Lauren Clason

Overlooked plans to add Medicare benefits get more attention
Savings from drug pricing bill would cover additional dental, vision, hearing coverage under Democratic plan

A long-shot bid to expand health care benefits for seniors is beginning to gain attention as part of Democrats’ signature health care bill, which the House is expected to vote on Thursday. 

Speaker Nancy Pelosi and committee leaders are aiming to use savings from the drug bill to add dental, hearing and vision benefits to Medicare. Democrats say the legislation could result in $500 billion in savings over a decade, based on guidance they received from the Congressional Budget Office. 

House Dems move forward with drug pricing bill
Committee approved a new plan that would limit drug prices — a top priority for the party

A House committee on Thursday approved a Democratic bill designed to limit drug prices, a top priority for the party, as another panel’s debate on the measure was poised to last for hours.

House leaders produced the 141-page bill after months of deliberations among various party factions, as progressives urged their colleagues to be bold despite GOP criticisms that the measure could hamper research into future cures. The bill, numbered HR 3, includes requirements for the Department of Health and Human Services to negotiate Medicare prices for the most expensive drugs, with commercial health plans also having the option of adopting those prices.

Democrats bow to critics, expand scope of drug price bill
The changes by House Democratic leaders were made to appease progressives who pushed for more aggressive action

House Democratic leaders unveiled changes to Speaker Nancy Pelosi’s drug pricing bill ahead of markups Thursday, seeking to appease progressives who pushed for more aggressive action.

The chamber is expected to vote on the bill this month.

Federal health officials propose loosening anti-kickback laws
Both proposals will have a 75-day comment period after they are published in the Federal Register

The Trump administration on Wednesday unveiled plans to loosen two anti-corruption laws for doctors, in a bid to promote new ways of delivering coordinated health care while attempting to preserve the laws’ core aim of combating fraud and abuse.

Physician groups have long sought changes to the anti-kickback law and the Stark self-referral law, saying the cumbersome rules impede the close provider relationships necessary to pay for health outcomes rather than the volume of services. The laws restrict doctors from accepting payments that induce business under Medicare and from referring patients to other businesses in which they have a financial interest, respectively.

Trump executive order to focus on modernizing Medicare
Rulemaking designed to contrast with Democrats’ ‘Medicare for All’

An executive order President Donald Trump will sign this afternoon will focus on modernizing Medicare by increasing access to telehealth and innovative therapies, according to senior officials.

The administration is also positioning the order as a contrast to Democratic presidential candidates campaigning on “Medicare for All” government-run health care, in part by strengthening private insurance plans that operate as part of the giant health program for seniors under the Medicare Advantage system. Seniors are a major voting bloc and health care is a significant part of the 2020 presidential campaign.

Political tensions escalate as drug pricing bills move forward
Rift began when Pelosi called for Medicare to negotiate prices for a set of high-cost drugs

The discord between the parties over plans to bring down drug costs deepened this week as Democrats insisted on allowing Medicare to negotiate prices and launched an impeachment inquiry that threatens to consume Congress.

Still, members of key committees said Wednesday they wanted to continue bipartisan work to lower costs, a major concern of voters, and lawmakers in both chambers took steps toward advancing their proposals. The House Energy and Commerce Health Subcommittee held the first hearing on legislation unveiled last week by House Speaker Nancy Pelosi, D-California, and Democrats leaving a caucus meeting on drug legislation late Wednesday said markups are expected soon after a two-week recess in October. Meanwhile, Senate Finance Chairman Charles E. Grassley, R-Iowa and ranking Democrat Ron Wyden of Oregon unveiled the text of their bill on Wednesday.

House drug price negotiation plan could apply beyond Medicare
Draft plan would have government set prices based on those in other wealthy countries

A comprehensive drug price bill being developed by House Democrats would give private insurers the benefit of government-negotiated prices, according to a summary of the measure obtained by CQ Roll Call.

Under the Democrats’ draft plan, the government would set prices based on what is paid in other wealthy countries, according to the summary. That is similar to how a proposal by the Trump administration would work.

Jerry Moran in line for Senate Veterans’ Affairs gavel

The news of Sen. Johnny Isakson’s pending resignation will have consequences when it comes to committee rosters, most prominently with Kansas GOP Sen. Jerry Moran the next in line to be chairman of the Senate Veterans Affairs’ Committee. 

Moran should be a familiar figure to veterans service organizations and other groups involved in policy, since he is a former chairman of the Military Construction-VA subcommittee of Appropriations. Senate Republicans tend to adhere to seniority rules, and Moran is the next lawmaker in line for the job. He also does not have any other full committee chairmanships, meaning there won’t be as much of a domino effect.

Johnson & Johnson ordered to pay $572 million in Oklahoma opioid lawsuit
The case could foreshadow outcomes in a massive consolidated case in Ohio later this fall

An Oklahoma district judge ordered Johnson & Johnson to pay more than $572 million in damages to help alleviate the state’s opioid epidemic, in a case where the state attorney general accused the company of being the “kingpin” of the crisis.

Attorney General Mike Hunter originally sought more than $17 billion for the state’s abatement plan, but District Judge Thad Balkman said he was constrained by legal limits around the “public nuisance” charge.

Planned Parenthood exits Title X program over gag rule
It left the program over a new rule prohibiting clinics receiving Title X funds from discussing abortions with patients

The nation’s largest provider of reproductive health services, including abortions, will exit the federal family planning program over the Trump administration’s “domestic gag rule,” which prohibits clinics receiving Title X funds from discussing abortions with patients.

Alexis McGill Johnson, Planned Parenthood Federation of America acting president and CEO, told reporters Monday that its clinics receiving Title X grants would begin submitting notices of withdrawal. The Department of Health and Human Services is requiring clinics to submit compliance plans by the end of the day.

Senate bill’s drug pricing provision raises industry alarms
Provision could force drugmakers to cut patient assistance for chemotherapy drugs

A little-noticed provision of the Senate Finance Committee drug price bill is alarming some doctors, with at least one group warning it could harm patients with fragile medical conditions.

The Community Oncology Alliance, an advocacy group for cancer doctors, is raising red flags about a provision it says could prompt drugmakers to cut patient assistance for pricey chemotherapy drugs, or shortchange doctors who buy them.

New Medicare initiative aims to fill holes in patient health records
The demo connects health data from multiple providers directly to a patient’s doctor

The Centers for Medicare and Medicaid Services on Tuesday unveiled a new initiative that aims to connect the dots between a patient’s health records held by different providers.

The Data at the Point of Care, or DPC, demonstration seeks to bridge the data gap by connecting Medicare’s Blue Button — a tool that allows Medicare patients to download their health records and save them in computer files or apps — directly to a patient’s doctor. A doctor could then see claims data from a patient’s other providers that might not be accessible otherwise.

Options for private health care a comfort and concern for veterans
New VA program expands private care options and boost pay for medical professionals. But some worry it could lead to wholesale privatization

Eugene Downs, a 93-year-old Navy veteran who served during World War II, the Korean War and the Vietnam War, has received nearly all of his care over the past 27 years from the Department of Veterans Affairs. He’s a regular at the Washington VA Medical Center, where he has “no gripes.”

“I get the best damn care anybody can get,” he says.

Congress is Trump’s best hope for drug pricing action
But divisions remain between Republicans and Democrats, House and Senate

An upcoming Senate bill is the Trump administration’s best hope for a significant achievement before next year’s election to lower prescription drug prices, but a lot still needs to go right for anything to become law.

Despite the overwhelming desire for action, there are still policy gulfs between Republicans and Democrats in the Senate, and another gap between the Senate and the House. And the politics of the moment might derail potential policy agreements. Some Democrats might balk at settling for a drug pricing compromise that President Donald Trump endorsed.

Trump unveils sweeping goals on kidney disease
Executive order aims to improve quality and cut costs by refocusing care on prevention

President Donald Trump outlined an agenda to improve preventive treatment of kidney disease Wednesday, zeroing in on a condition that afflicts more than 30 million Americans and costs more than $100 billion in annual Medicare spending.

The executive order Trump signed aims to improve quality and cut costs by refocusing care on prevention. The initiative’s overarching goals are to reduce the number of new patients with end-stage renal disease by 25 percent by 2030, and to have 80 percent of ESRD patients either receiving in-home dialysis or transplants by 2025.

Drug pricing legislation may not affect a new $2.1 million gene therapy drug
The blockbuster drug Zolgensma, which treats spinal muscular atrophy, is now the most expensive drug in the world

The recent approval of a treatment poised to become the world’s most expensive drug comes as Congress debates measures meant to address high prices — yet so far what lawmakers are attempting might not impact cases like this $2.1 million therapy.

The FDA announced Friday it was approving Novartis AG’s gene therapy Zolgensma, a one-time treatment designed to help young children with spinal muscular atrophy. The agency’s announcement said the safety and effectiveness of the drug was based on clinical trials that yielded positive results for patients with the rare disease.

New state laws highlight an escalating battle in the war over drug pricing
The laws restrict insurance from excluding manufacturer coupons or financial assistance from cost-sharing responsibilities

Recent laws in several states that protect drugmakers’ contributions toward patients’ prescription copays are highlighting an escalating battle in the larger war on drug pricing.

In the past month, Arizona, Virginia and West Virginia became the first states to enact laws restricting insurance companies from excluding most drug manufacturer coupons or other financial assistance from a patient’s cost-sharing responsibilities. Similar bills are pending in a host of other states, including Connecticut, Illinois, Indiana, Kentucky and North Carolina.

Single-payer health care systems are no easier in the states
Politics, costs and federal restrictions have already undercut efforts in Vermont and California

The hurdles for a government-run, single-payer health care system are amplified at the state level, where universal coverage ambitions are hampered by politics, costs and federal restrictions.

These realities ultimately undercut efforts in two of the nation’s most liberal states — Vermont, which ended its attempts to institute a single-payer system in 2014, and California, which is expected to fall short again this year.

Will FDA keep cracking down on teen vaping, other initiatives, after Gottlieb leaves?
Scott Gottlieb, fought teen vaping and approved record numbers of generic drugs will resign next month

Food and Drug Administration Commissioner Scott Gottlieb, who launched a campaign against teen vaping and approved a record number of generic drugs, is resigning next month.

The departure raises questions about whether the agency would continue to vigorously seek to curb the exploding use of e-cigarettes among young people, among other Gottlieb initiatives. But the commissioner, in a resignation letter listing accomplishments on this and other issues, said he was “confident that the FDA will continue to advance all these efforts.”

Azar touts rebate proposal as solution to 'broken' system
The proposal would create safe harbors under the anti-kickback statute for upfront discounts to patients and flat service fees to PBMs

Health and Human Services Secretary Alex Azar on Friday pitched a proposal he released the day before as a major step in reforming the complex system of the prescription drug supply chain and lowering prices.

The proposed rule released by HHS and the Office of the Inspector General Thursday would eliminate federal protections for manufacturer rebates paid to health plans and pharmacy benefit managers under federal health programs, although Azar expects the rule would also trigger changes in the commercial market. The proposal would instead create safe harbors under the anti-kickback statute for upfront discounts to patients and flat service fees to PBMs.