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CMS open to Medicare negotiation transparency

Presented by Express Scripts by Evernorth: Delivered every Tuesday and Friday by 12 p.m., Prescription Pulse examines the latest pharmaceutical news and policy.
Jun 02, 2023 View in browser
 
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By David Lim and Katherine Ellen Foley

Presented by

Express Scripts by Evernorth

With Robert King and Megan R. Wilson

Driving the day

A pharmacy

CMS will rethink its proposed requirement that drug companies can't disclose details about their negotiation process. | AP Photo

CMS SIGNALS COMPROMISE — The top Medicare official tasked with heading CMS’ drug price negotiation group signaled the agency might loosen its proposed requirement to restrict drug companies from disclosing details about the negotiation process.

The pharmaceutical industry raised concern that the floated restrictions on talking about the negotiations amount to a violation of the First Amendment in response to CMS’ initial guidance detailing how it intends to run the program — raising the specter of litigation if the agency did not walk back the requirement.

Meena Seshamani, director of Medicare, indicated in an interview with Robert that CMS is receptive to taking a lighter approach.

“We are looking at it and exploring it. I think we want to be able to set up a transparent program, and we understand these issues around proprietary information,” Seshamani said. “These are things we are continuing to think through.”

Still hiring: Seshamani said the agency is still trying to finish hiring roughly 100 people to staff the CMS drug price negotiation group, which is tasked with selecting 10 drugs for negotiation by Sept. 1.

“Jobs are continuing to be posted, we are continuing to hire,” Seshamani told Robert, adding that CMS is focused on bringing in economists and individuals with industry or clinical experience. “We will have a more comprehensive announcement soon.”

Steve Ubl, CEO of industry trade group Pharmaceutical Research and Manufacturers of America, pointed to letters from Republican lawmakers questioning why CMS needs to hire so many people. That, he says, is a sign that the GOP will consider changes to the drug price negotiation process once the industry can “continue to educate and collect the evidence base around these issues.”

“We don’t think it’s a real negotiation,” Ubl told POLITICO. “It’s more like a negotiation with a gun to your head if the alternative is to be excluded from the Medicare and Medicaid program or pay a tax on the proceeds of the medicine at some exponential level. I think you'll see over time legislation introduced, oversight conducted.”

POLITICO’s Health Care Summit on Wednesday, June 7, will explore how tech and innovation are transforming health care and the challenges ahead for access and delivery in the U.S. Register now.

IT'S FRIDAY. WELCOME TO PRESCRIPTION PULSE. Happy Pride Month, readers.

Send news, tips and compliments to David Lim (dlim@politico.com or @davidalim) or Katherine Ellen Foley (kfoley@politico.com or @katherineefoley).

TODAY ON OUR PULSE CHECK PODCAST, your host Katherine talks with Daniel Payne about his report on how hospitals, clinics, patient advocates and state workers are striving to prevent individuals from losing their Medicaid coverage as the program unwinds.

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A message from Express Scripts by Evernorth:

60 million Americans live in rural areas. Yet less than 10 percent of physicians practice in those parts of the country. That’s half the number of physicians needed to provide essential care to those communities. Express Scripts by Evernorth is expanding health care access for rural communities by advocating for more pharmacy services and reimbursement opportunities. Making health care more accessible for all. Learn more.

 
Tobacco

A smoker snuffs out a cigarette

The Biden administration wants to help Americans stop smoking. | Rich Pedroncelli/AP Photo

HHS ON SMOKING CESSATION — Biden administration officials said Thursday they plan to launch the first government-wide draft framework for smoking-cessation help for Americans. The framework, part of the Biden cancer moonshot, aims to harmonize smoking-cessation resources available through existing agencies, including the CDC, the FDA and the Department of Veterans Affairs.

“The goal is to coordinate [the resources] and leverage their work across the government,” said Rachel Levine, HHS assistant secretary for health.

Levine stressed that the program would focus on marginalized communities, including people of color and members of the LGBTQ community, who smoke at disproportionately higher rates than other groups. The program will also focus on preventing minors from using e-cigarettes.

“To end cancer caused by tobacco, we have to put into place multiple policies at the federal, state and local level that we know work,” said Erika Sward, assistant vice president of national advocacy for the American Lung Association.

FDA Commissioner Robert Califf noted that his agency is still on track to finalize rules that would ban menthol cigarettes and flavored cigars. The rule is expected this summer. He also said the FDA hopes to propose a rule that would limit the amount of nicotine permitted in cigarettes.

But Califf said that eliminating those products won’t be enough to guarantee more smokers quit. “Here’s what I’m concerned about … we’re gonna take away the menthol and these little cigars and [then] we ask the question, ‘what is the care package for these people when they’re going to quit?’”

Agencies have collaborated on smoking cessation in the past and will likely continue to do so outside the new framework. On Thursday, for example, the FDA and the National Institutes of Health jointly awarded funding for a new Center for Rapid Surveillance of Tobacco, which will help the agencies collect and analyze data faster on the types of tobacco products used nationwide.

 

GET READY FOR GLOBAL TECH DAY: Join POLITICO Live as we launch our first Global Tech Day alongside London Tech Week on Thursday, June 15. Register now for continuing updates and to be a part of this momentous and program-packed day! From the blockchain, to AI, and autonomous vehicles, technology is changing how power is exercised around the world, so who will write the rules? REGISTER HERE.

 
 
Around the Agencies

COHEN TO LEAD CDC — President Joe Biden plans to name North Carolina Health Secretary Mandy Cohen as the next director of the CDC, three people with knowledge of the matter told POLITICO.

The Washington Post first reported the anticipated appointment. Cohen, an Obama-era health official well known in Democratic policy circles, would replace outgoing CDC chief Rochelle Walensky, who is slated to leave the agency at the end of the month.

ADVOCACY GROUPS TO CMS: REGISTRY IS A BARRIER — Alzheimer’s disease advocates and doctors are frustrated and disappointed that Medicare will cover new treatments granted traditional approval only for patients enrolled in a clinical registry.

On Thursday, CMS said it would still require patient registries for coverage to see how the drugs work in real-world settings. It also said it would develop a nationwide portal where clinicians can enter patient data to ensure coverage is not delayed for treatments gaining traditional approval. The FDA is slated to decide whether to grant Leqembi, an Alzheimer’s treatment from Eisai and Biogen, traditional approval in July. No other drugs in the new class of Alzheimer’s treatments have received traditional approval.

“The bottlenecks will be worse than if there were no registry,” said R. Scott Turner, a neurologist and director of the Memory Disorders Program at Georgetown University. Turner said it would add a time constraint for doctors trying to treat as many patients as possible every day. “It’s unreimbursed effort and time, so who is going to want to do it?”

However, others said it is too soon to say whether the registry will delay or reduce patient access — and it could benefit clinicians in real time as they assess whether their patients are benefiting from a new treatment. “To me, this is serving two important purposes — you’re helping your patients get coverage [for an expensive drug] and that information is going to be available to you as a doctor,” said Diana Zuckerman, president of the National Center for Health Research, a patient advocacy think tank based in Washington.

 

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Industry Intel

COST PLUS DRUGS TARGETS HUMIRA — Coherus BioSciences plans to launch its biosimilar version of Humira, AbbVie’s blockbuster treatment for rheumatoid arthritis and other autoimmune disorders, at a massive discount in July, Megan reports.

The injectable medicine, called Yusimry, will have a list price of $995 per carton of two autoinjectors, the company said Thursday, 85 percent cheaper than its brand-name competitor. Coherus will also partner with the Mark Cuban Cost Plus Drug Company, co-founded by the tech billionaire, to offer the drug directly to patients for about $577 per carton of two autoinjectors.

Humira, one of the biggest-selling drugs in the U.S., has been on the market for 20 years without any lower-cost biosimilar competitors. That ended when Amgen launched its biosimilar, called Amjevita, in January. Several others are expected to come onto the market later this year.

 

DON’T MISS POLITICO’S HEALTH CARE SUMMIT: The Covid-19 pandemic helped spur innovation in health care, from the wide adoption of telemedicine, health apps and online pharmacies to mRNA vaccines. But what will the next health care innovations look like? Join POLITICO on Wednesday June 7 for our Health Care Summit to explore how tech and innovation are transforming care and the challenges ahead for access and delivery in the United States. REGISTER NOW.

 
 
Document Drawer

The FDA published draft guidance Thursday for drugmakers developing migraine medicines that lays out recommendations for efficacy, trial design, dose selection and other considerations.

The FTC and DOJ released a summary Thursday of their June 2022 two-day workshop on pharmaceutical mergers.

The FDA updated its compliance manual Thursday for inspection and field testing of radiation-emitting electronic products.

The FDA issued hurricane season recommendations Wednesday for medical device manufacturers, urging companies to consider stockpiling materials to avoid disruptions if a storm impacts the supply chain.

 

A message from Express Scripts by Evernorth:

Express Scripts by Evernorth believes America’s rural communities, and independent pharmacies, deserve better. That’s why we’re leading the way with new ways to close gaps in care through partnerships with independent pharmacies across the U.S.

We’re establishing the industry’s first Independent Pharmacy Advisory Committee to help pharmacies everywhere better support underserved communities. We’re making it easier to offer much-needed services like vaccinations, lifestyle counseling, and behavioral health screenings. And we’re increasing reimbursements paid to rural pharmacies for the essential services they provide today and well into the future.

We invite all our partners and our competitors to follow our lead. And help improve the quality of care for all. Learn more.

 
 

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