Insights

FDA Approves New Weight Loss Drug from Eli Lilly 

On Wednesday, the Food and Drug Administration (FDA) approved Eli Lilly’s diabetes drug tirzepatide for chronic weight management as public health undergoes a revolution in the treatment of weight loss.  Also known by its commercial name, Zepbound, the drug will be available to adults who are obese or overweight with at least one weight-related condition like high blood pressure.  Zepbound is the latest in new generation appetite-suppressing obesity drugs, following Novo Nordisk’s Ozempic in 2017 and Wegovy in 2021.  Eli Lilly estimates that Zepbound will be available in the US by the end of 2023 at a list price of $1,059.87. 

SFC Advances Bill to Lessen Impact of Medicare Payment Cuts 

Next year’s 3.4% cut to the Medicare Physician Fee Schedule (PFS) would be offset by 1.25% for one year, according to legislation unanimously advanced by the Senate Finance Committee on Wednesday.  Known as the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, the bipartisan health care package contains other provisions to boost access to mental health and substance use disorder services for people enrolled in Medicare or Medicaid, address high drug costs for Medicare Part D beneficiaries, increase transparency around pharmacy benefit managers (PBMs), and other items. It is not yet clear when this package will advance through the Senate or be married up with similar legislation in the House. 

CDC: Newborn Syphilis Cases Reach 30-Year High 

Cases of congenital syphilis in the US reached a 3-decade height of 3,761 cases in 2022, according to new data from the Centers for Disease Control and Prevention (CDC).  While syphilis cases rose among all racial and ethnic groups, the CDC noted that infants born to Black, Hispanic, or American Indian/Alaska Native mothers were up to 8 times more likely to have newborn syphilis than infants born to white mothers.  The jump in cases comes amid a broader increase in sexually transmitted infections (STIs) nationwide, which public health experts attribute to a lack of access to testing and years of underinvestment in public health.  The data is additionally worrying since the only recommended treatment for syphilis in pregnant people is in short supply. 

Manchin Says He Won’t Seek Reelection in 2024 

Sen. Joe Manchin (D-WV) announced on Thursday that he won’t be seeking reelection next year, marking the end of a 14-year stint in the US Senate.  As next steps, the former West Virginia governor said he’ll be traveling the country to see if there’s interest in a “movement to mobilize the middle,” sparking concerns among Democrats that Manchin could seek a third party or independent bid for the White House in 2024.  Manchin’s retirement increases the already decent odds of the GOP retaking the Senate in next year’s elections due to the state’s strong Republican bend.  The centrist senator has been a key bipartisan swing vote for much of his Senate career, especially regarding President Joe Biden’s major legislative accomplishments like the American Rescue Plan Act and the Inflation Reduction Act. 

ICYMI: Interactive White House Museum Coming to Downtown DC 

The White House Historical Society has announced plans for a 33,000-square foot interactive museum – just a block away from the actual White House.   Dubbed “The People’s House: A White House Experience,” the museum will feature recreations and replicas of the Rose Garden and the Oval Office, along with various galleries and media to give visitors a sense of what it was like to be in the Executive Mansion at different points in history.  The museum is set to open in fall 2024. 

FDA Approves First OTC Birth Control Pill

The Food and Drug Administration (FDA) approved the first-ever over-the-counter (OTC) birth control pill for all women of reproductive age. Called Opill, the drug will be available without a prescription at pharmacies, grocery stores, and convenience stores, as well as online. Perrigo, the drug’s manufacturer, estimates that the drug will be available to consumers within the first few months of 2024. While Perrigo has pledged to make the drug “accessible and affordable,” the company has yet to disclose the pill’s price. Opill’s approval comes amid growing legal and legislative battles over women’s access to abortion services since the overturning of Roe v. Wade last year.

White House Outlines Plan to Fight Tranq

The White House released a National Response Plan to coordinate a whole-of-government response to address the risky combination of fentanyl and xylazine. Known as “tranq,” xylazine is an easily obtainable veterinary medicine that a growing number of drug dealers are cutting with fentanyl to extend a user’s high. A recent study found overdose deaths from xylazine-laced fentanyl increased by 276% between January 2019 and June 2022. The plan contains six areas of focus that address testing, data collection, supply reduction, research, and scheduling. Administration officials say the plan’s goal is to reduce the number of xylazine-related deaths by 15% in three of four US census regions by 2025.

Administration Proposes New Limits on Short-Term Plans

The Biden administration issued a proposed rule to reverse Trump-era policies that expanded the availability of short-term, limited-duration (STLD) plans. According to the rule, STLD plans would be limited from a maximum of three years to just three months, and STLD plan providers would be required to communicate to consumers what the plans do and do not cover. STLD plans do not have to meet the same requirements as Affordable Care Act (ACA) plans, such as coverage of pre-existing conditions and some essential health benefits like prescription drugs. Stakeholders have until September 11, 2023 to comment on the proposed rule.

CDC: More ER Visits Tied to Cannabis Use

A growing number of young people are going to the emergency room (ER) for marijuana-related emergencies, according to data from the Centers for Disease Control and Prevention (CDC). These ER visits occur when children and adolescents consume toxic levels of cannabis, which can result in confusion, vomiting, seizures, or difficulty breathing. The data found the sharpest rise in marijuana-tied ER visits among children under age 11, which increased 214% between 2019 and 2022. According to the CDC, pandemic-related stresses may have driven more children to consume cannabis products as a coping mechanism. The CDC recommends that adults safely and securely store marijuana products to help prevent unintentional ingestions among minors.

ICYMI: Climate Protesters Disrupt Congressional Softball Game

A group of protesters opposed to fossil fuels disrupted the Congressional Women’s Softball Game for 10 minutes, prompting several softball players to throw an impromptu dance party. Founded in 2009, the Congressional Women’s Softball Game pits lawmakers against journalists in a match to raise money for young survivors of breast cancer. The game resumed after Capitol Police told the protesters they would face arrest if they did not leave the field. Journalists prevailed over the lawmakers 15-9 in a game that raised a record $588,000.

FDA Fully Approves New Alzheimer’s Drug Leqembi

The Food and Drug Administration (FDA) granted full approval to Leqembi, setting up the stage for the Alzheimer’s treatment drug to become the first to receive broad coverage under Medicare. The announcement comes after months of lobbying by Alzheimer’s disease patients and advocates to make the drug more widely available through full approval. Developed by Eisai and Biogen, the drug slows the progression of Alzheimer’s disease by targeting amyloid plaques in the brain. However, Leqembi has faced controversy for its high $26,500 price tag that could lead to higher Medicare premiums, as well as reports of side effects like brain bleeding and swelling. CMS will require any physician who prescribes Leqembi to submit a patient’s medical information to a registry that will be used to evaluate the drug’s benefits or harms.

CMS Updates Guidance on Drug Price Negotiations

The Center for Medicare and Medicaid Services (CMS) recently issued revised guidance for the Medicare Drug Price Negotiation Program, likely in response to several lawsuits challenging the program. A component of the Inflation Reduction Act, the drug price negotiations are set to take course through next year. Since the IRA became law, the US Chamber of Commerce, Bristol Myers Squibb, Merck, and PhRMA have filed lawsuits against CMS that allege the program violates the First, Fifth and Eighth amendments of the Constitution. The new guidance offers relief for drug manufacturers who choose not to participate in the negotiation program by setting up a program for drugmakers to leave Medicare and avoid excise taxes.

Home Health Providers Sue CMS over Payment Cuts

The National Association for Home Care & Hospice (NAHC) filed a lawsuit against CMS that challenges a 3.925% payment cut for calendar year2023 that applies to home health providers. The lawsuit comes just days after CMS proposed a 2.2% cut in its calendar year 2024 Home Health Prospective Payment System proposed rule. The lawsuit alleges CMS put forth an invalid methodology to determine whether payment model changes are budget neutral. According NAHC, lower payments are forcing home care providers to close their doors, resulting in fewer patients receiving care. To address payment cuts, Sens. Debbie Stabenow (D-MI) and Susan Collins (R-ME) recently introduced legislation to take away some of CMS’s rate-setting authority.

JAMA: Maternal Mortality Rates Double

Maternal mortality rates have more than doubled between 1999 and 2019, according to a new study published by the Journal of the American Medical Association (JAMA). While the study found an increase in pregnancy-related deaths across all racial and ethnic groups, Black and Native American women were observed to have the highest death rates. Additionally, states in the South, the Midwest and the Great Plains saw the highest increases. Common causes of maternal death include mental health conditions, hemorrhages, hypertension, and blood clots. According to the study’s authors, increasing access to health care could prevent many pregnancy-related deaths.

ICYMI: It’s Summer Movie Season on the National Mall

“Summer Movies on the Lawn” officially returns next week with the screening of “Willy Wonka and the Chocolate Factory” (1971) on July 13. Started in 2017 by the Library of Congress, the summer movie series on the National Mall provides an opportunity for visitors to watch the National Film Registry in a scenic setting. The 2023 series will conclude on August 10 with the screening of “Jaws” (1975).

FDA Allows Narcan to Be Sold Over the Counter

On Wednesday, the Food and Drug Administration (FDA) approved Narcan, an opioid overdose-reversal drug, to be sold over the counter without a prescription. The announcement comes as opioid overdose deaths hover near record highs.  At a press conference, the Director of the White House Office of National Drug Control Rahul Gupta said businesses, such as restaurants, banks, and schools will be encouraged to purchase the drug. Narcan manufacturer Emergent BioSolutions said the spray will be available for online and over the counter purchase by the summer.

JAMA: Telehealth Linked to Fewer Opioid Overdoses

A study published in the Journal of the American Medical Association (JAMA), found that the utilization of telehealth services for opioid use disorder during the COVID-19 pandemic reduced the odds for a fatal overdose among Medicare beneficiaries. The study determined that beneficiaries who started treatment during the pandemic and received telehealth services had a 33% lower risk of a fatal overdose. The study also found that fatal drug overdoses were 59% less likely among individuals who received medication to treat opioid use disorder and 38% less likely among those treated with buprenorphine in an office-based setting.

FDA Proposes Overhaul of Fast-Track Approval Process for Cancer Drugs

The FDA’s accelerated approval pathway could become more stringent, according to a draft guidance document released Tuesday. The accelerated approval pathway allows the FDA to approve a drug based on surrogate endpoints rather than a direct measure of a clinical benefit, which allows for drugs to receive an earlier approval. The draft guidance aims to strike a balance between speed and quality by requiring oncology drugs to go through randomized controlled trials (RTCs) that compare the effectiveness of an experimental drug against a conventional one.  The deadline for stakeholders to comment on the draft guidance is May 26, 2023.

Lawmakers Question Becerra on Coverage Determination for Alzheimer’s Drug

In multiple hearings to review the president’s proposed Fiscal Year (FY) 2024 budget, several Republican lawmakers voiced their criticism of a decision by the Centers for Medicare and Medicaid Services (CMS) to limit coverage of a class of Alzheimer’s drugs only to patients who are participating in relevant clinical trials. These drugs, which utilize amyloid plaque-blocking technology, have been marred with controversy due to their high cost and risk of side effects such as brain swelling and brain bleeding.  In response to the criticism, Health and Human Services Secretary Xavier Becerra repeatedly explained that FDA and CMS have different criteria for evaluating experimental drugs as mandated by law.

Most Doctors Say COVID-19 Misinformation a Problem

Seven in 10 doctors say misinformation about COVID-19 has made it harder to treat patients, according to a poll by the de Beaumont Foundation and Morning Consult.  A similar number of physicians surveyed said misinformation has negatively impacted patient outcomes.  The survey also found that 90% of physicians surveyed agreed on the benefits of COVID-19 vaccines.  Most doctors also noted that COVID-19 misinformation has seeped into other areas of health care, with two-thirds saying misinformation is common regarding weight loss, dietary supplements, mental health, and other vaccines.

Former Congressional Aide Launches Union Tracker for Senate Staff

A former member of Minnesota Sen. Tina Smith’s staff launched a Senate Union Tracker earlier this month as a way to track which senators support collective bargaining protections for Senate staff and efforts to unionize among their own staff. Motivated by subpar pay and long hours during his time in the Senate, the former staffer hopes the tracker will help improve working conditions for those still working in the Senate.  Since the website launch, over a dozen Democrats have favorably voiced their support for unionization in the tracker.

House Report Criticizes FDA’s Approval of Alzheimer’s Drug

The Food and Drug Administration (FDA) inappropriately worked with the drug manufacturer Biogen for approval of the Alzheimer’s disease drug Aduhelm, according to a report from Democrats on two House committees.  Originally approved in July 2021, Adulhelm came under intense criticism for its uncertain clinical benefits, high list price, and potential for side effects like brain bleeding and swelling.  The report found the FDA’s interactions with Biogen were “atypical” – particularly through use of joint briefing documents – and failed to follow the agency’s own documentation protocol.  The report’s release precedes a highly anticipated January 6 announcement from the FDA on the approval of Lecanemab, another Alzheimer’s drug that uses a technology similar to Aduhelm that targets amyloid proteins in the brain.

OIG Report Calls for Better Part B Oversight

The Centers for Medicare and Medicaid Services (CMS) needs to conduct “robust oversight” to ensure that the agency makes appropriate payments for Part B-covered drugs, according to a new report from the HHS Office of the Inspector General (OIG).  Medicare spends about $40 billion every year on Part B drugs, and CMS uses manufacturer-reported average sales price (ASP) for the drug from quarterly sales to calculate provider payments.  However, due to incorrect or missing ASP data from manufacturers, CMS was unable to calculate an ASP-based payment amount for 8% of drug codes at least once between 2016 and 2020.  According to the report, CMS does not check the accuracy of the manual processes used to analyze ASP data.  The report also found that CMS does not incorporate its ASP data collection into watchdog reports.

SAMHSA: 25% of Adults Had A Behavioral Health Disorder in 2021

Roughly a quarter of US adults had a mental illness or substance use disorder in 2021, according to an annual survey released earlier this week by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey also found that 16% of the population, or 46 million people, met the criteria for a substance disorder in 2021, and only 6% of the 46 million actually sought treatment.  Additionally, the survey found that 22% of the population, or 61 million people, used illicit drugs in 2021, with the most commonly used drug being marijuana. The report echoes growing concerns on the prevalence of substance abuse and mental health issues across the nation.

NIH Launches Pilot Telehealth Program for COVID-19

On Thursday, the National Institutes of Health (NIH) launched the Home Test to Treat program, a new pilot program that will provide free COVID-19 health services like tests, telehealth sessions and at-home treatments in selected communities.  Later this month, local and state officials in Berks County, Pennsylvania, will be the first to pilot the program. Other communities around the nation will be selected to participate in this program based on need, socioeconomic factors, and access to health care.  The NIH is aiming to offer this service to up to 100,000 Americans over the next year.

Sen. Debbie Stabenow Announces Retirement 

Sen. Debbie Stabenow (D-MI) announced Thursday that she will not seek re-election and will leave the Senate at the end of her term on January 3, 2025, making her the first Senate Democrat to announce that she won’t be on the ballot in 2024.  Formerly a member of the Michigan state Senate and later a member of the US House of Representatives, Stabenow was first elected to the Senate in 2000.  Stabenow is the Senate Agriculture Committee’s top Democrat since 2011 and has been a longtime advocate for mental health care and tireless proponent for increasing domestic manufacturing.  Stabenow’s retirement announcement created an opening in a key swing state that is likely to attract strong interest from both parties.  According to reports, Reps. Debbie Dingell (D-MI) and Elissa Slotnik (D-MI) are already considering a run.

ICYMI: House Offices Reopened to Visitors

After nearly three years of pandemic and security-related restrictions, visitors on official business will no longer require a staff escort in the House office buildings and tourists will be able to access the gallery overlooking the House floor.  The removal of these restrictions was ordered by House Republicans, who now control the House with a slim majority in the 118^th Congress.  The new Republican House majority also ordered the removal of metal detectors at the House chamber, which were first installed in the wake of the January 6, 2021, insurrection on the US Capitol.  For the time being, however, staff escorts are still required for visitors to Senate office buildings.

Report Calls for FDA to Break Up

The Food and Drug Administration (FDA) should be split up to address problems plaguing the agency’s food oversight arm, according to a new report by the Reagan-Udall Foundation.  The agency asked the Reagan-Udall Foundation to analyze its operations in the wake of the infant formula crisis earlier this year.  According to the report, flaws in the FDA’s leadership structure and poor communication among agency officials has resulted in the agency’s food safety operations being consistently underfunded, understaffed, and underprioritized.  The report also suggested a less drastic measure that would create a deputy commissioner position with authority for overseeing food.  Any move to split up the agency would require approval from Congress.

FDA Authorizes COVID-19 Boosters for Kids under 6

On December 8, the FDA approved bivalent COVID-19 booster shots from Pfizer and Moderna for children six months to six years of age.  The announcement comes as children’s hospitals across the country are at capacity for kids suffering from a range of respiratory illnesses, including COVID-19, respiratory syncytial virus (RSV), and the flu.  However, the rules on who can get a shot when differ depending on whether the initial vaccine regimen came from Pfizer or Moderna.  Children under age six who have completed Moderna’s two-dose regimen can get their bivalent booster if it’s been at least two months since their last shot, while children under six who received the first two doses of Pfizer’s three-dose regimen can use the new bivalent booster for their third shot.  However, children who received all three initial vaccine doses from Pfizer aren’t yet eligible for a booster shot.

ICER: Biggest Drug Price Increases Not Substantiated

According to a report by the Institute for Clinical and Economic Review (ICER), price increases among seven of the ten drugs in 2021, which saw the largest increases from the year prior, were not supported by clinical evidence.  Out of the $805 million increase in drug spending from 2020-2021, Bausch Health’s Xifaxan, an antibiotic drug for traveler’s diarrhea, saw the biggest increase of nearly $175 million in spending, while Johnson & Johnson’s schizophrenia drug Invega Sustenna and Amgen’s osteoporosis drug Prolia were second and third with respective spending increases of $170 million and $124 million.  According to ICER, the report is intended to inform policymakers and lawmakers on policies they can pursue to address high drug prices.  However, the report acknowledged that the impact of the Inflation Reduction Act’s Medicare drug price negotiation on commercial payers remains uncertain.

ACA Marketplace Enrollment Reaches 5 Million

Nearly 5.5 million individuals from November 1 to December 3 selected a 2023 health plan through the federally facilitated and state-based marketplaces, according to the Centers for Medicare and Medicaid Services (CMS).  Roughly 80% of enrollees renewed their health care coverage, while the rest were new enrollees.  33 states currently use the federal marketplace for the 2023 open enrollment period, which runs through January 15, 2023.  CMS also reported that state-based exchanges will automatically renew coverage for about 2.9 million residents nationwide.

Top Ways and Means Republicans Make Their Case for Chairmanship

With current Ways and Means Committee Ranking Member Kevin Brady (R-TX) set to retire soon with the end of the 117^th Congress, three senior Republicans on the committee are making the case to succeed Brady and chair the committee in the next Congress.  As the Republican Steering Committee prepares to vote on who will get the chairman’s gavel in January, Rep. Vern Buchanan (R-FL) is touting his business background, Rep. Jason Smith (R-MO) is taking a populist approach while emphasizing his ties to working class voters, and Rep. Adrian Smith (R-NE) is presenting himself as a top policy expert.  Whoever is elected chairman will have the opportunity to shape health care policy, due to the committee’s jurisdiction on Medicare.

ICYMI: Representatives Vie for New House Offices

73 incoming House members were assigned their designated workspaces on Capitol Hill as a part of a biennial office lottery that took place late last week in the Cannon House Office Building.   While past lotteries followed the alphabetical order of members’ names, this year’s lottery was completely randomized.  The Rayburn House Office Building is usually seen as the most desirable office location, since the building is connected to the Capitol by the subway.

New Drug Shows Potential to Slow Alzheimer’s Disease

The experimental drug lecanemab has the potential to slow the progression of Alzheimer’s disease, according to late-stage clinical trial data from drugmakers Biogen and Eisai.  While Phase 2 trial data released in the summer did not show a large difference between lecanemab and a placebo in Alzheimer’s disease patients over 12 months, newly released Phase 3 trial data found that the drug was associated with less cognitive decline after 18 months of use.  However, instances of patients experiencing brain swelling and brain bleeding have raised concerns over the drug’s safety.  The news follows controversy over the decision by the Food and Drug Administration (FDA) last year to approve another Alzheimer’s drug from Biogen, in spite of clinical trial data that showed the drug’s efficacy to be limited.

Senate Panel Discusses Prior Authorization, Kids’ Mental Health

Senators from both parties touted legislation to expand mental health integration into pediatric care in a Wednesday hearing from the Senate HELP Subcommittee on Children and Families that focused on how the pandemic has exacerbated mental health challenges facing adolescents.  Other bipartisan legislation discussed in the hearing would streamline transitions from high school to college for students with disabilities and increase Medicaid reimbursement for children’s mental health services.  Prior authorization reform was also a topic of discussion during the hearing, as several witnesses pointed out that long wait times and high administrative costs are preventing many teens from accessing mental health care services in a timely manner.

HHS Proposes Changes to Privacy Records for Substance Use Disorder Patients

Currently, a substance use disorder patient must provide consent every single time a health care provider needs to share the patient’s records.  However, a newly proposed rule from the Department of Health and Human Services (HHS) would allow providers to share a patient’s records multiple times after receiving a patient’s consent only once.  According to a press release, the new privacy rules would ensure individuals are not denied “life-saving care” due to concerns about records disclosure.  The rule would also increase coordination among providers of treatment for substance use, expand HHS enforcement authority under 42 CFR part 2, and update breach notification requirements to HHS.  Stakeholders have until January 31, 2023, to comment on the proposed rule.

CDC: Deaths Linked to Substance Abuse Climb among Seniors

Deaths associated with drug and alcohol abuse are steadily rising, according to new data from the Centers for Disease Control and Prevention (CDC).  According to the data, death rates from drug overdoses among people 65 and over have more than tripled since 2000, while alcohol-related deaths among seniors have jumped more than 20% from 2019 to 2020.  The CDC also noted that alcohol-related death rates are higher overall among men over the age of 65, with older men seeing death four times higher than women when considering seniors 75 and older.   The report additional found growing use of fentanyl and synthetic opioids among seniors.

CDC to Start Wastewater Testing for Polio

The CDC announced on Wednesday plans to begin wastewater surveillance for polio in select communities with low vaccination rates.  The CDC will use data from the surveillance program to assist with vaccination programs if necessary.  Communities in Michigan, New York, and Pennsylvania will be the first to adopt the wastewater testing programs, which will last for at least four months.  The CDC first hinted that it may begin wastewater testing program for polio in the summer when a single case of paralytic polio was found in Rockland County, New York.  The risk of polio to the public remains low because more than 92% of Americans were vaccinated during childhood.

ICYMI: White House Celebrates 100^th Lighting of National Christmas Tree 

President Joe Biden celebrated the 100^th lighting of the National Christmas Tree on Wednesday in a ceremony that included performances from Shania Twain and Gloria Estefan.  During the ceremony to light the 27-foot white fir, President Biden emphasized the importance of national unity and called on Americans to reflect on their blessings. The lighting of the National Christmas Tree began as a tradition a century ago under President Calvin Coolidge.

Becerra Authorizes FDA to Issue EUAs for Monkeypox Tests

Health and Human Services (HHS) Secretary Xavier Becerra issued an emergency declaration on Wednesday to allow the Food and Drug Administration (FDA) to issue emergency use authorizations (EUAs) for monkeypox tests.  The announcement comes one month after HHS declared monkeypox to be a public health emergency.  According to Becerra, the declaration will help propel the government’s response to monkeypox by expanding access to testing.  In a separate announcement, the FDA issued its first EUA for a monkeypox test to Quest Diagnostics.  While the US is currently conducting more than 80,000 tests per week, some experts warn confusion over where patients get tests could be limiting access to monkeypox tests.

White House Pushes for COVID-19 Funding in CR

The Biden administration is pushing Congress to include $22.4 billion in a continuing resolution (CR) to help the domestic fight against COVID-19.  Due to dwindling funds, the administration has already announced it will no longer send free COVID-19 tests to people’s homes, and federal funding for COVID-19 vaccines is likely to end soon.  Additionally, the White House has communicated that it has no objection to attaching the reauthorization of FDA user fees to a CR, although the administration declined to offer its outright support for the proposal.   However, the likelihood that either proposal makes it into a CR is uncertain, as congressional appropriations leaders are currently hashing out whether to include Democratic energy policies in a stopgap spending measure.  Even if Congress is able to quickly pass a CR later this month, lawmakers could become embroiled in another appropriations fight later this year when the CR is expected to end.

Study: Private Equity-Owned Practices Leave Patients with Higher Bills

Physician practices acquired by private equity firms were associated with higher spending and more patient visits, according to a study published by the Journal of the American Medical Association.  The study found an average increase of 20%, or $71, in charges per claim, and 11%, or $24, in amount allowed per claim.  Private equity-owned practices were also reported to have about 26% more unique patients.  According to a press release by the study’s authors, the higher billing could be due to either more efficient documentation of services or up-coding/up-charging to insurance companies.   The study only examined dermatology, gastroenterology and ophthalmology medical practices purchased by private equity.

Federal Judge Rules HIV Drug Coverage Requirement Violates Religious Freedom

On Wednesday, US District Judge Reed O’Connor ruled that requiring employers to provide the HIV prevention drug PrEP violates their religious freedom, potentially jeopardizing the mandatory coverage of preventative health care services under the Affordable Care Act (ACA).   According to the Texas employers behind the suit, the provision violates the Religious Freedom Restoration Act by forcing people to pay for coverage that conflicts with their faith and values.  The ruling is not the first time O’Connor has challenged the ACA – in 2018 he ruled the entire health care law to be unconstitutional, which the Supreme Court overturned in 2021.  It was not immediately clear what kind of impact the ruling will have beyond the employers challenging the ACA provision.

ICYMI: Portraits of Barack and Michelle Obama Unveiled at White House 

Former President Barack Obama and former First Lady Michelle Obama returned to the White House this week for the unveiling of their official portraits.  President Obama’s photo-realistic portrait was painted by Robert McCurdy and Michelle Obama’s portrait was painted by Sharon Sprung.  The portrait unveiling is a long tradition that goes back to 1978 when President Jimmy Carter invited his immediate predecessor, Gerald Ford, back to the White House. Wednesday’s unveiling event would have traditionally been held during the Trump presidency, although both parties mutually declined to participate according to sources.

FDA Authorizes Boosters Tailored to BA.5

On Wednesday, the Food and Drug Administration (FDA) authorized bivalent COVID-19 booster shots from Pfizer and Moderna that target both the original COVID-19 strain and the Omicron BA.4/5 subvariants.   The Centers for Disease Control and Prevention (CDC) is widely expect to sign-off on the boosters today, which means pharmacies could start administering doses after Labor Day weekend.  According to the FDA, it may take up to two months before data is available on how effective the updated boosters are at preventing infection.  So far, the federal government has secured 171 million doses from Pfizer and Moderna.

House Democrats Consider CR through December 16

According to news reports, House Democratic leaders are working on a continuing resolution (CR) that would extend current government funding levels through December 16.  The current fiscal year ends on September 30, and House Democrats are hoping to bring their CR to the House floor for consideration during the week of September 12.  While negotiations over stopgap spending bills have typically been contentious, lawmakers may be more willing to cut a deal sooner rather than later this month due to an eagerness to return to the campaign trail ahead of November’s midterm elections.   Of note, a CR could include a reauthorization of FDA user fee programs, which are also set to expire at the end of September.

CDC: Life Expectancy in US Dropped to 76 Years in 2021

Life expectancy in the US fell from 79 years in 2019 to 76.1 years in 2021, according to data from the CDC.  The decline marks the first time life expectancy dropped two consecutive years in nearly a century.  According to the CDC, the decline in life expectancy can be attributed to the COVID-19 pandemic and increases in unintentional injuries, namely drug overdoses.  While a drop in life expectancy was observed in all 50 states, the CDC found that Southern states saw the biggest declines, as well as Indiana, Missouri, New Mexico, Ohio, and Oklahoma.

HHS Issues $20M in Grants on Maternal and Infant Health

On Monday, the Biden administration took a major step in carrying out its Blueprint for Addressing the Maternal Health Crisis by announcing investments of over $20 million to improve maternal and infant health.  According to a press release from the Department of Health and Human Services (HHS), the awards include $9 million to the State Maternal Health Innovation Program, $4 million to the Rural Maternity and Obstetrics Management Strategies Program, $3 million to 19 Healthy Start programs to reduce maternal health disparities, and $4.5 million to the Catalyst for Infant Health Equity Program.

ICYMI: Fencing Around Supreme Court Removed

Metal fencing that had surrounded the Supreme Court building for the past few months finally came down earlier this week.  The fences were initially erected in May after a draft decision to overturn Roe v. Wade leaked, which prompted protests in front of the court building.  However, the building itself remains closed, and the court has yet to comment on when the building will reopen to the public.

On August 16, the Food and Drug Administration (FDA) finalized rulemaking to allow hearing aids to be purchased over-the-counter (OTC), which is widely expected to increase access for millions of Americans with mild to moderate hearing loss.  This rule was 5 years in the making – why now?

Background

While FDA has regulated hearing aids for decades, the agency had previously only focused on assuring safety and effectiveness of prescription hearing aids.  In 2017, Congress stepped in and passed a law to require the agency to issue rules for over-the-counter devices. Lawmakers were hoping establishing a new category of hearing aids would address:

• Cost:  Lack of competition in the market means hearing aids can cost between $2,000 and $7,000 per pair.

• Coverage:  Most commercial insurance plans and Medicare don’t cover the cost of hearing aids for people with mild to moderate hearing loss because they’re not considered an essential medical device – or in other words, they’re considered “elective.”
• Access:  Additionally, getting hearing aids requires a prescription from an audiologist or other specialist.  Buying devices in a retail setting or online would provide more options for consumers.

A Rule that Was Years in the Making

It’s taken a long time for the idea of over-the-counter hearing aid sales to go from initial concept to final rule.  Sens. Chuck Grassley (R-IA) and Elizabeth Warren (D-MA) got so fed up with the agency dragging its feet that they introduced legislation to require FDA to issue rulemaking on OTC hearing aids.  Even though the bill was signed into law as part of the FDA Reauthorization Act of 2017, it still took the agency 5 years to finalize the rule.  Why?

COVID.  Yes, the needed change in focus of the agency to address COVID was a no-brainer, but President Trump signed the bill 2+ years before the virus struck….

Change in administration.  Yes there was a change in administration but it took President Biden until July 2021 to issue an executive order directing his own agency to issue rule making.

So why the delay?  It turns out that balancing stakeholder concerns was complicated.  When FDA issued the proposed rule in October 2021, the agency received more than 1,000 comments from the public.  Here is where the rule ended up:

• Output levels:  Lowers the maximum sound output to reduce the risk from over-amplification of sound
• Volume control:  Requires all OTC aids have a user-adjustable volume control
• Label and packaging language:  Simplifies phrasing so safety concerns can be easily understood

• State authority:  Retains authority by States to require an audiological evaluation for minors and other previously granted State exemptions applicable to non-OTC hearing aids

What’s Next? 

The final rule goes into effect in 60 days, which is the date that over-the-counter hearing aids can officially be marketed.  Already, Best Buy has announced that it plans to have hearing aids available in 300 of its 1,000 stores by the fall.

Even though Congressional Democrats weren’t able to get Medicare coverage for hearing aids signed into law, the rule signals real financial relief and a step toward health equity for millions.  Good news for consumers makes for good politics…right ahead of the November 8^th elections.