Insights^

Find our analysis on legislation, regulations, MedPAC meetings, and more. 

What Happened, What You Missed: May 22-26, 2023

CMS Proposes Greater Drug Price Transparency in Medicaid

A newly proposed rule from the Centers for Medicare and Medicaid Services (CMS) would require pharmacy benefit managers (PBMs) that contract with Medicaid to disclose the prices they pay for prescription drugs. The proposed rule is part of a Biden administration effort to boost price transparency by tamping down on spread pricing, which refers to the practice of charging health plans for prescription drugs more than what they pay the pharmacy and pocketing the difference. The proposed rule comes as House and Senate committees advanced legislation this month that would ban the practice. Another key provision of the proposed rule would provide CMS and states with a drug price verification survey to help federal and state officials better negotiate what Medicare pays for expensive drugs. The deadline for stakeholders to comment on the proposed rule is July 25, 2023.

Debt Default Looms as Lawmakers Depart for Memorial Day

Despite recent progress on debt ceiling talks in Washington, lawmakers left the Capitol for Memorial Day weekend without a deal being reached. Assuming members are provided 24 hours’ notice before a final vote, the soonest the House can take a vote on a debt ceiling measure is Tuesday night. According to Republican negotiator Rep. Garret Graves (R-LA), major progress has been made on spending caps and energy permitting, while discussions remain underway on work requirements and unspent COVID-19 aid. Even if the House approves a debt ceiling bill early next week, Congress may not be able to completely raise the debt limit until June 3-4, which runs rather close to the estimated default date.

Surgeon General’s Warning on Kids’ Social Media Use

Overuse of social media can harm the mental health and well-being of children and adolescents, according to a new advisory from US Surgeon General Dr. Vivek Murthy. While the advisory acknowledges that social media provides some benefits to kids, such as helping kids feel more accepted and providing an outlet for creativity, survey data shows that social media use is attributed to body dysmorphia, poor eating behaviors, social comparison, and low self-esteem. To help protect kids from the harmful effects of social media, the Surgeon General recommends that policymakers create age-appropriate safety standards, support digital literacy education in schools, require more data privacy protections, and require social media companies to share health-related data.

CDC: HIV Cases Drop among Young People

New HIV infections among people ages 13-24 dropped 34% between 2017 and 2021, according to data from the Centers from Disease Control and Prevention (CDC). Public health officials attribute the decline to new medications that prevent infections and improvements in HIV testing. However, the decline in infections was not equally reflected among all racial or ethnic groups, as Black/African Americans and Hispanics/Latinos ages 13-24 saw a much smaller decline in infections compared to White people in the same age range. To address these disparities, the CDC recommends increasing investment in HIV prevention programs, expanding access to HIV self-testing, and addressing social determinants of health.

FDA Approves Synthetic Opioid Reversal Drug

On Tuesday, the Food and Drug Administration (FDA) approved Opvee, a prescription nasal spray that can reverse overdoses of synthetic opioids like fentanyl. The Indivior-produced drug is the first nasal spray to treat opioid overdoses in adults and children over 12 years of age. According to the FDA, Opvee can reduce the effects of opioid overdoses, such as respiratory depression, sedation, and low blood pressure if administered quickly. Opvee is similar to Narcan, which the FDA approved for over-the-counter use in March 2023. While it remains unclear how the new nasal spray will be used differently from Narcan, an advantage of Opvee is that it is better suited to address fentanyl, which stays in the body longer than heroin and other opioids. Indivior expects to launch Opvee in October at the earliest.

ICYMI: Memorial Day Travelers Can Expect Lower Gas Prices

If you’re hitting the road for Memorial Day weekend, rejoice: the average price of a gallon of gasoline is $3.53, which is about a dollar lower than last year’s national average of . (https://blucactus.blue) 60. However, gas prices are still higher than they were pre-pandemic, and travel experts warn that a busy road travel season this summer could bump gas prices up higher.

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House Energy and Commerce Committee Marks Up 6 Health Care Bills

On May 24, 2023, the House Energy and Commerce Committee marked up 19 bills, including six healthcare bills on price transparency, pharmacy benefit managers, drug pricing, 340B and site neutral payments, among other topics. 

What Happened, What You Missed: May 15-19, 2023

GAO Report Shows Impact of Non-Compete Agreements on Health Care Workers

Many health care workers face restrictions on changing jobs due to non-compete agreements (NCAs), according to a new report from the Government Accountability Office (GAO). More than 57% of health care and social assistance workers employers surveyed in 2022 by the GAO reported that they use NCAs for at least some of their workers. To compile the report, GAO surveyed 446 private sector employers and 25 state attorney general offices. Among the reasons health care employees cited in the report for requiring NCAs are the protection of intellectual property and trade secrets, and minimization of turnover. The report’s release comes as the Federal Trade Commission (FTC) works to finalize rulemaking that could bar many employers from imposing NCAs on workers. While health care providers say NCAs are necessary to retain workers, health care workers say the agreements limit career growth.

McCarthy Speaks Positively on Debt Ceiling Negotiations amid Concerns

Speaker Kevin McCarthy (R-CA) spoke of recent debt talks with the White House in a more favorable light, saying he sees “the path that we could come through.” McCarthy also remarked that top negotiators could reach an agreement in principle by this weekend. However, signs that negotiations are moving forward have sparked concerns from some House Republicans, particularly Freedom Caucus members who say they won’t support any agreement to raise the debt ceiling without significant budget cuts. Similarly, several Democratic members of Congress reacted negatively to news that President Joe Biden could be open to enhanced Medicaid work requirements as part of a possible deal. For instance, House Democratic Leader Hakeem Jefferies characterized changes to work requirements as a “nonstarter.”

Biden Nominates Bertagnolli to Lead NIH

President Joe Biden announced his intent to nominate National Cancer Institute (NCI) Director Dr. Monica Bertagnolli to be the Director of the National Institutes of Health. News broke last month that the administration was close to nominating the NCI chief for the top job at NIH. However, several issues caused the administration to delay a final decision on Bertagnolli, including Rochelle Walensky’s unexpected resignation as Director of the Center for Disease Control and Prevention and concerns from Sen. Bernie Sanders (I-VT) on the NCI Director’s commitment to lowering drug prices. Bertagnolli will now face Senate confirmation hearings this summer that will likely focus on several contentious issues, including NIH funding amid a difficult budgetary environment, the origins of COVID-19, and the pandemic response. A Wyoming native, Bertagnolli was the chief of surgical oncology at Dana-Farber Brigham Cancer Center before becoming the NCI chief in October 2022.

Appeals Court Preserves ACA’s Preventative Coverage Requirements

Employers are still required to fully cover the cost of specified preventive health care services, according to a US Court of Appeals for the Firth Circuit order issued on Monday. The order overturns a March 2023 ruling by Judge Reed O’Connor of the Federal District Court for the Northern District of Texas that would have eliminated coverage of most preventive health care services mandated by the Affordable Care Act (ACA). Some 100 million people use ACA-covered preventative health services each year, which range from screenings for cancer and depression to drugs that prevent HIV transmission. O’Connor, who ruled the ACA to be unconstitutional in a 2018 decision, argued that the US Preventative Services Task Force does not have the constitutional authority to determine which health care services should be considered preventative. The appeals court’s order will remain in effect while the case works through the appeals process

Gallup: Depression Rates at All-Time High

The percentage of American adults who have been diagnosed or treated for depression reached a record high in 2023, according to a new poll from Gallup. The poll found 29% of US adults report being diagnosed with depression at some point during their lifetimes, a nearly 20% increase from 2015. Additionally, the survey found more than 17% of adults were either have or are currently being treated for depression. According to the poll, women and young adults saw depression rise at higher rates compared to other groups. While depression had been rising in the US for the past several years, researchers say the impact of the COVID-19 pandemic on social isolation, loneliness, and psychological exhaustion has likely played a role in boosting depression diagnoses and treatment. To conduct the poll, Gallup surveyed 5,167 adults between February 21-28.

ICYMI: Portrait of Former Speaker Paul Ryan Unveiled at Capitol

Key members of Congress gathered in the Capitol’s Statuary Hall on Wednesday for a ceremony to unveil a portrait of former Speaker Paul Ryan (R-WI). First elected to Congress, Ryan served as speaker from 2015-2019, where he played a pivotal role in enacting major tax reform legislation. The event was attended by fellow former Speakers Nancy Pelosi (D-CA), Newt Gingrich (R-GA) and John Boehner (R-OH). Current Speaker Kevin McCarthy (R-CA) also attended to provide brief remarks on Ryan’s commitment to addressing the national debt, which is timely given McCarthy’s role in negotiations to raise the debt ceiling.

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Senate Homeland Security and Governmental Affairs Dives into Medicare Advantage Denials

On May 18, 2023, the Senate Committee on Homeland Security and Governmental Affairs, Subcommittee on Investigations, held an hearing entitled “Examining Health Care Denials and Delays in Medicare Advantage.”  There was bipartisan concern over prior authorization and profits at Medicare Advantage plans. 

Senate Aging Committee Dissects Problems with Nursing Home Inspection Process

On May 18, 2023, the Senate Aging Committee held a hearing entitled “Residents at Risk: The Strained Nursing Home Inspection System and the Need to Improve Oversight, Transparency, and Accountability”The hearing focused on how nursing homes are not being properly inspected, putting residents at risk of harm or even death.

(www.pillaicenter.com)

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