| | | | |  | | By Daniel Payne and Krista Mahr | | | Due to a production error, today's Pulse arrived in your inbox later than usual. We apologize for the delay. With Erin Schumaker, Megan R. Wilson and Carmen Paun
| | |  Lawmakers are looking to broaden the health care services that can be provided at home instead of in the hospital. | Joe Raedle/Getty Images | CAN AT-HOME CARE SAVE MEDICARE? A new bill from Reps. Adrian Smith (R-Neb.) and Debbie Dingell (D-Mich.) marks a rare, bipartisan collaboration on a potential solution to Medicare’s financing problem, POLITICO’s Ben Leonard and Erin report. By moving an array of services for Medicare beneficiaries from hospitals to living rooms, lawmakers hope they can save money while giving older Americans an option many say they want after the pandemic: To receive care in their homes. What’s in the bill would: — Create a new Medicare benefit allowing certain beneficiaries ineligible for Medicaid to have a home health worker for up to 12 hours a week — Facilitate house calls by paying doctors monthly in place of the existing fee-for-service structure — Broaden reimbursement for home-based services, including dialysis, lab tests and infusions — Task HHS with studying whether other procedures could move to the home, such as X-rays The price tag: The bill has drawn support from tech companies, insurers, venture capitalists, providers and telehealth advocates. However, some health economists say, while there could be potential cost savings, they’re skeptical about rosy projections for parts of the package. “The cost implications probably vary across the different provisions, and it’s hard to know what the total costs might be,” said Rachel Werner, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics. What’s next: Moving Health Home, a coalition of tech-enabled home care companies including Best Buy’s Current Health, health system Intermountain and dialysis provider DaVita, has backed the push. The groups see moving care into the home as a way to improve patients’ outcomes, reduce costs and bolster access. WELCOME TO FRIDAY PULSE. While reading this, you might be reaching for a cup of coffee — an action neuroscientists still don’t completely understand. Recent research points to an overlooked brain system’s important role in picking up a cup of Joe (as well as influencing blood pressure and heart rate). Send coffee recommendations and health news to dpayne@politico.com and kmahr@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Alice Miranda Ollstein talks with Maggie Miller, who reports on the breach of DC Health Link, uncovered last month, which involved the theft of more than 50,000 customers, including at least 17 House members and almost 600 House staffers.
| | | | | | | A message from PhRMA: What do PBMs not want you to see? Insurers and PBMs get savings that can reduce the cost of some brand medicines by 50% or more. But, insurers and PBMs don’t have to share these savings with you. People need to see what’s going on. | | | | | | | 
Sen. Bernie Sanders will face off with drugmaker and pharmacy benefit manager executives at a May hearing on drug pricing. | Josh Reynolds/AP Photo | FIRST IN PULSE: SANDERS SETS SIGHT ON INSULIN, PBMs — Senate HELP Committee Chair Bernie Sanders (I-Vt.) is summoning executives from top insulin makers and pharmacy benefit managers as part of his efforts to rein in drug prices, Megan reports. The hearing, slated for May 10, comes after major drugmakers Eli Lilly, Novo Nordisk and Sanofi announced they would be slashing insulin prices. It will feature testimony from those CEOs, plus executives from the three largest PBMs, which negotiate discounts on drugs like insulin with drugmakers and decide which medicines insurance plans will cover. Sanders tells Megan the announcements to reduce prices are “an important step forward,” but there’s more to do on drug pricing, adding the U.S. “cannot continue to pay, by far, the highest prices in the world for prescription drugs while drug companies and PBMs make billions in profits.” While PBMs argue they lower drug costs by using bargaining power to obtain drug discounts, critics have countered that drugmakers raise their prices to give larger rebates to the PBMs and receive preferential placement on insurance formularies. “Recent price cuts on insulin clearly demonstrate that drug companies alone have the ability and discretion to set, raise and lower their prices,” said Katie Payne, a spokesperson for the Pharmaceutical Care Management Association, a PBM industry group.
| | | | 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. | | | | | | | | | SHAKEN CONFIDENCE — After Covid-19, parents worldwide have been less likely to believe vaccinating their children is important, Carmen reports. Covid-19 prompted the largest sustained backslide in childhood immunization in 30 years and is putting kids’ lives at risk, according to data collected by the Vaccine Confidence Project for UNICEF. The decline in vaccine confidence was about 15 percent in the United States, according to the VCP, a research group based at the London School of Hygiene and Tropical Medicine. South Korea and Papua New Guinea saw a 44 percent drop, the biggest decrease in the 55 countries surveyed. Those attitudes have consequences. Hesitancy, along with other factors like lockdowns early in the pandemic, led to some 67 million children worldwide missing out on vaccinations between 2019 and 2021, with vaccination coverage levels declining in 112 countries. USAID LAUNCHES GLOBAL HEALTH EMERGENCY RESPONSE SYSTEM — The U.S. Agency for International Development will have a new system to tackle multiple crises at the same time, Administrator Samantha Power said Thursday at the Center for Global Development. USAID said the new system will help the agency coordinate action around health emergencies, increase its capacity to respond fast and effectively and surge funding and staff where they’re most needed, Carmen reports. Neither Power nor USAID specified a budget or more details about how it would work. Power’s global health vision: The USAID administrator laid out her three goals for the agency’s global health work in the same speech: turning Covid-19 into a manageable respiratory illness everywhere, building up global defenses against new outbreaks and pandemic threats and investing in primary health care workers who are the backbone of our health systems.
| | | META AND MISINFORMATION — Meta’s oversight board said Thursday the company needs to review how its algorithms amplify harmful Covid-19 misinformation and should consider dissenting viewpoints in its content removal decisions, POLITICO’s Rebecca Kern reports. The board recommended Meta, the parent company of Facebook, continue removing misinformation about Covid that could directly contribute to someone’s immediate physical safety, but it also said the company should reassess the 80 pandemic-related claims currently subject to removal. Meta said it plans to respond to the recommendations within 60 days.
| | | | A message from PhRMA:   | | | | | MERGER NO MORE? On Thursday, the Federal Trade Commission sued to pause a New Orleans area hospital merger that closed in January, arguing the companies may have illegally bypassed federal antitrust scrutiny of the deal, POLITICO’s Josh Sisco reports. Louisiana’s state Legislature and attorney general approved the Jan. 3 deal, in which nonprofit Louisiana Children’s Medical Center closed its $150 million purchase of a competing trio of hospitals operated jointly by Tulane University and Tennessee-based Hospital Corporation of America. But the FTC says the companies defied merger reporting requirements, arguing that the deal should have been submitted for federal review and approval before completion. Most mergers over a certain value — currently $111.4 million — must be reviewed by the FTC or Justice Department. The hospitals don’t see it that way. They said the merger didn’t require federal scrutiny because they had received state approval under a process known as certificate of public advantage, which can provide immunity from federal scrutiny if the companies’ business is properly supervised by state regulators.
| | | ADMISSIONS AND ABORTION — A new study found most college students and prospective students say state laws on reproductive health are a factor in their decision to enroll at an institution, POLITICO’s Bianca Quilantan reports. More than 70 percent of college students say state reproductive health laws are a factor in their decision to stay enrolled at their current college, while 60 percent of unenrolled adults, ages 18 to 59, who don’t have a degree say the laws are at least somewhat important to their decision. A higher percentage of women than men say the state laws are important to factor into decisions to enroll or remain enrolled in an institution. Researchers said “the potential to discourage enrollment is especially great in terms of women and young adults — both of whom are disproportionately represented on college campuses.”
| | | | NARCAN UNDER $50 — Emergent BioSolutions said Thursday that it planned to charge “less than $50” for a two-pack of the nonprescription version of its opioid overdose reversal nasal spray, POLITICO’s Katherine Ellen Foley reports. The company declined to give more price specifics, noting that retailers ultimately decide on the final price. Two packs of prescription Narcan cost about $70, though this price depends on insurance coverage. It’s unclear whether insurance companies will continue to cover Narcan without a prescription; many insurance plans do not cover over-the-counter drugs. Emergent estimates that its OTC Narcan will hit store shelves by late summer.
| | | | 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. | | | | | | | | | Christopher LaPrade is now senior director of international advocacy at PhRMA, with a focus on Latin America. He previously was senior portfolio manager for global outreach at the American Chemical Society. Annette Guarisco Fildes, CEO of the ERISA Industry Committee since 2015, is retiring. ERIC President James Gelfand will take on the role of CEO alongside his current responsibilities.
| | STAT and MuckRock report that the NIH’s $1 billion in long Covid research funding has produced little so far. The Atlantic reports on long Covid being dismissed as the world moves on from the pandemic. The New York Times reports on the fight over a drug that is good for horses but bad for humans.
| | | | 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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