House looks to weaken Medicare negotiation

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Operation Tweak the IRA commences

Two proposals to weaken Medicare’s drug price negotiation program are getting a hearing before a House Energy & Commerce subcommittee today.

One bill, dubbed the ORPHAN Cures Act, would allow an orphan drug to avoid negotiation as long as it is approved exclusively for rare diseases. Currently, the law only exempts drugs that have a single orphan designation from the negotiation process.

The bill has bipartisan backing, though Democratic lawmakers are a who’s who of pharmaceutical industry allies from states with a big biotech presence: Rep. Scott Peters (Calif.), Don Davis (N.C.), Josh Gottheimer (N.J.), and Wiley Nickel (N.C.).

The other, called the Maintaining Investments in New Innovation Act, would delay the negotiation process for genetically targeted technologies by four years, to put them on par with the exemptions that biologic drugs receive.

Mr. Cuban goes to Washington

The White House is hosting a listening session on PBM reform on Monday, with invitees including the namesake of the Mark Cuban Cost Plus Drug Company Mark Cuban and FTC Chair Lina Khan, my colleague Ed Silverman scooped yesterday.

The listening session comes as efforts to reform PBM practices have stalled amid disagreements on Capitol Hill over their scope. Read more, including what Cuban told Ed his agenda would be going into the meeting.

To fight another day

Now that talks on major health issues like PBM reform and site-neutral payments have stalled, many of my sources are now expecting a major health care showdown in December. Take this comment by Taylor Hittle, a GOP staffer on the House Education and the Workforce Committee, at the National Association of Benefits and Insurance Professionals event in Washington this week:

“Going into the lame duck, we are really hopeful to be able to get [PBM reform] past the finish line,” she said.

There’s a slew of new deadlines for health policy on Dec. 31. Here are a few to watch:

• Medicare’s telehealth flexibilities will be expiring. These are potentially expensive, popular policies that lawmakers will be eager to extend.
• Allowances for employers to provide first-dollar telehealth coverage to employees in high-deductible health plans will also expire.
• Physicians will be facing yet another 1.25% in cuts to their Medicare payments.

Another important dynamic: Rep. Cathy McMorris Rodgers (R-Wash.) and several other top GOP health care lawmakers in the House are retiring (and note that Sen. Bernie Sanders (I-Vt.) hasn’t said he’s running for re-election yet). So there may be an additional incentive to pass legacy items. Don’t underestimate the power of this dynamic — see former Sen. Lamar Alexander’s last-minute push to pass surprise billing protections in his final days as a senator in 2020 as one example.

The next preventive care showdown

A federal appeals court is set to hear arguments Monday about whether HHS can require insurers to cover preventive services like PrEP and certain health screenings at no cost to patients, my co-author Sarah Owermohle writes. Since the ACA passed, the agency has attached that requirement to several dozen preventive services through a volunteer panel of doctors and scientists known as the U.S. Preventive Services Task Force.

But the plaintiffs in Braidwood v. Becerra argue the group has no constitutional authority to make those calls, and a lower court sided with them. If that decision holds up, employers and insurers likely wouldn’t rush to raise costs or gatekeep services like cancer screenings. But no-cost PrEP access is under particular threat; the lower court also ruled that required PrEP coverage violated religious freedoms.

Oral arguments are before a three-judge panel, in this case one Biden appointee and two Trump appointees, one of whom last year heard the abortion pill case that will soon go before the Supreme Court.

What we’re reading

• How Panera Bread ducked California’s new $20 minimum wage law, Bloomberg
• FTC says pharmacy benefit managers are stonewalling requests for information, STAT
• U.S. opens UnitedHealth antitrust probe, Wall Street Journal
• CDC advisory panel says people 65 and older should get a Covid spring booster shot, STAT
• Why won’t Medicare deliver food to sick seniors, if it could get them healthy?, STAT