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Bipartisan heartburn over PEPFAR deal

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Mar 21, 2024 View in browser
 
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By Ben Leonard and Chelsea Cirruzzo

Presented by 340B Health

With Lauren Gardner

Driving The Day

Rep. Rosa DeLauro (D-Conn.).

Sen. Rosa DeLauro told Democrats that PEPFAR is included in a spending bill that would extend the HIV/AIDS program for one year. | Francis Chung/POLITICO

PEPFAR RESOLUTION, BUT ANGER REMAINS — A long battle over the future of the U.S.’ leading program to fight HIV/AIDS globally appears to be drawing to a close this week, as Congress is poised to pass a spending bill that would extend the program for a year, POLITICO’s Alice Miranda Ollstein and Carmen Paun report.

House Appropriations ranking member Rosa DeLauro (D-Conn.) shared the news during a closed-door conference with Democrats on Wednesday, a source familiar with the meeting told POLITICO and confirmed by several advocacy groups involved in the negotiations.

The President’s Emergency Plan for AIDS Relief reauthorization won’t include the anti-abortion riders that conservatives had pushed for. The program’s authorization lapsed in October, which left uncertainty for the program amid the conflict over abortion.

PEPFAR is credited with saving more than 25 million lives worldwide after then-President George Bush signed it into law in 2003. But conservatives have said its funds go to abortion providers overseas, a claim the Biden administration, the program’s leaders and outside development experts deny.

Despite the end of the conflict — for now — few are happy about the compromise. 

Republican lawmakers and anti-abortion advocates are miffed that the bill doesn’t have new restrictions on PEPFAR. The Heritage Foundation and other conservative groups say they’ll score the vote to come in the days ahead and penalize members who support it.

“It’s not a win to say that instead of five years of not protecting the unborn, we’ll just have just one — we still consider that murder,” said Max Primorac, a senior research fellow at Heritage.

Democrats and progressive organizations are peeved that the measure would only extend the program for a year instead of five for the first time in its 20-plus-year history. They say it will weaken the country’s influence and leave HIV services in an uncertain position.

“A five-year reauthorization shows that we are still a world leader,” Sen. Ben Cardin (D-Md.), who chairs the Senate Foreign Relations Committee, said in an interview Wednesday.

What’s next: Congress has until the end of the day Friday to avert a partial government shutdown including HHS.

WELCOME TO THURSDAY PULSE. We’re sad to report that inflation has hit Cups — a national treasure. Reach us and send us your tips, news and scoops at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.

 

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Support the 340B PATIENTS Act The 340B PATIENTS Act eliminates harmful big pharma restrictions on 340B savings that are vital for expanding health care and support for patients and rural communities in need. By restricting 340B pharmacy partnerships, drugmakers have siphoned billions from the health care safety net solely to bolster their profits. The 340B PATIENTS Act stops this damaging behavior. We call on Congress to support this vital legislation. Learn more.

 
In Congress

Reps. Cathy McMorris Rodgers (R-Wash.) and Frank Pallone (D-N.J.).

The House Energy and Commerce Committee, led by Chair Cathy McMorris Rodgers and ranking member Frank Pallone, advanced several health care bills Wednesday. | Francis Chung/POLITICO

E&C’s CLEAN BILLS OF HEALTH — The House Energy and Commerce Committee on Wednesday advanced more than a dozen health care bills — most of them unanimously — clearing them for consideration by the full House.

The legislation would largely reauthorize programs set to expire at the end of the fiscal year.

Those garnering unanimous support included measures to extend the National Alzheimer’s Project, reauthorize a program to deal with provider burnout and bolster rural emergency medical services. Other bills getting unanimous backing would continue programs for traumatic brain injuries and boost funding for Down syndrome research.

The lone bill that didn’t get unanimous backing was the Kidney PATIENT Act, which would delay CMS from moving oral-only drugs for chronic kidney disease into a different payment system.

Supporters, including sponsor Rep. Buddy Carter (R-Ga.), argue the change would restrict access and increase costs. But some Democrats, including committee ranking member Frank Pallone (D-N.J.), opposed it, arguing that the system “is not ready for the transition.”

CBO REVEALS THINKING ON OBESITY DRUGS — The Congressional Budget Office said at an event Wednesday that it expects Medicare premiums and cost-sharing would rise for patients if Congress lifts its ban on Medicare covering weight-loss drugs.

The drugs are pricey, and the nonpartisan office said its future pricing is “highly uncertain.” CBO expects that HHS would pick semaglutide, a popular diabetes and obesity treatment, for price negotiation in Medicare under the Inflation Reduction Act "within the next few years," which would reduce its price and possibly those of other anti-obesity drugs.

The office also expects generic competition to emerge in the second decade of a lifted ban on Medicare coverage and new medications to become available.

“The new drugs might be more effective, have fewer side effects or be taken less frequently or more easily than current medications,” CBO analyst Noelia Duchovny told the National Academies’ Roundtable on Obesity Solutions. “Those improvements could translate to higher prices, on average, even if prices decline for drugs that exist today.”

The scorekeeper also said it doesn’t know of empirical evidence tying the use of anti-obesity drugs to lower health care spending in other areas but said simulations also show reduced spending in other health care areas.

What's next: CBO seeks research on the drugs’ price and effectiveness and their short- and long-term clinical impacts and effects on spending.

Lawmakers are also trying to change how the CBO scores preventive care. The House passed a bill via voice vote Tuesday that would require the agency to weigh whether a bill would save money over a 30-year budget window instead of 10 if Congress asks for it.

BECERRA’S HOUSE CALL — HHS Secretary Xavier Becerra faced questions from House lawmakers Wednesday about whether the proposed fiscal 2025 budget had enough funding for pandemic preparedness and how HHS addresses obesity.

Pandemic preparedness: At a House Appropriations Committee hearing, Rep. John Moolenaar (R-Mich.) pointed to a recent report by an HHS agency that said it would need an additional $11.5 billion over five years to replenish the Strategic National Stockpile but said the proposed budget requests far below that need.

“We all just swept up $4 billion we had in Covid funding, all which could’ve gone to address these issues,” Becerra responded, adding HHS had to make “tough choices.”

Obesity drugs: Members of the Appropriations and House Ways and Means committees wanted to know more about what role HHS might play in making those drugs available. Becerra told Rep. Bonnie Watson-Coleman (D-N.J.) that state Medicaid programs can choose to pay for the drugs but that a congressional statute prevents Medicare from doing so.

“We have to work with you to see what we can do,” he said.

Rep. Andy Harris (R-Md.) asked whether Supplemental Nutrition Assistance Program, or SNAP, benefits could be restricted to prevent people from buying junk food, adding that HHS has promoted “Food as Medicine.”

Becerra said he couldn’t disagree with Harris “but we oftentimes don’t get to control what gets included in these programs.”

 

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Public Health

LIFE EXPECTANCY RISES — People born in the U.S. in 2022 can expect to live 77.5 years — up from 76.4 in 2021 — an increase in the U.S. life expectancy for the first time in two years, according to a CDC report out Thursday.

It comes after life expectancy had dropped in 2020 and 2021, which experts have said was driven by Covid-19 deaths and drug overdoses.

The life expectancy rate still hasn’t recovered to pre-pandemic levels: In 2019, life expectancy was 78.8.

Covid dropped from the top three leading causes of death in 2022, from third to fourth, replaced by unintentional injuries, the report said. Heart disease and cancer remain the top leading causes of death in the U.S.

The rise in life expectancy comes as overdose deaths leveled out between 2021 and 2022, according to a separate CDC report also released Thursday.

According to that report, while overdose deaths nearly quadrupled over the past two decades, they did not significantly increase between 2021 and 2022. The rate of drug overdose deaths was 32.4 deaths per 100,000 people in 2021 and 32.6 deaths per 100,000 people in 2022.

 

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PHARMA WATCH

GSK CAPS INHALER COSTS — GSK is the latest manufacturer to cap out-of-pocket costs at $35 a month for its suite of inhalers treating asthma and COPD, Lauren reports.

The company said Wednesday it will set the price ceiling for eligible patients by the beginning of 2025 and release more details "closer to implementation."

Boehringer Ingelheim and AstraZeneca recently announced similar price caps on their asthma and COPD inhalers after Democrats on the Senate Health, Education, Labor and Pensions Committee launched an investigation into the companies’ high prices for the medicines, versions of which have been available for decades.

 

Easily connect with the right N.Y. State influencers and foster the right relationships to champion your policy priorities. POLITICO Pro. Inside New York. Learn more.

 
 
WHAT WE'RE READING

The Associated Press reports on a new type of hospital in rural America.

HealthcareInfoSecurity reports on changes HHS’ Office for Civil Rights made to HIPAA guidance related to tracking technology.

POLITICO’s Erin Schumaker reports on Sen. Rand Paul (R-Ky.) getting a Democratic partner to investigate Covid origins.

 

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The 340B PATIENTS Act will end harmful drug company restrictions on 340B savings that are vital for protecting patients and communities. By restricting 340B pharmacy partnerships, big pharma has siphoned billions from the health care safety net solely to bolster its profits. The 340B PATIENTS Act stops this damaging behavior. We call on Congress to support this vital legislation. Learn more.

 
 

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