CONGRESS.
MA Prior Auth. A popular bill to require prior authorization processes operate electronically between providers and Medicare Advantage plans got a surprisingly high “informal CBO” score of $10B versus $8B expected. That is an improvement on a $16B figure from last year but still too high for leadership so more tweaking will be in order.
Pandemic Oversight. The House Select Subcommittee on the Coronavirus Pandemic held its first hearing featuring the Dr. Martin Kulldorff from Harvard, Dr. Jay Bhattacharya of Stanford and Dr. Marty Makary from Johns Hopkins.
The debate that is forming – we will see if it holds – is that certain measures like school closures, vaccine mandates etc., were made in good faith by public health officials with the information they had at the time. The other side of that coin is that public health leaders knowingly made mistakes and attempted to suppress dissent.
Expect also the origins of the SARS-CoV-2 virus to be part of the debate in light of recent headlines.
Limiting Defense Production Act. A bipartisan bill reported out of House Financial Services that would limit the use of the Defense Production Act to the purchase and production of items necessary for national defense. The use of DPA under the Trump and Biden administrations have arguable been used more broadly that for the national defense.
PBM’s Long for This World? I have been expecting Congress to get something done on PBMs for years now. Had it not been for the implications for Medicare Advantage premium rates, it probably would have been done by now.
House Oversight and Accountability Chairman, James Comer announced an investigation into Pharmacy Benefit Managers. His effort coincides with similar inquiries at the Federal Trade Commission.
The PBM industry’s defense for years has been that savings from managing the pharmacy benefit is passed on to customers. Hardly anyone has every asked the follow-up questions about the PBM’s relationships to the parent company insurance companies.
THE WHITE HOUSE.
Vaccine Wars. FDA's Adcomm reviewed RSV vaccines from both PFE and GSK. GSK fared a bit better but in both cases the vote was not unanimous. At the PFE meeting, members actually raised concerns about public trust in the approval process. In any event, the FDA is likely to approve but the question of clinical uptake is very much an open question.
Other Stuff.
North Carolina Medicaid Expansion. North Carolina's Governor Rory Cooper reached an agreement with his Republican legislature to expand Medicaid while ending the state's restrictive Certificate of Need laws. North Carolina has one of the most concentrated health care markets in the country. It may be too late for reducing the influence of the near monopoly of Atrium but it is a deal that may be repeated elsewhere.
COVID Origins. File under stuff more people already know. The Department of Energy, which operates the U.S.’ highly secretive national laboratory system, has concluded with “low confidence” that SARS-CoV-2 originated in a laboratory, not an animal.
The disclosure says more about how much the relationship between China and the U.S. has deteriorated than the science of viruses. Things are not likely to improve which has us thinking about China-dependent businesses like ISRG.
Upcoming Evans
CNC: Overcoming Medicaid Redetermination. March 8 @ 10am ET
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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