce heart attack risk for obese people.
| | | | YOUR GUIDE TO EMPIRE STATE POLITICS: From the newsroom that doesn’t sleep, POLITICO's New York Playbook is the ultimate guide for power players navigating the intricate landscape of Empire State politics. Stay ahead of the curve with the latest and most important stories from Albany, New York City and around the state, with in-depth, original reporting to stay ahead of policy trends and political developments. Subscribe now to keep up with the daily hustle and bustle of NY politics. | | | | | | | | A TEST FOR TESTS — There's a partisan divide over how Congress should approach the oversight of medical tests as the FDA pushes to finalize regulations for some of them next month, POLITICO’s David Lim reports. Republicans on the House Energy and Commerce Health Subcommittee made their case Thursday that the FDA exceeded its authority in proposing that many laboratory-developed tests be regulated as medical devices. But Democrats backed the FDA's effort, saying it's needed to ensure accuracy and reliability. The path forward: Both sides agreed that legislation would be better than agency action, but there wasn't consensus on how to handle it. Some suggested that changing the VALID Act, which failed to become law in 2022, could be a path forward. House E&C Chair Cathy McMorris Rodgers (R-Wash.) said the FDA's regulation would be too pricey to comply with. Rodgers led efforts to block the VALID Act from hitching a ride on a spending package at the end of 2022. Ranking member Frank Pallone (D-N.J.) said the FDA’s rule could reduce unnecessary treatments or undertreatment due to inaccurate tests. In the upper chamber: Sen. Bill Cassidy (R-La.), ranking member of the Senate Health, Education, Labor and Pensions Committee, asked the industry, advocacy groups and regulators for information this month on how to improve oversight of the tests. But it’s unclear whether HELP Chair Bernie Sanders (I-Vt.) is interested.
| | | | A message from 340B Health:   | | | | | CHANGES TO 998 COMING — The 988 mental health and suicide hotline will dispatch callers based on their location instead of their area code, FCC Chair Jessica Rosenworcel said Thursday alongside the newly formed Senate Mental Health Caucus. Many people don’t have area codes that correspond with where they live, a limitation of the existing system. Caucus chairs Sens. Alex Padilla (D-Calif.) and Thom Tillis (R-N.C.) introduced legislation to route the calls by location, but Rosenworcel said she “came to realize” she could work with Congress to change the way the system works. “That means we can get you resources that are local … and we might be able to save more lives,” Rosenworcel said. Looking forward: Rosenworcel told Pulse she hopes to have the FCC rulemaking “out the door” in the next “several weeks.”
| | THE FUTURE OF MEDICARE ADVANTAGE — Moody’s Ratings projects that about 60 percent of Medicare enrollees will be on Medicare Advantage plans by 2030, according to a new analysis. In 2023, 51 percent of enrollees were on the privately run plans, which have surged in popularity in recent years. What Moody’s thinks it means: The organization’s analysts expect that hospital revenue will be at increased risk, pointing to an “uptick in claim denials” in MA. Larger hospitals are “best positioned” to deal with the situation, Moody’s analysts wrote, but hospitals “of varied sizes and types” are still ending Medicare Advantage contracts. The analysts also noted that insurers are seeing profitability in MA plans fall, meaning they could reduce network sizes or negotiate rates more aggressively to counter lower earnings. The response: A spokesperson for insurer lobbying group AHIP said the report “assumes a conclusion based on one hypothetical and narrow assumption without taking into account a host of factors, including increasing utilization trends among seniors who are relying on more health care services in 2024.” Susan Reilly, a spokesperson for the Better Medicare Alliance, which represents MA insurers, said plans can’t “on a whim severely limit networks” due to adequacy requirements and said there’s “little evidence” that MA rates differ from traditional rates.
| | | | Easily connect with the right N.Y. State influencers and foster the right relationships to champion your policy priorities. POLITICO Pro. Inside New York. Learn more. | | | | | | | | | PULSE OXIMETER DISPARITIES — Black patients were more likely than white patients to have low blood oxygen levels missed by pulse oximeters, according to new data from Epic Research, adding to a growing body of evidence on the issue. Researchers examined more than 13,000 hospitalized patients between 2016 and 2023 who received both pulse oximeter and blood-gas oxygen-saturation results. The latter is generally more accurate but more invasive, requiring a blood test. Black patients were 32 percent more likely than white patients to have their blood oxygen overestimated by pulse oximeters, which can lead to delayed care. Although research has shown these issues for decades, the pandemic brought renewed focus on the devices, which measure oxygen levels using light on a patient’s finger. In 2021, the FDA warned that the devices may be less accurate for people with dark skin. The FDA held an advisory meeting on the issue last month, where outside health experts pushed the agency to do more to bolster pulse oximeter performance for people with darker skin tones. The FDA is considering defining performance metrics for prescription and over-the-counter pulse oximeters.
| | POLITICO's John Sakellariadis and Gavin Bade report that UnitedHealth Group CEO Andrew Witty will testify before the Senate Finance Committee next month following the Change Healthcare attack. Healthcare Dive reports on Walgreens’ VillageMD selling 11 of their locations. STAT reports on the lasting health impact of asbestos despite a recent ban.
| | | | A message from 340B Health: Support the 340B PATIENTS Act
340B hospitals are the backbone of the nation’s health care safety net, providing essential services to patients with low incomes and those living in rural America. 340B hospitals play a vital role in delivering 77% of Medicaid hospital care, providing 67% of the nation’s unpaid care, and offering comprehensive specialty services that otherwise might not be available. 340B helps lower health care costs and enable doctors, nurses, and pharmacists to provide expanded care for the benefit of their community—all at no cost to the taxpayer.
The 340B PATIENTS Act will end harmful drug company restrictions on 340B savings that are vital for protecting patients and communities. By restricting 340B pharmacy partnerships, big pharma has siphoned billions from the health care safety net solely to bolster its profits. The 340B PATIENTS Act stops this damaging behavior. We call on Congress to support this vital legislation. Learn more. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |
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