| | | | |  | | By Daniel Payne and Krista Mahr | | | With Megan Messerly and Megan R. Wilson
| | |  Doctors in states where gender-affirming care remains legal say that, because of bans in other states, clinics in blue states could be overwhelmed. | Rick Bowmer/AP Photo | ‘CONSTANT FEAR’ — Nearly a third of the country has banned gender-affirming care for transgender youth. But even in states where such care remains legal, death threats, harassment, litigation fears and, in some cases, a lack of support from institutions have created a chilling effect that’s undermining doctors’ ability to provide care, several doctors who treat transgender youth told Megan Messerly. “I got an email telling me that I’m evil, I’m foolish, my work is opposing God, that I harm children, that I’m going to hell, and that I should die,” Meredithe McNamara, an assistant professor of pediatrics at Yale University, told POLITICO. “The threats, the harassment, the constant fear of, ‘Did I say that right? Is that OK? Should I have said that differently? … Did I say anything that is going to get my family targeted in some way?’” The threats, which continue to grow as states pass new bans, have made some doctors fearful of speaking out publicly against misinformation about the care they provide. Some doctors are torn between their obligations as pediatricians to advocate for children and their desire to keep themselves, their families, their patients and their hospitals safe. “There’s a non-zero chance somebody might kill me, and I know that. I don’t like it. At least I would die standing up for my values, but I’ve had to make peace with that,” said Alex Dworak, assistant professor of family medicine at the University of Nebraska Medical Center. Every major medical association, including the American Medical Association, the American Academy of Pediatrics and the American Psychological Association, supports the use of gender-affirming care to treat transgender people, including youth, with gender dysphoria. But those who oppose the care argue that kids should wait until they’re adults to decide to take hormones or undergo surgery and the science around such treatments is unsettled. “I’ve sat down and met with transgender youth and adults. I understand their struggles are real, and my heart goes out to them,” said Montana Gov. Greg Gianforte, who is expected to soon sign a ban into law. But, he argued, it is “right and appropriate” to restrict minors’ access to hormones and surgery. WELCOME TO MONDAY PULSE. Scientists may have found the cause of graying hair — meaning new ways to stop it could be on the horizon. Have any other big news dropping soon? Give us a first look at dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Ben Leonard, who reports on an effort to move more care from the hospital to the home — a shift that supporters, including a bipartisan group of lawmakers, say is a win-win that would give patients what they want and shore up Medicare’s teetering finances.
| | | | | | | A message from PhRMA: The 340B program was designed to support true safety-net providers and help their patients afford medicines. But many hospitals have co-opted the program turning it into one that boosts their bottom lines at the expense of patients. In fact, an analysis found 340B hospitals charge uninsured patients nearly 4X what they pay to acquire cancer medicines through 340B. The 340B program should help patients afford their medicines, not make hospitals a profit. | | | | | | | 
Last week's Supreme Court ruling keeps mifepristone on the market for now. | LM Otero/AP Photo | ACCESS MAINTAINED (FOR NOW) — The Supreme Court maintained access to a widely used abortion pill for the time being, POLITICO’s Alice Miranda Ollstein and Josh Gerstein report. The high court’s decision keeps the drug, mifepristone, available for now, but the legal battle over the drug, which has become the most common method of abortion nationwide, could drag on for months if not years to come. At stake in the larger battle: the most common form of abortion in the U.S. Two related storylines to follow in the wake of the court’s ruling: — The politics haven’t changed much. Many politicians, regardless of party, used the Supreme Court’s Friday ruling to reiterate many of the abortion arguments they’ve been making since the landmark Dobbs decision last year, POLITICO’s Kelly Garrity reports. Some Republicans are using the opportunity to push hard for more abortion restrictions. Others have taken a more careful approach, looking to strike a balance that will reach more voters in the 2024 election. Democrats have also taken a familiar tack, saying the government shouldn’t add new restrictions to abortion while arguing the FDA should maintain the authority to regulate medication. — A new telehealth industry finds itself at risk. The possibility of new restrictions on abortion medication is forcing a burgeoning industry of telehealth providers to consider fallback plans, POLITICO’s Ruth Reader reports. Despite a Supreme Court decision to allow the abortion pill to remain on the market for now, the uncertainty around what a lower court might rule on the issue — and where a case might go from there — is causing confusion for providers seeing patients online.
| | | | GO INSIDE THE 2023 MILKEN INSTITUTE GLOBAL CONFERENCE: POLITICO is proud to partner with the Milken Institute to produce a special edition "Global Insider" newsletter featuring exclusive coverage, insider nuggets and unparalleled insights from the 2023 Global Conference, which will convene leaders in health, finance, politics, philanthropy and entertainment from April 30-May 3. This year’s theme, Advancing a Thriving World, will challenge and inspire attendees to lean into building an optimistic coalition capable of tackling the issues and inequities we collectively face. Don’t miss a thing — subscribe today for a front row seat. | | | | | | | | | FIRST IN PULSE: AHIP HITS AT ‘BIG PHARMA’ — America’s Health Insurance Plans, the leading insurance lobby, is launching a seven-figure ad campaign touting the industry and accusing drugmakers as the culprits of high drug prices, Megan R. Wilson reports. The ads, which feature caricatures of high-powered drug lobbyists, will appear on television and social media, targeting outlets in Washington — and effectively bringing a war between insurers and the pharmaceutical industry into the open. “Big Pharma’s mantra has been ‘don’t look here’ while pointing fingers at others and complicating a simple problem. The problem is the price — drug prices that are set and controlled by manufacturers and manufacturers alone,” AHIP CEO Matt Eyles told Megan. “We can’t continue to be distracted by perpetual tactics designed to keep prices high.” — PhRMA has been hammering insurers and pharmacy benefit managers — the pharmaceutical middlemen that negotiate drug discounts with drugmakers and design prescription drug benefits for health plans — in ads for years, saying the industries don’t pass the savings from the discounts negotiated with drugmakers onto consumers. Congress is mulling a slew of proposals that take aim at PBMs, the largest of which are owned by insurance companies. Although insurers are part of a coalition called the Campaign for Sustainable Rx Pricing that successfully pushed for drug-pricing policies in the Inflation Reduction Act, this is AHIP’s most expensive rebuttal — saying in the ads that pharmaceutical manufacturers are pushing policies “to weaken your bargaining power.” What’s next: Payers and PBMs are lobbying to enact reforms to the patent system brand-name drugmakers use to maintain exclusivity of their products.
| | | | STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today. | | | | | | | | PRESSING ON PAYMENTS — Nonprofit and for-profit hospitals are coming together in an ad campaign to press for more Medicare payments, your host reports with Megan R. Wilson. The ads come just days before the House Energy and Commerce Subcommittee on Health is scheduled to hold a hearing on a number of bills aimed to increase transparency and competition in health care. What worries hospitals: One piece of legislation, slated for discussion during this week’s hearing, would create “site-neutral” Medicare payments for some services — meaning the reimbursement wouldn’t change based on where a patient is treated. An American Hospital Association spokesperson told Pulse that such a policy would cost hospitals a lot of money, arguing they’re already in a difficult financial situation. Hospitals will continue to push that argument through the week and beyond. “Medicare ‘site neutral’ payment may fit on a bumper sticker but this ‘one-size-fits-all’ policy won’t ensure seniors get the right care at the right time in the right setting,” Chip Kahn, president and CEO of the Federation of American Hospitals, said in a statement first shared with Pulse. “The fact is paying for services based on a ‘one-size-fits-all’ scheme would have a devastating effect on access to hospital care that Medicare beneficiaries and all Americans depend on.”
| | | | A message from PhRMA:   | | | | | Megan R. Wilson reports that Medicare Advantage threats are spurring a record lobbying blitz by insurers. The New York Times reports that the Sackler family gave millions to an institution that advises on opioid policy.
| | | | A message from PhRMA: About 80% of 340B sales are to hospitals, but these hospitals are not required to use 340B-generated profit to help patients afford their medicines. Most 340B hospitals don’t have policies to help low-income patients access medicines through their financial assistance policies, and such hospitals often spend less on charity care than non-340B hospitals. So, who is the 340B program helping? | | | | | | | Follow us on Twitter | | | | Follow us | | | | |
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