| | | | |  | | By Krista Mahr and Daniel Payne | | | With Dan Goldberg, Daniel Lippman and Megan. R. Wilson
| | |  A Biden administration policy designed to encourage health care providers to treat underserved communities could backfire. | AP Photo/Bebeto Matthews | UNINTENDED CONSEQUENCES — A Biden administration policy designed to encourage health care providers to treat underserved communities may backfire, POLITICO’s Dan Goldberg reports. What’s the problem? The Centers for Medicare and Medicaid Services implemented a new payment model this year that aims to award doctors and medical groups more money to treat underserved populations with greater medical needs. The government relies, in part, on the Area Deprivation Index to adjust payments to providers, and it's an important part of the Biden administration’s ACO REACH program, a Medicare pilot that offers provider groups a set amount of money each month to treat a roster of underserved patients. The ADI uses several factors, including home value, to measure socioeconomic disadvantage in every census block in America. But in parts of the country where extreme wealth and poverty live side by side, the ADI metric can produce distorted results. Home values tend to be higher in urban areas, even in places rife with poverty and poor health outcomes. Take Washington: Predominantly Black neighborhoods in southeast Washington, D.C., have high rates of poverty and low life expectancy, but the ADI remains relatively low, according to a recent article in Health Affairs, which found that under CMS’ policy, “no neighborhood in Washington, DC, would be considered disadvantaged.” What CMS says: The agency is aware of the critiques and said it may adjust the model in time. But it broadly defended its use of ADI. “The ACO REACH Model promotes health equity,” Liz Fowler, director of the CMS Innovation Center, said in an email to POLITICO. “ADI, which is captured at the census block level, is a widely-accepted measure of social risk. It includes multiple measures of disadvantage such as local socioeconomic factors correlated with health disparities and underservice.” WELCOME TO TUESDAY PULSE — Firefly populations are dropping, and yep, we screwed that one up, too. Send your best memories of firefly sightings, news and tips to kmahr@politico.com and dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Ben Leonard talks with Myah Ward about her story on Sen. John Fetterman’s return to Congress this week and how the lawmaker’s experience with depression shows that Washington is more openly talking about mental health and making the issue a policy priority.
| | | | | | | A message from PhRMA: Did you know that the three largest PBMs blocked access to more than 1,150 medicines last year? That includes medicines that could lower your costs at the pharmacy. Pharmacy benefit managers are putting their profits before you. Haven't heard about this? That’s by design. | | | | | | | 
The rise of new cooling cigarette products in California doesn’t bode well for the FDA’s forthcoming rule banning menthol cigarettes nationwide. | Getty Images | NO MENTHOL, STILL COOL — As California cleared store shelves of menthol cigarettes last December following a statewide ban, tobacco giant R.J. Reynolds began restocking them with new non-mentholated cigarettes that boast a similar cooling experience for smokers, Katherine and POLITICO’s Rachel Bluth report. By March, sales of the new cigarettes were on pace to replace nearly half of menthol sales compared with last year. Public health experts hoped that removing menthol cigarettes from the market would lead more smokers to quit — but RJR’s new products could thwart the efforts if regulators can’t keep them off the market. The rise of the products in California doesn’t bode well for the FDA’s forthcoming rule banning menthol cigarettes nationwide, set to be finalized later this year. “The FDA is the entity that should enforce this problem,” said Desmond Jenson, the deputy director of the commercial tobacco control program at the Public Health Law Center. “But it is also the unfortunate truth that the FDA created this problem by authorizing these products.” Abigail Capobianco, an FDA spokesperson, declined to comment on RJR’s new cigarettes but said the final rule banning menthol cigarettes will be comprehensive. “[It] will take into consideration all of the public comments, including comments on compliance and enforcement of the rule, such as how [the tobacco industry] may attempt to evade the requirements of the rule,” she said. CMS MOVES TO HELP PEOPLE LEAVING PRISON — CMS announced a plan Monday that will help states offer health insurance coverage to people leaving prison. The new rule, called the Medicaid Reentry Section 1115 Demonstration Opportunity, will “allow state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions,” the agency said in a statement. The goal is to “help Medicaid enrollees establish connections to community providers to better ensure their health care needs are met during their reentry process.” The big picture: The move is part of a Biden administration push to expand access to medication-assisted treatment for substance use disorders. People leaving prison are at an exceptionally high risk of fatal overdose, and access to treatment in prison reduces that risk, research has found. “We want to see every jail and prison across America offer this lifesaving care, and today’s announcement will help more States do that,” Rahul Gupta, head of the Office of National Drug Control Policy, said in a statement.
| | | | A message from PhRMA:   | | | | | FIRST IN PULSE: HEAT ON HOSPITALS — Better Solutions for Healthcare, a business coalition that’s so far been focused on individual states, is establishing a national footprint as it urges Congress to take aim at the hospital industry’s role in rising health care costs, Megan reports. As part of the launch in Washington, it’s adding high-powered employer and insurer groups, including the American Benefits Council, the National Alliance of Healthcare Purchaser Coalitions, the Blue Cross Blue Shield Association and America’s Health Insurance Plans. It’s pushing policymakers to look at increasing consolidation among hospitals, crack down on violators of hospital price transparency rules and enact site-neutral payment and honest billing practices. Critics argue that hospitals are a leading cause of increased health care costs. But the industry counters that their own costs — including a spike in the amount hospitals pay for labor and drugs — have been rising steadily. Hospitals also point fingers at the insurance industry, blaming it for not passing on any savings it received over the years to consumers. MEDICAL SCHOOLS’ DIVERSITY PROBLEM — A new study from UCLA Health has found that students who are Black, Hispanic and Native American not only face greater financial barriers in getting into med school than their white counterparts but are also more often discouraged along the way by advisers. The findings, published in JAMA Health Forum, found that Black, Hispanic, and Native American students faced more barriers, such as being unable to afford test materials and having more university debt. It also found that Asian, Black, Hispanic and Native American students were more likely to have an adviser negatively impact their choice to apply to med school. And the pathway for students of color could be about to get harder: An impending Supreme Court ruling could ban affirmative action, the practice that takes race as one of many factors into consideration when reviewing applications. Why it matters: While diversity in medical schools is slowly improving, according to the Association of American Medical Colleges, the persistent dearth of doctors of color across America’s health care system has been found to have a negative effect on patients, with some calling the problem itself a “public health crisis.”
| | | | 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. | | | | | | | | | ON THE ORIGINS OF COVID — The Covid pandemic probably started with two accidental lab leaks at a virology lab in the Chinese city of Wuhan, says a report released Monday by Sen. Roger Marshall (R-Kan.), the top Republican on the Senate HELP Primary Health and Retirement Security Subcommittee, Carmen Paun writes. The report presents no new smoking gun or details about the separate incidents but reiterates circumstantial evidence pointing to a lab leak. That evidence includes the type of research conducted at the Wuhan Institute of Virology and its proximity to the first coronavirus outbreak. The World Health Organization has said the lab leak theory and the theory that the virus first infected an animal and then spread to people remain on the table. U.S. agencies are split on the issue. What’s next: The House Select Subcommittee on the Coronavirus Pandemic will hold a hearing today on the intelligence on Covid’s origin.
| | | | 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. | | | | | | | | | Holly Iverson Hayden is now director of public policy for direct health care company Nomi Health, where she will oversee Nomi’s policy and regulatory efforts. She most recently was a local and state government relations and community engagement manager at Verizon.
| | The New Yorker writes about the biotech companies trying to extend the longevity of human reproductivity. Researchers in Canada say they’ve figured out how to filter “forever chemicals” from water, The Washington Post reports. STAT reports on how Uber has been trying to help get women to their prenatal appointments — and get insurers to cover it.
| | | | A message from PhRMA: Insurers and their PBMs don’t want you to see that you could be paying more than they are for your medicines. Rebates and discounts can significantly lower what insurers and PBMs pay for medicines. These savings can reduce the cost of some brand medicines by 50% or more. But insurers and PBMs aren’t required to share those savings with you at the pharmacy counter.
They don’t want you to see that they use deductibles, coinsurance and other tactics to shift more costs on to you. Or that the three largest PBMs control 80% of the prescription drug market. Or that last year they blocked access to more than 1,150 medicines, including medicines that could have lowered costs for you at the pharmacy.
PBMs and insurance practices are shrouded in secrecy, they need to be held accountable. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |
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