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

What Happened, What You Missed: May 1-5, 2023

Study: 340B Suppresses Uptake of Biosimilars

Hospitals that participate in the 340B Drug Pricing Program see lower adoption of biosimilar drugs, according to a new study from Health Affairs. Roughly a third of the nation’s hospitals participate in the 340B program, which requires manufacturers to provide discounts on most drugs administered in the outpatient setting to help safety-net hospitals, although the discounted drugs are reimbursed by Medicare at the same rate as they are in non-340B hospitals. Researchers also found that 340B hospitals were associated with an overall increase in the use of increased use of pricier biologic medications. To conduct the study, researchers examined 340B hospitals’ 2017-2019 Medicare claims data for two commonly used biosimilars.

Vaccine Mandate for Employees at CMS-Certified Facilities Drops on May 11

The requirement for federal government employees to be vaccinated for COVID-19 will end on May 11, the same day the COVID-19 public health emergency (PHE) is set to expire. President Biden is expected to issue an executive order in the coming days to rescind the mandate, which applies to federal employees, contractors, international visitors, and people working at Centers for Medicare and Medicaid Services (CMS)-certified facilities. Originally put in place in September 2021, the vaccine mandate was blocked by a federal appeals court in March 2023 after initially being upheld by a federal court in January 2023. According to the Biden administration, nearly 98% of federal employees have been vaccinated against COVID-19.

CBO Posts Estimate on TANF Work Requirements in Debt Ceiling Bill

Congressional Budget Office (CBO) released an estimate that the work requirement provision in the recently passed House debt ceiling bill would lower federal expenditures, but increase the number of people without health insurance without increasing hours spent in employment. H.R. 2811, the Limit, Save, Grow Act of 2023 raises work requirements for certain Medicaid recipients up to 80 hours per month and increases the age through which those persons must continue working. CBO estimated that while this provision would save the federal government $109 billion over 10 years, it would increase costs to states $65 billion.

FDA Clears First RSV Vaccine for Seniors

On Wednesday, the Food and Drug Administration (FDA) approved Arexvy as the first vaccine for respiratory syncytial virus (RSV). Manufactured by GlaxoSmithKline, the vaccine is administered as a single shot, and it approved only for adults ages 60 and older. Assuming a Centers for Disease Control and Prevention (CDC) independent advisory committee votes to recommend the vaccine in June, Arexvy could be available to older adults as soon as this fall. Although RSV is mostly associated with babies and young children, an estimated 159,000 American adults 65 and older are hospitalized each year with RSV, and an estimated 10,000-13,000 die as a result of their infection. RSV vaccines for younger populations are currently under review and could made available by the end of the year.

Sen. Ben Cardin to Retire

Sen. Ben Cardin (D-MD) announced on Monday that he won’t seek a fourth term in the US Senate in 2024. A longtime fixture in Maryland politics, Cardin was first elected to the Maryland House of Delegates while he was still a student at the University of Maryland Carey School of Law. He went on to become the chamber’s youngest speaker in 1979, and in 1986, he was elected to represent Maryland’s Third Congressional District in the US House of Representatives, where he served until 2007. That same year, Cardin became Maryland’s junior senator in the US Senate, where he would serve on the powerful Finance Committee. During his tenure in the Senate, Cardin has been a strong proponent of oral health, and he frequently sponsored legislation to make dental care a covered benefit under Medicare. Cardin’s announcement has set off what’s expected to be a competitive Democratic primary to succeed him. While no formal announcements have been made, Reps. Jamie Raskin (D-MD) and David Trone (D-MD) are seen as possible candidates, as well as Prince George’s County Executive Angela Alsobrooks.

ICYMI: Freshman Lawmakers Launch Congressional Sneaker Caucus

Freshman Rep. Jared Moskowitz (D-FL) launched the Congressional Sneaker Caucus last week with fellow freshman Rep. Lori Chavez-DeRemer (R-OR). Moskowitz and Chavez-DeRemer are among a small but growing number of lawmakers and staff who are opting to wear sneakers over more traditional dress shoes on Capitol Hill. Both members of Congress say they intended to use the caucus as a way for sneaker fans on both sides of the aisle to find common ground. They also hope to host meetings and partner with manufacturers on philanthropic activities.

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What Happened, What You Missed: April 24-28, 2023

KFF: Up to 24 Million Could Lose Medicaid Coverage

Between 8 and 24 million Americans could be disenrolled from Medicaid following the end of the COVID-19 public health emergency (PHE), according to a new analysis from the Kaiser Family Foundation (KFF). The PHE suspended the Medicaid redetermination process, which states use to determine eligibility for Medicaid coverage. KFF’s analysis drew on estimates from a recent survey of state Medicaid officials conducted with Georgetown University. The redetermination process, which started April 1, will vary across the states due to different policy choices state officials have made as well as a variation in state administrative structures. It remains unknown how many people who lose Medicaid coverage will transition to other health coverage or become uninsured.

FDA Approves New ALS Treatment

On Tuesday, the Food and Drug Administration (FDA) approved via the accelerated approval pathway a new drug called Qalsody for a rare form of amyotrophic lateral sclerosis (ALS). Developed by Biogen, Inc., the drug works to reduce levels of a blood protein associated with brain injury. Due to its accelerated approval status, Qalsody must undergo more research on its effectiveness in order to remain on the market. The FDA estimated there are fewer than 500 patients in the US with the form of ALS that the Biogen drug treats. According to Biogen, the drug could be available to ALS patients as soon as next week.

Kaiser Permanente to Acquire Geisinger to form New Nonprofit

Kaiser Permanente announced Wednesday plans to acquire Pennsylvania nonprofit hospital system Geisinger Health to form a new nonprofit value-based health care organization. Known as Risant Health, the new entity will operate independently from Kaiser Permanente’s care and coverage model. The acquisition of Geisinger’s is part of an overarching strategy at Kaiser Permanente to obtain similar nonprofit, value-oriented community-based health systems in the coming years. In a recent interview, the company said it plans to invest $5 billion into Risant over the next five years and expects to add half a dozen additional systems to the new organization. The acquisition follows a growing trend of hospital and provider consolidation as hospitals continue to face financial strain related to the COVID-19 pandemic.

CDC: Smoking Down while E-Cigarette Use Continues to Rise

A recent survey from the Centers for Disease Control and Prevention (CDC) paints a mixed picture on the state of tobacco use in the nation. Between 2020 and 2022, the percentage of Americans who reported they are smokers dropped from 12.5% to 11%. However, the e-cigarette use rose from 4.5% to 6% over the same period. While use of combustible tobacco such as cigarettes has declined in recent decades, e-cigarette use has steadily grown in recent years, particularly among teens and adolescents. According to the CDC, smoking is a major cause of preventable disease, disability, and death. The agency also says that 9 in 10 lung cancer deaths were caused by smoking.

ICYMI: A Look Back on Jerry Springer’s Career in Politics

While Jerry Springer, who died this week at age 79, is best-known as a talk show host, his time in politics is often overlooked. Shortly after graduating from law school, Springer took a job with Robert F. Kennedy’s presidential campaign in 1968. A year following a failed bid for Congress, Springer was elected to the Cincinnati City Council in 1971. In 1977, the city council elected Springer for a one-year term to serve as mayor due to an unconventional election system that has since been altered. Springer also sought the Democratic nomination for Governor of Ohio in 1982, and he considered running for US Senate in 2000 and 2004 before ultimately deciding to back out due to negative associations with his eponymous television show. Additionally, Springer considered joining the Ohio gubernatorial race in 2018, but he decided against it due to his age.

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House Approps Subcommittee Examines the Provider Relief Fund and Healthcare Workforce Shortage

On April 26, 2023, the House Appropriations Subcommittee on Labor, Health and Human Services, and Education held an oversight hearing on the Provider Relief Fund (PRF) and health care workforce shortage.  Members queried Administrator Carol Johnson of the Health Resources and Services Administration (HRSA) around the PRF and how the President’s FY 2024 Budget would impact the health care workforce shortage. 

House Energy and Commerce Subcommittee Debates Bills on Transparency and Reducing Health Care Costs

On April 26, 2023, the House Energy and Commerce Health Subcommittee held a legislative hearing to discuss several bills and legislative proposals aimed at increasing transparency and lowering costs in health care.    The hearing was mostly bipartisan in tone and it is likely that these bills will be passed out of committee shortly.  

House Ways and Means Subcommittee Looks at Tax-Exempt Status for Hospitals

On April 26, 2023, the House Ways and Means Oversight Subcommittee held a hearing entitled “Tax- 

Exempt Hospitals and the Community Benefit Standard.”  Members agreed that more must be done to better understand the use of tax-exempt status by hospitals, the role of hospitals in providing charity care for their patients, and how the IRS may need to increase and improve oversight of those hospitals for the benefit of communities and American taxpayers. 

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