With Rachel Roubein and Alice Miranda Ollstein
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— Senators are pressing to deploy the rebate rule as a pay–for tactic in one of the massive infrastructure packages on the horizon — but challenges abound.
— CMS wants to impose harsh fines on hospitals that don’t publish their prices, earning swift criticism from the industry.
— From medical colleges to state universities, coronavirus vaccine mandates are gaining steam even ahead of full approvals.
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SENATORS CIRCLE DRUG SAVINGS FOR MASSIVE RELIEF BILL — Months after rumors first circulated that drug–pricing provisions could provide major savings for coronavirus relief packages, they’re back in play for infrastructure legislation.
The latest: Some lawmakers searching for savings to cushion the bipartisan $1.2 trillion bill have set their sights on delaying the Medicare rebate rule, a controversial Trump-era provision with a big price tag.
Sen. Rob Portman (R-Ohio), one of 11 Republicans in the Senate group negotiating the relief package, said Sunday that he backs delaying the rule, which Biden already pushed back a year to the start of 2023. Completely repealing the rule — as others endorse — would save about $180 billion, according to staff who spoke with Playbook’s Rachael Bade. (The original rule introduced by the Trump administration was projected to cost the federal government up to $196 billion over 10 years.)
The problems: Portman told reporters Monday night that Democrats instead want to use those savings for their own reconciliation bill, which also needs pay-fors. And other health care costs in the package—from Medicare coverage for dental, vision and hearing to closing the Medicaid coverage gap and boosting home care funding—still far eclipse the potential rebate rule savings, so other offsets could be necessary. Plus it’s not clear where the White House stands on the rule, which has major pharmaceutical industry support.
Overall, there’s also the small problem of no final bill text yet. Majority Leader Chuck Schumer is aiming for a Wednesday vote while negotiators hammer out these details. But GOP negotiators, grating at the timeline and some provisions, are hesitant to advance the deal.
“We had over two dozen differences we had to work out and negotiate, and we got through probably half, maybe even less,” Portman said of late-Sunday negotiations.
BIDEN ADMIN WANTS TO STIFFEN PENALTIES ON HOSPITALS FOR HIDING PRICES — CMS is proposing harsher fines for hospitals that don’t publish the prices they charge, strengthening a new Trump-era transparency measure opposed by the industry, Rachel Roubein writes.
As of Jan. 1, hospitals will be required to publicize rates in easy-to-read formats for 300 common services. But many experts thought the penalty for noncompliance — $300 a day — wasn’t strong enough to force some hospitals to disclose negotiated rates that had long been kept private.
— Citing early reports that many hospitals are not complying with the new requirements, the Biden administration wants to up the maximum annual penalty from $109,500 to $2 million per hospital. The agency also proposed in its annual Medicare hospital rule to require hospitals to ensure that patients can download the list of prices and find them in website searches.
Patient advocates have complained that only a sliver of hospitals is complying with the transparency rules meant to arm patients with more information about the cost of care. Hospitals, who lost a last-minute court battle to overturn the policy, came out in swift opposition to the provision and said the requirements were burdensome.
“We are deeply concerned about the proposed increase in penalties for non-compliance, particularly in light of substantial uncertainty in the interpretation of the rules,” the American Hospital Association said in a statement.
BIDEN ADMIN KEEPS TRUMP’S CUTS TO DRUG DISCOUNT PROGRAM — The agency is also proposing to continue a nearly 30 percent cut in reimbursement for drugs purchased through the 340B program. Hospitals have fiercely opposed the policy and sued to strike it. But a D.C. Circuit Court of Appeals upheld the cuts last summer, and the Supreme Court earlier this month said it would take up the case during its next term.
MOMENTUM GROWS FOR VACCINE MANDATES — A federal judge Sunday night denied an attempt to block Indiana University from requiring students and employees be vaccinated against the coronavirus in order to be on campus.
“In short, the balance of harms and the public interest favor Indiana University and the determination that it has reasonably determined the best course of action for the health of its academic community this upcoming fall semester,” Judge Damon Leichty wrote in a more than 100-page decision.
The decision — on what could be the first of several vaccine mandate cases to land in court — arrived days after the Association of American Medical Colleges urged its members to require vaccinations, too.
“We are not alone in our thinking,” AAMC President and CEO David Skorton, said in a statement, adding that more employers are likely to get on board when FDA grants full approval. “We are aware of the sensitive nature of this recommendation and understand that it must be made on an institution-by-institution basis, subject to legally required exceptions and consistent with state law.”
FIRST IN PULSE: SENATORS PRESS BIDEN FOR TRANSPLANT SYSTEM REFORM — A bipartisan group of senators led by Ron Wyden (D-Ore.) and Chuck Grassley (R-Iowa) sent a letter Monday urging CMS to speed up reforms that would boost oversight of organ transplant groups.
“The COVID-19 pandemic is exacerbating the need for organs now and creating an urgent health equity issue,” the 12 lawmakers wrote. While CMS has finalized a rule overseeing organ procurement organizations’ outcomes, the agency wouldn’t actually start decertifying failing groups until 2026. Meanwhile, the senators said, data has been available for years showing that many of these organizations are underperforming.
Some health experts project a dramatic increase in organ transplant needs post-pandemic and “the failures of the current organ donation system disproportionately hurt patients of color,” they added.
FIRST IN PULSE: SENATORS RESTART CAREGIVERS CAUCUS — Colorado Democrat Michael Bennet and West Virginia Republican Shelley Moore Capito are reforming the Assisting Caregivers Today, or ACT, caucus with AARP on board.
The caucus will advocate for policies to support family caregivers, an estimated 40 million people who help feed, bathe, dress and transport family members with physical or cognitive limits. The estimated economic value of their unpaid work was $470 billion in 2016, Bennet and Capito said.
STUDY: ALZHEIMER’S PREVALENCE LAYS BARE HEALTH DISPARITIES — Many U.S. communities of color with the highest prevalence of Alzheimer’s disease are beset with other social issues including high rates of poverty, lack of health insurance, low incomes and little opportunity for exercise, according to a data analysis by UsAgainstAlzheimer’s Center for Brain Health Equity and the Urban Institute.
Black Americans are roughly two times more likely, and Latinos are 1.5 times more likely, to develop Alzheimer’s than non-Latino white people. The analysis charted figures for 25 counties nationwide with the highest rate of Alzheimer’s and other dementia among people of color. Texas’ 27th district, which covers Corpus Christi and a portion of the state’s east coast, has the highest rates among Black and Latino Americans.
Without intervention, by 2030 nearly 40 percent of all Americans living with Alzheimer’s will be Latino or Black, the report concluded. Authors recommended better data, CMS incentives for early care and NIH focus on recruiting underrepresented communities in research.
BOLSTERING SUBSTANCE ABUSE CARE IN ERs — Hospitals that fail to provide substance abuse care in their emergency rooms could be breaking federal law, according to a new report from the Legal Action Center. The report lands amid surging overdose deaths, including a 30 percent increase last year.
What hospitals could do: The report argues that providers could violate four different laws, including the Americans with Disabilities Act and Title VI of the Civil Rights Act, if they don’t appropriately screen for substance use, make referrals and prescribe drugs for opioid use disorder.
Novavax’s goal of producing 2 billion shots a year — the vast majority for low-income countries in need — increasingly looks like a pipe dream for 2021 as the company still strives to file for use, Kaiser Health News’ Sarah Jane Tribble and Rachana Pradhan write.
If California was still using its Covid-19 color tiers, at least 12 counties would meet the threshold for the most restrictive purple tier, John Woolfolk and Harriet Blair Rowan report in The Mercury News.
The Tennessee Department of Health abruptly postponed a virtual vaccine summit aimed at training state medical professionals, the latest state withdrawal of vaccine outreach, The Tennessean’s Brett Kelman reports.
The pain associated with intrauterine devices can be excruciating and last for months; but while IUD use has grown, many women say they feel their pain is overlooked or swept aside by providers, Caroline Kitchener writes for The Lily.
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