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

What Happened, What You Missed: October 11-15

Biden Likely to Nominate Califf to Lead FDA

On October 14, The Washington Post first reported that former Food and Drug Administration (FDA) Commissioner Robert Califf is the Biden administration’s top pick to lead the FDA.  Califf previously served as FDA Commissioner for nearly a year during the second term of the Obama administration.   Despite the agency’s important role in addressing the COVID-19 pandemic, the FDA has been without a permanent leader since the current administration took office in January.  If confirmed, Califf will play a pivotal role in leading the FDA through what is hopefully the final stage of the pandemic and overseeing the review of vaccines and treatments.  However, the White House has said a final decision has yet to be made, and sources close to the vetting process have acknowledged that the situation could still change.

FDA Advisory Panel Approves Moderna “Booster” for Seniors, At-Risk People

The FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) unanimously voted on Thursday to recommend that the agency authorize a “booster” dose of Moderna’s COVID-19 vaccine for all individuals over 65 and younger people who have chronic medical conditions and/or are essential workers.  The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) is expected to vote on the Moderna booster doses on October 21, and a final FDA decision could follow within days. Recap: three weeks ago, the FDA amended the emergency use authorization (EUA) of Pfizer’s COVID-19 vaccine to make it the first vaccine available as a booster dose.

Authorization of COVID-19 Antiviral Pill Anticipated in December

In their October 14 public meeting, the FDA VRBPAC announced that it will meet on November 30 to review data on Merck’s experimental oral antiviral COVID-19 treatment, which potentially means that FDA could issue an EUA for the antiviral drug sometime in December.  On Monday, Merck submitted an EUA for the drug, known as molnupiravir, which contained data showing that the antiviral treatment reduced hospitalization and death by 50%.  While the FDA does have the option to bypass review by VRBPAC, the agency communicated in a press release that it believes a “public discussion” will help “ensure clear understanding of the scientific data” necessary to decide whether it’s worth approving the antiviral for emergency use.

House Dems Clear Short-Term Debt Ceiling Bill, but Divisions on Reconciliation Bill Remain

On October 12, the House voted 219-206 to increase the debt ceiling by $480 billion, staving off default through at least early December. But despite unanimous support among House Democrats to address the debt ceiling, which they will have to address again in two short months, members of the caucus have yet to come to an agreement on a $3.5 trillion budget reconciliation package. Democrats can only afford to lose three votes in the House and no votes in the Senate. Therefore, achieving unanimous or near-unanimous support in both chambers has been an enormous challenge for the White House and Democratic leadership, who are eager to pass a measure in the upcoming weeks.  On Tuesday, Speaker Nancy Pelosi (D-CA) acknowledged that the bill’s final price tag is likely to be lower than $3.5 trillion as lawmakers within the party continue to negotiate on the  final package.

ICYMI: Zebras Are on the Loose outside Washington, DC

Three zebras who escaped from a farm in Upper Marlboro, MD in August have been spotted roaming the wooded areas and green spaces of the Maryland suburbs of Washington, DC for the past several weeks.  While wildlife experts say the zebras appear to be safe due to a lack of predators like lions and hyenas, one of the zebras unfortunately died last month after it was caught in an illegal snare trap in Prince George’s County, MD.  Although local animal control officials are on the case, experts say catching the zebras will be difficult due to their intelligence and strong fight-or-flight response.

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Collins Leaves Big Shoes to Fill at NIH

Francis Collins announced plans to retire from his role as Director of the National Institutes of Health (NIH) on October 5.  This is a big deal for the Biden administration, as this leaves another crucial leadership position vacant, as the administration still has not nominated a Commissioner for the Food and Drug Administration (FDA).

Brief background: The Staunton, Virginia native first came to NIH in 1993 to serve as Director of the National Human Genome Research Institute, a role he held for 15 years.  Under his leadership, the institute made landmark discoveries of disease genes and contributed to the international Human Genome Project, which for the first time fully mapped all genes of the human genome.  Collins was later nominated to lead NIH under then-President Barack Obama and was confirmed by the Senate in 2009. (pongsak-clinic.com)

Why is he retiring?  Even though a public health emergency is still ongoing, Collins told reporters that his “hour-to-hour oversight” is no longer as necessary now that three vaccines are out and case numbers are declining nationwide.  According to reports from PoliticoCollins initially wanted to quit last winter, but National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci convinced him to stay on a little while longer.

It wasn’t a spur of the moment decision.  Collins said he had been thinking about retirement for the past 3-4 months.  By making the decision now, Collins hopes to facilitate a smooth transition for the next NIH director.

Who’s taking over?  Principal Deputy Director Lawrence Tabak, number two at NIH, is most likely to serve as acting director in the interim.  But it’s unclear if he’s in the running for the top job – Collins said in an October 5 interview that he wants a woman to succeed him.  The only certainty is that Fauci won’t be the next NIH director – he’s already said no to the role.

Whoever takes over will have big shoes to fill.  During his decade-plus at the helm of NIH, Collins:

And whoever becomes the next NIH director has plenty of challenges to look forward to, including:

  • Leading the agency though the next (and hopefully final) phase of the pandemic.
  • Shaping the development of the Advanced Research Projects Agency, or ARPA-H.
  • Overseeing clinical trials for COVID-19 treatments.
  • Defending the administration’s public health policies and handling of the  pandemic on Capitol Hill.

It’s also worth noting that Francis Collins is a bit of a Renaissance man.  Here are some of his other accomplishments outside of leading the world’s largest medical agency.

Collins won’t be the NIH director anymore, but he isn’t leaving NIH.  In fact, he’s planning to return to his laboratory at the National Human Genome Research Institute.

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Why Feelings Are Mixed on the New Surprise Billing Rule

The administration’s latest interim final rule to implement the No Surprises Act dropped on September 30.  Here’s a look at the various reactions from stakeholders and why they are mixed.

What does it say?  The rule outlines a baseball-style, independent dispute resolution (IDR) process for settling payment disputes between out-of-network providers and commercial insurance plans.  Before the IDR process can begin, both parties involved must enter into a 30-day negotiation period to determine a payment rate.  If these negotiations fail, either party can initiate the IDR process.

Next, both parties submit their proposed payment rate with supporting documentation to a certified IDR entity, who then issues a binding determination by selecting one of the party’s proposed rates.  When making a determination on which rate to select, the IDR entity must “begin with the presumption” that the most appropriate rate is the median of contracted rates for a specific service in the same geographic region.

  • Why? According to the rule, emphasizing the median in-network rate will help ensure that IDR outcomes are predictable and that stakeholders are not incentivized to overuse the IDR process.

In addition to the median-in network rate, other factors IDR entities may consider include the level of training, experience, and quality and outcomes measurements of the provider or facility that is furnished.

Insurers’ reactions have been favorable overall.  America’s Health Insurance Plans said the focus on the median in-network rate “is the right approach” to encourage all stakeholders to work together and negotiate in good faith.  And the ERISA Industry Committee said the IDR process will reinforce the intention of the No Surprises Act.”

But hospitals aren’t so happy.  The Federation of American Hospitals said the rule “misreads Congressional intent” on establishing a “fair and balanced” IDR process, while the American Hospital Association said the rule “unfairly favors insurers to the detriment of hospitals” and other providers.

Reactions from lawmakers are mixed, too.  Like hospital stakeholders, comments from members of Congress have focused on the rule’s prioritization of median in-network rates in the IDR process.  Ways and Means Committee Chair Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) said in an October 5 letter to the administration that the rule’s bias towards a median rate is not consistent with the law passed by Congress, which requires IDR entities to consider a range of factors when determining the appropriate rate.

However, House Education and Labor Committee Ranking Member Virginia Foxx (R-NC) commented that the rule is “consistent with congressional intent.” Both the Ways and Means Committee and the Education and Labor Committee played key roles in drafting the No Surprises Act.

When the No Surprises Act passed late last year, it was considered a win for hospitalswho favored settling out-of-network payment disputes with an IDR process.  In contrast, private health plans were advocating benchmark rates based on the median in-network rate as a solution.  By prioritizing median in-network rates in the IDR process, could the administration be attempting to balance the concerns of all health care stakeholders? 

What’s next: The administration will issue a rule later this year to implement the pharmacy and prescription drug reporting requirements of the No Surprises Act.  Despite a 60-day public comment period, the rule is final, and stakeholders will be required to comply with all of its provisions beginning January 1, 2022.  In the meantime, Reps. Neal and Brady have requested additional written justification from key administration officials on how the latest rule complies with the No Surprises Act, and stakeholders will continue to engage with the administration on upcoming rules.

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What Happened, What You Missed: October 4-8

Pfizer Asks FDA to Authorize Vaccine for Kids

On October 7, Pfizer formally asked the Food and Drug Administration (FDA) to authorize its COVID-19 vaccine for emergency use in children aged 5-11.  When approved, an estimated 28 million children in the US will be eligible for vaccines.  The FDA Vaccines and Related Biological Products Advisory Committee is scheduled to meet on October 26 to discuss use of the Pfizer vaccine in kids, and federal health officials have said emergency use authorization (EUA) could come between late October and late November.

Senate Clears Short-Term Debt Ceiling Increase

Late Thursday, the Senate voted 50-48, a party line vote, to increase the debt ceiling by $480 billion, which the Treasury Department estimates will enable the federal government to continue to borrow money through December 3.  The current debt limit expired on August 1, and the Treasury Department has been using extraordinary measures to ensure the federal government can meet its debt obligations since then.  However, Thursday’s vote doesn’t change the underlying standoff that caused gridlock over the debt ceiling in the first place.  Since extraordinary measures have been mostly exhausted, the Treasury Department will have little wiggle room to ensure the government can continue to pay its bills if Congress once again fails to address the debt ceiling by December 3.

White House Announces New $1B Investment in At-Home COVID-19 Tests

On October 6, the Biden administration announced plans to invest an additional $1 billion to boost the manufacturing capabilities for rapid, at-home COVID-19 tests.  According to the White House COVID-19 Response Coordinator Jeff Zients, the administration’s $1 billion investment along with the FDA’s recent approval of a rapid antigen test from ACON Laboratories could increase the number of at-home tests by 200 million per month by the year’s end.  As more Americans return to work and school, many public health experts have said more at-home tests could stop asymptomatic spread and control outbreaks.

Experimental Antiviral Shows Promise in Reducing Hospitalization, Death from COVID-19

On October 1, Merck reported that a phase 3 trial of its oral antibody treatment molnupravir reduced the risk of hospitalization or death by about 50% in COVID-19 patients.  The company also mentioned that it plans to seek an emergency use authorization from the FDA “as soon as possible.”  Public health experts see the arrival of an antiviral pill along with the availability of vaccines for children as a major step in transitioning out of the current public health emergency.

ICYMI: Filming Underway in DC for New HBO Series on Watergate

Over the past two weeks, Washington, DC residents have spotted Woody Harrelson and Justin Theroux, who are in town to film an upcoming HBO docuseries on the Watergate scandal called The White House Plumbers.  Filming of the five-part series has so far brought 1970s-era cars and a recreation of the Nixon campaign headquarters into downtown DC.  Fun fact, Justin Theroux is a Washington, DC native.

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Video Games: A New Frontier for Politics?

227 million Americans play video games.  That includes a grow number of US lawmakers, who are not only embracing video games as a hobby but incorporating them into their campaigns.

Video games come to Washington.  A Politico Magazine article published in 2018 profiled a few members of Congress and their interest in video games.  Reps. Scott Peters (D-CA) and Darrell Issa (R-CA) indicated video games provide a way for lawmakers of different parties to bond, while Rep. Jared Polis (D-CO), now Governor of Colorado, said video games improve critical thinking skills.

Politicians haven’t always liked video games, to say the least.  In 1993, then-Sen. Joe Lieberman (D-CT) first suggested banning violent video games, while then-Sen. Hillary Clinton (D-NY) introduced legislation to add more restrictions to violent and sexually explicit games in 2005.  Over the past 20-plus years, many politicians have at least partially blamed video games on mass shootings, including then-President Donald Trump with the 2018 Parkland High School shooting, and House Minority Leader Kevin McCarthy (D-CA) with the 2019 shooting in El Paso.

Video Games on the Campaign Trail

However, lawmakers’ changing attitudes on video games has coincided with political campaigns’ increased use of video games.  In September 2020, the Biden-Harris campaign made available virtual yard signs that players of the game Animal Crossing could download and place in their virtual front yards.  The COVID-19 pandemic may have also inspired the Biden-Harris campaign to dive into the world of virtual organizing, as many Democratic campaigns had suspended in-person events and shifted online due to the virus. But, the Biden-Harris campaign wasn’t the first political campaign to use  video games – in 2008, the Obama-Biden campaign placed ads on virtual billboards in Madden NFL 09 and NBA Live 08.

Given the large number of Americans that play video games, it’s hard to deny the potential video games offer politically.  Campaigns can use video games to target specific demographics such as men aged 18-49, who are disproportionately more likely to participate in gaming.  And unlike print, radio, and television ads, video games offer an interactive format that can be potentially more persuasive than traditional forms of media.

That doesn’t mean video games are the new frontier for campaigns.  Instances of campaigns ads in video games appear to be the exception, not the rule, and it’s unclear to what extent politics will encroach on the world of gaming.  Most video game developers prefer to keep their products apolitical, largely to avoid pushback from their (mostly male) customers.  Additionally, many people turn to video games as a way to take a break from aspects of the real world – like politics.  While politicians may see video games as fertile ground for outreach, fear of backlash from developers and gamers could slow down the adoption of virtually campaigning as a major way to reach potential voters.

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