CDC gives the nod to Covid vaccines for under 5s. Now pediatricians will try to convince parents.

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Jun 21, 2022 View in browser   By Krista Mahr and Sarah Owermohle Presented by Editor's Note: POLITICO Pulse is a free version of POLITICO Pro Health Care's morning newsletter, which is delivered to our subscribers each morning at 6 a.m. The POLITICO Pro platform combines the news you need with tools you can use to take action on the day's biggest stories. Act on the news with POLITICO Pro. QUICK FIX — The CDC gives the nod to vaccines for under-5s, and the work for pediatricians begins. — Online care for opioid addiction surged during the pandemic, but patients could lose access to help if the federal government doesn't act. — A deep dive into Chief Justice John Roberts' speeches and commentary offer a possible road map for a middle ground on Roe. WELCOME TO TUESDAY PULSE — It's summer, but a lot of kids are getting a raw deal. Some 100,000 public pools won't open this year because of a nationwide lifeguard shortage. Boo. Send news and tips to kmahr@politico.com and sowermohle@politico.com.   A message from PhRMA: Did you know that only three insurance company PBMs control 80 percent of the prescription drug market? They use their market power to get tens of billions in rebates and discounts that should be going to you. Tell Congress those savings belong to patients .   Driving the Day The CDC has recommended vaccines for children under 5 in the U.S. | Pedro Vilela/Getty Images IT FINALLY HAPPENED — Well, that was fast. On Saturday, the Centers for Disease Control and Prevention recommended that children ages 6 months to 5 years get the Pfizer-BioNTech or Moderna Covid-19 vaccine, as POLITICO's Katherine Ellen Foley reported. By Monday morning, our pediatrician's office emailed to say the vaccines were available and appointments were open for our 4-year-old to come get a shot. For many families, this will be game-changing, allowing them to get back to feeling comfortable at the grocery store and in the classroom for the first time in well over two years. And, based on our talks with several pediatric long Covid clinics around the country, the measure certainly feels like a critical step forward to protect kids from long Covid — a potentially debilitating and life-altering condition of as-yet-unknown scope. "For parents all over the country, this is a day of relief and celebration," President Joe Biden said in a statement on Saturday. Then again: This chart from the CDC tracks children's vaccine coverage across the country. Although the chart needs an update, it shows that, at the end of May, about 70 percent of 5- to 11-year-olds remained unvaccinated. It's hard to imagine why that percentage would be substantially different among even younger children, especially when pediatricians say that vaccine hesitancy for routine immunizations is rising. The White House has pledged to ensure a smooth rollout of the pediatric doses. (There are already plenty of complaints on social media that it's not happening.) But the real push will need to come from pediatricians, nurses and community leaders to convince more parents of the safety, efficacy and necessity of vaccinating their youngest kids. THE OPIOID ADDICTION TOOL THAT COULD BE LOST — During the pandemic, tens of thousands of patients seeking treatment for opioid use disorder found it online where a new crop of startups has changed the landscape of care in an epidemic that's still raging, Krista and our Ben Leonard write. Currently, patients ready to stop misusing opioids can connect online with clinicians almost immediately from their homes — and get prescriptions for the life-saving drug buprenorphine without having to arrange an in-person exam first. But many patients could lose that access when the federal public health emergency, due to expire later this year, ends along with the flexibilities that have allowed patients to seek help outside their state and skip in-person visits. Both the Trump and Biden administrations have sought to increase access to buprenorphine as America's opioid crisis has deepened. But despite the federal push, the drug can still be exceedingly hard for people to obtain. In 2020, just over 11 percent of people 12 and older with an opioid use disorder in the past year received medication-assisted treatment, according to the Substance Abuse and Mental Health Services Administration. The DEA, which regulates controlled substances like buprenorphine, said in March that it's working to make permanent the pandemic permissions given to practitioners to treat patients without an in-person visit. But the agency has yet to follow through on a 2009 pledge to expand telehealth access for controlled substances and has blown through 2018 and 2019 congressional deadlines, too. COULD THERE BE A MIDDLE GROUND ON ROE? Ahead of the Supreme Court's expected ruling on Roe v. Wade in the next two weeks, POLITICO's Josh Gerstein looks at Chief Justice John Roberts' public speeches and commentary to see what a compromise on the landmark case might look like — if Roberts can find one. The central organizing principle for a Roberts opinion, Josh writes, is likely to be one the chief justice has repeatedly articulated: The court shouldn't issue a sweeping decision when a more modest one would do. During previous arguments in Dobbs v. Jackson Women's Health Organization, Roberts has appeared to stake out a middle ground, suggesting that the essential right to end a pregnancy could be maintained even if states were allowed to sharply limit abortion before viability outside the womb. He indicated that the pivotal issue for abortion rights might be whether a pregnant person has sufficient opportunity to get an abortion, not the age of the fetus. Roberts has signaled on other occasions he might be more inclined than his conservative colleagues to back away from the brink of overturning Roe. An opinion that upholds Mississippi's 15-week ban but claims to leave Roe in place might also save the court from being the focus of a hot summer of protests over abortion — and keeping the court out of the political spotlight whenever possible has also been another of Roberts' goals. In Congress PBMS UNDER THE MICROSCOPE  — Members of the House Committee on Education and Labor have requested that the Government Accountability Office conduct a study on pharmacy benefit managers, citing concerns about their role in drug pricing. In a letter shared with Pulse, lawmakers asked the GAO to look into PBMs' services to commercial health plans and how they are reimbursed, the use and effect of PBM formularies and rebating arrangements on commercial drug spending on payers and beneficiaries, and what role the Employee Retirement Income Security Act's fiduciary requirements have in the services PBMs provide to commercial plans.   A message from PhRMA:   At the Agencies USAID SENDS FIRST PEDIATRIC DOSES OVERSEAS — The U.S. Agency for International Development delivered the first two shipments of Pfizer's pediatric Covid-19 vaccines to Mongolia and Nepal over the weekend in collaboration with the COVAX vaccine facility, the agency said on Monday. In May, the U.S. committed to send Covid-19 boosters and pediatric vaccine doses for 5- to 11-year-olds. USAID will continue to work with COVAX to ship pediatric doses to partner countries worldwide that have requested them, an agency statement said. IN THE STATES IOWA, CALIFORNIA WEIGH IN ON ABORTION — The Iowa Supreme Court on Friday ruled that the right to abortion is not a fundamental right under the state's constitution, POLITICO's Megan Messerly writes. The court's decision, which reversed a 2018 ruling, creates a path for state lawmakers to pass restrictions on abortions ahead of the Supreme Court's expected decision on Roe. Iowa has a six-week abortion ban on its books that's been enjoined, though future court action could allow it to take effect if Roe is overturned. Lawmakers in the conservative-led state could also pass a new abortion ban. While the court ruled abortion is not fundamentally protected in the state, it didn't rule on what standard should replace it. In California, meanwhile, the Senate cleared a proposal on Monday that would ask voters in November to add abortion rights to the state constitution, POLITICO's Victoria Colliver and Sakura Cannestra write. Two-thirds of lawmakers in both houses must approve CA Senate Constitutional Amendment 10 (21R) before June 30 for it to qualify for the November ballot. The proposal would not need any Republican votes to clear that threshold. What We're Reading STAT News investigates why Black doctors are being forced out of training programs at higher rates than their white colleagues. The White House is trying to find a durable Covid-19 vaccine that won't require unpopular boosters, The Wall Street Journal reports. The Washington Post writes about a Texas teenager who learned she was pregnant days before the Texas abortion ban took effect. Now, she has twins.   A message from PhRMA: This may come as a shock, but did you know that only three insurance companies and their pharmacy benefit managers (PBMs) control 80% of patients' medicines? They sure act like it. They use their market power to get tens of billions in rebates and discounts on medicines – rebates and discounts that should be going to patients. They decide what medicines are covered, what medicines aren't and what you pay for them. Regardless of what your doctor prescribed. That's too much control, and it leaves you fighting them for your medications, instead of fighting your illness. PBMs are putting their profits before your medicine. It's time we do better than that for patients. Tell Congress those savings belong to patients.     Follow us on Twitter Tucker Doherty @tucker_doherty Dan Goldberg @dancgoldberg Erin Banco @ErinBanco Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ Rachael Levy @rachael_levy David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Sarah Owermohle @owermohle Carmen Paun @carmenpaun Megan R. Wilson @misswilson   Follow us

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