Friday, July 12, 2024

Seeking the cure for medical debt

Presented by the PBM Accountability Project: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.
Jul 12, 2024 View in browser
 
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By Chelsea Cirruzzo and Ben Leonard

Presented by 

the PBM Accountability Project

With Ruth Reader

Driving The Day

Bill Cassidy speaks at a press conference.

Sen. Bill Cassidy and other Republicans on the HELP Committee are at odds with their Democratic colleagues over how to solve medical debt. | Kevin Dietsch/Getty Images

MULLING MEDICAL-DEBT SOLUTIONS — Americans owe around $220 billion in medical debt — but senators are split along party lines on what to do about it, POLITICO’s Toni Odejimi reports.

At a Senate Health, Education, Labor and Pensions Committee hearing on Thursday, lawmakers offered different solutions: Democrats favored erasing the debt to encourage Americans to get care without fear of financial strain. Ranking member Bill Cassidy (R-La.) and the other Republicans on the panel prefer to redefine government policies to ensure that hospitals use subsidies for patient care.

The hearing comes after the Biden administration announced a plan in June that would block creditors from considering an applicant’s medical debt.

Reform or erase? Republicans are skeptical of erasing debt and instead offered certain reforms, including:

A focus on individual hospitals that don’t provide sufficient charity care to patients

More oversight into how hospitals use revenue from the 340B program, which requires pharma companies to offer discounted drugs to hospitals that serve low-income patients on the condition that the hospitals provide charity care

“A one-time cancellation of medical debt is not a solution. It is a Band-Aid approach to a one-time problem that’s gonna come back,” said Cassidy.

Democrats pushed for debt cancellation to help patients maintain the care they need, pointing to evidence that financial stress can exacerbate health problems.

Can transparency help? There was bipartisan support for improving price transparency in health care, but Sen. Tina Smith (D-Minn.) joined fellow Democrats in expressing doubt that transparency alone would fix the larger issue of medical debt.

She said price transparency “doesn’t solve the problem of high-deductible insurance plans,” which require patients to cover costs up to a level typically in the thousands of dollars.

What about medical credit cards? Some hospitals offer credit cards to allow patients to pay upfront. Lawmakers and doctors at the hearing said they worried about how it could change the industry.

“This is a pernicious new way of trying to further financialize health care in this country,” Abdul El-Sayed, director and health officer of the Wayne County Department of Health, Human and Veterans Services in Detroit, told the committee.

WELCOME TO FRIDAY PULSE. The CDC is yet again warning people to beware of receiving shady “Botox” from unlicensed individuals after seven people were injured in Tennessee and New York from counterfeit products. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.

 

A message from the PBM Accountability Project:

Patients, providers, and employers deserve to pay transparent, fair prices for prescription drugs, but pharmacy benefit managers (PBMs) are gaming the system while eating up profits and driving up costs. The Wall Street Journal recently uncovered that PBM middleman “mark up prices of generics for cancer, multiple sclerosis and other complicated diseases,” particularly medications from mail-order pharmacies that PBMs own. Congress must act now and protect patients from big PBMs pigging out on patient savings. Learn more at pbmaccountability.org.

 
In Congress

John Cornyn walks up a staircase at the U.S. Capitol.

Sen. John Cornyn's Affordable Prescriptions for Patients Act passed in the Senate on Thursday. | Francis Chung/POLITICO

DRUG PATENT BILL ADVANCES — The Senate approved on Thursday legislation that would stop drugmakers from gaming the patent system to stifle biosimilar competition, Ben reports.

The bill, the Affordable Prescriptions for Patients Act from Sen. John Cornyn (R-Texas), would restrict how many patents a pharmaceutical company can dispute during the “patent dance” process.

That process was established in 2010 to speed up the patent litigation process before a biosimilar product is introduced. There aren’t limits on how many patents a name-brand biologic manufacturer can assert during the dance, which supporters say enables abuse.

Changes: The legislation, approved by unanimous consent, was amended to cut the “product-hopping” prohibition, which drew scrutiny from brand-name drug lobby PhRMA. The prohibition allows companies to try to move demand for a brand-name drug with impending generic competition to a different brand-name drug that wouldn’t face such competition. The industry had argued the legislation would “upend the biopharmaceutical innovation ecosystem.”

The Congressional Budget Office last month estimated the legislation — before the product-hopping prohibition was cut — would reduce the federal deficit by more than $3 billion over 10 years. Without that provision, the CBO said it would save $1.8 billion, Cornyn said Thursday on the Senate floor.

Why it matters: The legislation could be used as a potential “pay-for” in a post-election health care package.

 

Understand 2024’s big impacts with Pro’s extensive Campaign Races Dashboard, exclusive insights, and key coverage of federal- and state-level debates. Focus on policy. Learn more.

 
 
AROUND THE AGENCIES

HEALTH IT REACTS TO ONC PROPOSAL — Health tech advocates worry that a Biden administration proposal to enable data-sharing in a public health emergency would burden the industry, Ruth reports.

Brett Meeks, executive director of the Health Innovation Alliance, says the ONC’s proposed rule is a big expansion. “For the last 15 years of that statute being on the books, they’ve only done [electronic health records]. So this is a big change,” he said.

The proposal creates certifications for public health and payers to partake in standardized protocols for data-sharing between them.

While ONC certifications are voluntary, Meeks thinks that language in the proposed rule indicates that other agencies might in the future require companies to get certified to receive federal dollars, whether through Medicare, the CDC, or HHS.

“At that point, they become less voluntary and more mandatory,” he said. Meeks also pointed to a section ONC included on severability, saying it indicated that the agency thought someone might sue to strike down individual provisions of the rule. According to the section, an entire rule wouldn’t be affected if any of its provisions were to be struck down.

AHIP, an insurer trade association, said it continues to review the proposed rule, including its certification standards for payers, noting that plans aren’t subject to ONC certification program requirements.

The American Medical Association praised the rule for clarifying when a doctor can decline to share a patient’s reproductive health information. This comes after the Biden Administration finalized a rule earlier this year barring providers from sharing abortion-related records with state or law enforcement officials.

EXAMINING CHRONIC ILLNESS IN WOMEN — The NIH must increase its research focus on chronic conditions in women, a report requested by the agency’s Office of Research on Women’s Health says.

The report, published this week by the National Academies of Sciences, Engineering, and Medicine, calls for the NIH to address what report authors say are underresearched areas. And it comes as the House considers a fiscal 2025 HHS budget that could restructure the NIH into fewer centers.

House Republicans argue the move would make the NIH more efficient and mission-driven without reducing funding, while some House Democrats worry it would disrupt research.

The current fiscal spending package would provide $100 billion for the ORWH, an increase from fiscal 2024. The House Appropriations Committee requests a specific focus on heart disease, lung cancer, Alzheimer’s disease and rheumatoid arthritis.

The report recommends NIH focus research on:

Improving diagnostic tools, which can help avoid misdiagnosis as women often present different symptoms of diseases than men in some conditions, like heart disease

Understanding women-specific factors, such as how reproductive milestones, like one’s first period or menopause onset, can impact the development of chronic conditions

Understanding the biology of chronic conditions in women, like pelvic floor disorders or uterine fibroids — as well as how the environment and genetics play a role

Understanding why women are more likely than men to have multiple chronic illnesses at the same time, how those conditions impact quality of life for women, and how traumatic events may relate to chronic conditions

Learning how inequities and biases in health care contribute to diagnoses and treatment of chronic conditions in women

 

A message from the PBM Accountability Project:

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Names in the News

Joshua Skora, Andrea Cunha and Leah D’Aurora Richardson have joined Foley & Lardner LLP as partners in its health care and life sciences sector. All come from K&L Gates LLP.

 

Understand 2024’s big impacts with Pro’s extensive Campaign Races Dashboard, exclusive insights, and key coverage of federal- and state-level debates. Focus on policy. Learn more.

 
 
WHAT WE'RE READING

STAT reports on how alcohol is driving types of cancer in the U.S.

NBC News reports on a new UN report showing how fertility rates are declining more rapidly than expected worldwide.

POLITICO’s Sophie Gardner reports on a lag in getting mpox vaccines to the Democratic Republic of the Congo.

 

A message from the PBM Accountability Project:

PBMs are pigging out on employer and patient savings while Americans struggle to afford the medicines they need.

A groundbreaking new study in Washington state uncovered several ways that big PBMs are reaping record amounts of prescription drug profits, hurting local pharmacies, employers and ultimately the patients at the pharmacy counter:

· For a subset of matched claims between the plan sponsors and the pharmacies, the average plan sponsor (employer) costs were approximately $165,000 higher (roughly 80% more) than the reimbursement provided to pharmacies (approximately $8 more per prescription).
· Plan sponsor (employer) costs increased by 30% while pharmacy reimbursement decreased by 3% between 2020-2023.
· PBM-owned mail-order pharmacies had drug markups that were more than three times higher than the markups at retail pharmacies.
· In one example, as reported by the Wall Street Journal, PBMs charged more than $6,000 for a cancer drug that costs $55.

We need Congress to put an end to the great PBM pig-out. Learn more at pbmaccountability.org.

 
 

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Chelsea Cirruzzo @chelseacirruzzo

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