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Capitol Checkup: 'Medicare for all' gets Obama boost; Azar promotes PBM power


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Capitol Checkup: 'Medicare for all' gets Obama boost; Azar promotes PBM power

Former President Barack Obama gave the so-called "Medicare for all" single-payer platform being proposed by some Democrats a boost, calling it a "good idea."

But the head of the Center for Medicare and Medicaid Services, Seema Verma, quickly pushed back, calling the single-payer concept "More government control [that] leads to higher premiums and fewer choices."

"Medicare for all would take our healthcare system in the wrong direction," Verma said in a Sept. 7 tweet.

She insisted Medicare for all "would be Medicare for none."

During Obama's Sept. 7 speech at the University of Illinois — the start of what is expected to be several addresses to rally Democrats around their party's candidates ahead of the November midterm elections — the 44th U.S. president also criticized his successor and the Republicans for trying to dismantle the Affordable Care Act, or ACA, saying those actions have already "cost more than three million Americans their health insurance."

"And if they're still in power next fall, you'd better believe they're coming at it again. They've said so," Obama said.

Some in Congress, like Sen. Bernie Sanders, I-Vt., who has introduced Medicare-for-all legislation, say it is time to move on to a single-payer system.

Obama had previously wavered on the Medicare-for-all idea.

"If I was starting from scratch I would have supported a single-payer system, because it's easier for people to understand and manage," Obama said in January 2017 in a broadcast interview with Vox, two weeks before he left office. "And that's essentially what Medicare is — a single-payer system for people of a certain age — and people are very satisfied with it, and it's not that complicated to understand how to access services. But that wasn't available. We weren't starting from scratch."

He made similar remarks eight years earlier when he was trying to get the ACA passed through Congress.

"We don't want a huge disruption as we go into healthcare reform where suddenly we're trying to completely reinvent one-sixth of the economy," Obama said during a May 14, 2009, town hall in explaining why he was not pursuing the Medicare-for-all approach at that time.

Two months later at a July 2009 press conference, Obama said that as much as he wanted to cover all Americans with health insurance, he acknowledged his plan was unlikely to do so.

While the ACA has been a contentious issue in the past three U.S. election cycles, it has grown more favorably with Americans in recent years, with half of the U.S. now holding a positive view of the 2010 law, according to the most recent poll from the nonpartisan, nonprofit Kaiser Family Foundation.

A majority of Americans, or 75%, said it was "very important" to retain the ACA's pre-existing medical condition protections, which are currently under threat by a lawsuit being fought in a federal district court in Texas.

A new analysis by the Associated Press and Avalere Health found that millions of Americans covered under ACA plans are expected to have only modest premium increases in 2019, while others may even get price cuts.

In March, Kaiser reported that nearly 60% of Americans favored a national health plan, with that number rising to 75% when those respondents were asked if that approach could be made optional, with people being able to keep their current form of coverage — a concept backed by Sen. Elizabeth Warren, D-Mass.

The Center for American Progress also has proposed a structure that would guarantee universal coverage, but the so-called "Medicare Extra For All" program would also allow employer-based insurance.

Azar backs more PBM power

Meanwhile, Health and Human Services Secretary Alex Azar last week again touted the administration's efforts to lower healthcare costs, including the prices of prescription drugs.

"The outcome we're aiming for is pretty simple: better healthcare at a lower price," Azar said during a Sept. 6 meeting of HHS' Physician-Focused Payment Model Technical Advisory Committee.

Later that same day, Azar repeated his demand for drugmakers to change their business practices and lower the prices of their medicines.

"The current pricing structure is unsustainable and will not remain," Azar said at biomedical advocacy group Research!America's 2018 National Health Research Forum. "It is going to change."

He called for pharmacy benefit managers, or PBMs, to have "more power to negotiate" on behalf of private insurance plans that operate under the Medicare Part D program and cover prescription medicines sold at the pharmacy counter.

"We have hamstrung the PBMs too much there," the health secretary said.

Azar has repeatedly sent mixed signals about PBMs — frequently criticizing them as the key driver of high U.S. drug prices, only to later back off of those accusations.

Azar's boss, President Donald Trump, said he wants to eliminate PBMs.

But the administration has taken more actions to try to give PBMs more negotiating leverage.

Late last month, CMS told Medicare Part D plans that in 2020, they could employ indication-based formularies like other private-sector plans — meaning they may cover only certain uses of a medicine rather than all approved by the U.S. Food and Drug Administration.

A CMS spokesperson, however, told S&P Global Market Intelligence the agency does "not have data to share" to show that the move would expand beneficiaries' choices and lower their costs — claims the administration has made in promoting the change.

Nor has CMS received any feedback from drugmakers or health plans on which to base the agency's expectations for lower costs, the spokesperson acknowledged.

If Part D plans exclude any U.S.-approved indications, they must ensure there is another "therapeutically similar" drug on their formularies to treat the condition or disease to ensure they are meeting the anti-discrimination requirements.

But the CMS spokesperson said the agency was "unable to generalize without specific" examples and submissions on whether "therapeutically similar" meant the same as "equal to" in terms of efficacy and safety.

The spokesperson also said CMS did not anticipate any additional costs to taxpayers for the review process to determine if a drug was therapeutically similar to the excluded medicine.

Officials call for collaboration on brain, other research

Also at the Research!America forum, National Institutes of Health Director Francis Collins said to expect a draft blueprint by summer 2019 of the next stage of the Brain Research through Advancing Innovation Neurotechnologies, or BRAIN, Initiative — a collaborative project between the U.S. government and the private and academic sectors, which is aimed at finding new ways to treat, cure and prevent neurological diseases and disorders, like Alzheimer's, Parkinson's, autism, schizophrenia and epilepsy.

The BRAIN Initiative — launched by Obama in 2013 — has been embraced by Congress, Collins said, adding that he expects it to continue to receive financial support in the fiscal 2019 budget.

"This is a very bold effort to understand how those 86 billion neurons between your ears do what they do," he said.

The initiative has been the start of a "new moment for the brain," added France Cordova, director of the National Science Foundation, one of the government partners on the project.

In addition to the affordability of medicines and brain research, the daylong meeting of top government health officials and leaders from the drug industry and academic research and patient advocacy communities focused on the need for greater collaboration in a number areas, including the opioid crisis, antimicrobial resistance, digital health, chronic and rare conditions and emerging infectious diseases.

House panel advances 'gag clause' bill, other health legislation

In an unusual Friday session, the House Commerce Energy and Commerce Health Subcommittee on Sept. 7 voted to advance legislation that would ban so-called gag clauses, which prevent pharmacists from telling customers when they can pay less in out-of-pocket costs for their prescription medicines by not using their insurance plans.

The Senate passed its own version of the gag clause bill last week by unanimous consent.

Rep. Michael Burgess, R-Texas, chairman of the House health panel, noted that the subcommittee had met only two days earlier to discuss the gag bill and five other measures and initially had expected to hold the vote at least a week after that Sept. 5 session.

The bills now go to the full committee for consideration.

Among the measures that were adopted by the House subcommittee was a bill aimed at ensuring that two panels that provide analysis and recommendations to Congress — the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission — have access to drug pricing and rebate data.

Another measure would extend by another five years a Medicaid pilot program established in 2005 — the Money Follows the Person Demonstration — which enables eligible beneficiaries to receive long-term care services in their homes or other community settings, rather than in institutions, such as nursing homes.

Also advanced to the full House committee was the ACE Kids Act, which would permit states to create a Medicaid health home option specific to children with medically complex conditions.

In addition, the health panel backed a bill to permit state Medicaid Fraud Control Units to investigate and prosecute provider fraud and patient abuse in any setting. Right now, the units are restricted to only investigating Medicaid fraud and abuse in healthcare and board-and-care facilities.