| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | Presented by PCMA // Pharmaceutical Care Management Association | With Daniel Payne
| | |  A new GAO report has Rep. Richard Neal, ranking member of the House Ways and Means Committee, concerned about CMS' limited data on nursing home ownership. | Toya Samo Jordan/Getty Images | OWNERSHIP OPACITY — CMS’ data on private equity ownership of nursing homes has significant limitations, according to a Government Accountability Office report first obtained by Pulse. The details: The report to House Ways and Means Committee ranking member Richard Neal (D-Mass.) found that CMS’ data didn’t include all of many nursing homes’ owners. That could be because some didn’t meet reporting requirements for ownership or comply with reporting mandates. The watchdog report also found that the agency’s data doesn’t have a way to easily identify private equity companies and isn’t “designed to do so.” GAO estimated that about 5 percent of nursing homes were private equity–owned in 2022, though it might be an underestimate. Thirty-three of the 200 randomly sampled nursing homes had owners that weren’t reported in CMS data. CMS didn’t respond to a request for comment. CMS in February proposed a new definition of private equity firms that would require nursing homes to disclose more about their ownership. CMS has raised concerns about the quality of care at nursing homes — particularly ones owned by private equity firms. “Consumers should be able to know who’s responsible and accountable for the care they’re receiving,” Mark Unruh, a Weill Cornell Medical College professor whose 2021 research found higher Medicare costs and increased hospitalizations at private equity nursing homes than ones not owned by such firms, told Pulse. The broader context: The report comes as both sides of the aisle in Congress look to boost transparency in health care. Neal has raised concerns that the sweeping health transparency package that was set to hit the House floor last week didn’t include private equity reporting requirements. The “report shows significant limitations in CMS’ ability to identify what’s happening behind the scenes,” Neal said. The response: The American Health Care Association and the National Center for Assisted Living, which represents nursing facilities, said it supports transparency but focusing on private equity ownership is a “red herring.” “This has become a distraction from the real issues that impact the majority of nursing homes, like Medicaid underfunding and workforce shortages,” the group told Pulse. The American Investment Council, the leading private equity industry group, is concerned that CMS’ proposal defines private equity inaccurately and that it is being unfairly targeted. Drew Maloney, head of the group, previously told POLITICO that if Congress or CMS want more data, it should be across the board. WELCOME TO TUESDAY PULSE. Vaccine skepticism may be impacting dogs. A majority of dog owners raised questions about canine vaccinations in a recent study. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.
| | | | A message from PCMA // Pharmaceutical Care Management Association: Big Pharma is the link between patients and high drug prices. Don’t fall for Big Pharma’s “delinking” blame game. Weakening tools pharmacy benefit companies use to lower drug costs gives Big Pharma more power to keep drug prices high. The Big Pharma bills to end so-called “delinking” hand billions of dollars annually to drug companies, while costing patients and payers billions. “Delinking” means employers lose out on savings and employees pay more for prescriptions. | | | | | HAPPENING 9/28 — INSIDE THE CANCER MOONSHOT: Join POLITICO on Thursday, Sept. 28 for an in-depth discussion on the future of cancer treatment and innovation. Hear from experts including scientists, government officials and industry leaders as we explore the critical roles played by private industry, nonprofits, the National Cancer Institute and the new Advanced Research Projects Agency for Health in achieving the Biden administration's goal of cutting the cancer death rate in half over the next 25 years. Don't miss this opportunity to dive into the progress of cancer treatments and learn about the challenges patients encounter in accessing care. REGISTER HERE. | | TODAY ON OUR PULSE CHECK PODCAST, host Kelly Hooper talks with Ben, who explains how hospitals are seeing a rise in uncompensated care as millions lose Medicaid coverage after redetermination resumed — and what that could mean for hospitals.
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The House has delayed votes on several health care bills, including the SUPPORT Act, which promotes opioid recovery and treatment. | John Moore/Getty Images | HEALTH BILLS HIT A SNAG — The House was poised to vote on reauthorizing the SUPPORT Act, which is set to expire this weekend and tackles the opioid epidemic, this week, but that’s been thrown into question, Ben reports. The bill, along with several other health care bills, was yanked from the list of legislation to potentially be considered this week under suspension of the rules, meaning they would require a two-thirds vote. The other legislation pulled from the list includes a bill to boost cybersecurity at the suicide prevention hotline, the PREEMIE Reauthorization Act, the Medicaid Primary Care Improvement Act and the Preventing Maternal Deaths Reauthorization Act. It’s unclear why plans have changed, but the move comes as House Speaker Kevin McCarthy attempts to avert a government shutdown before Sunday, a proposition that’s growing increasingly unlikely. CASSIDY WANTS CDC INFO — Senate HELP Committee ranking member Bill Cassidy (R-La.) will ask stakeholders how the CDC can bolster public health in areas like epidemiology, global health and data modernization. “I applaud the agency on the steps it has taken to try to modernize itself, but there is more work to be done. Rather than fixate on the past, I hope to identify opportunities to better position the agency for its future as a more open, collaborative, and responsive institution, while rebuilding its relationship with and accountability to Congress,” Cassidy wrote in the letter requesting input he’s set to send. He will also ask for information on how the agency can better work with other groups and plans to ask for feedback through Oct. 20.
| | | | HAPPENING 9/28 — INSIDE THE CANCER MOONSHOT: Join POLITICO on Thursday, Sept. 28 for an in-depth discussion on the future of cancer treatment and innovation. Hear from experts including scientists, government officials and industry leaders as we explore the critical roles played by private industry, nonprofits, the National Cancer Institute and the new Advanced Research Projects Agency for Health in achieving the Biden administration's goal of cutting the cancer death rate in half over the next 25 years. Don't miss this opportunity to dive into the progress of cancer treatments and learn about the challenges patients encounter in accessing care. REGISTER HERE. | | | | | | | | DIABETES DRUG PRICE SET FOR NEGOTIATION — Drugmaker AstraZeneca says it will negotiate a price with Medicare for its diabetes drug Farxiga, the company told POLITICO’s David Lim. Farxiga — used to treat type 2 diabetes, heart failure and chronic kidney disease — was among the first 10 drugs selected by CMS last month for price negotiations Congress ordered in the 2022 Inflation Reduction Act. Nearly 800,000 Medicare Part D enrollees used Farxiga between May 2022 and June 2023 at a cost of approximately $3.3 billion, according to CMS data. Multiple drugmakers, including AstraZeneca, have sued the Biden administration over the Medicare drug price negotiation program. Pharmaceutical companies with a drug selected for the program can submit data on the product to CMS until Oct. 2. WHY VACCINES FOR KIDS ARE SCARCE — Amid hiccups in the initial rollout of updated Covid-19 vaccines on the commercial market, pediatric Covid vaccines have also seen lags, according to local health leaders, Chelsea reports. “We got used to the moment that once there was a recommendation, vaccines were actually pre-positioned across the country, and they really just had to be unboxed and ready to go,” Adriane Casalotti, chief of government and public affairs of the National Association of County and City Health Officials, told Pulse. “That’s not the situation we’re in now.” Since federal officials authorized and recommended updated Covid shots, consumers began reporting issues with finding vaccines and getting their insurance to pay for them. According to anecdotal reports, pediatric Covid vaccines were some of the hardest to come by. Casalotti said many of NACCHO’s members have yet to receive pediatric vaccines, and she expects that supply won’t arrive until the end of the month. Philadelphia’s health department, for example, said last week that it expects to begin scheduling pediatric appointments in early October. Casalotti points out that the avenue for vaccination is also a challenge. Under the Public Readiness and Emergency Preparedness Act, pharmacists can vaccinate children as young as 3 years old against Covid through 2024, but Casalotti said not all pharmacists are comfortable with vaccinating younger children. HHS is working with providers, pharmacists and insurers to iron out vaccine-rollout woes in the coming days. Casalotti says the amount of demand for pediatric vaccines is encouraging and notes that supply will become available over time.
| | | | A message from PCMA // Pharmaceutical Care Management Association:   | | | | | ANOTHER STRIKE — More than 500 health workers who provide dialysis care are on strike, asking for more staff and pay, Daniel reports. The workers at Satellite Healthcare and Fresenius Kidney Care clinics in California allege the companies retaliated against employees who tried to form a union or speak out about care practices. “While we dispute the union’s claims about Satellite, we respect the rights of these striking employees to engage in lawful union activities and are in discussions with the union,” Satellite Healthcare said in a statement. The strike comes as more than 75,000 Kaiser Permanente health workers threaten to strike should they not come to an agreement with their employer about wages and other issues.
| | | | DON’T MISS POLITICO’S TECH & AI SUMMIT: America’s ability to lead and champion emerging innovations in technology like generative AI will shape our industries, manufacturing base and future economy. Do we have the right policies in place to secure that future? How will the U.S. retain its status as the global tech leader? Join POLITICO on Sept. 27 for our Tech & AI Summit to hear what the public and private sectors need to do to sharpen our competitive edge amidst rising global competitors and rapidly evolving disruptive technologies. REGISTER HERE. | | | | | | | | | NC MEDICAID EXPANSION LATEST — North Carolina Gov. Roy Cooper, a Democrat, said Monday that the state will launch its Medicaid expansion Dec. 1, Ben reports. State officials had proposed Oct. 1, but the date was pushed back due to delays in the budget process. Cooper said Friday he would allow the legislature’s budget to become law and direct state officials to begin to launch Medicaid expansion. The state expects that 300,000 people getting family planning benefits under Medicaid will be automatically enrolled in full coverage.
| | | | Kate Klimczak will return to NIH as associate director for legislative policy and analysis and director of the Office of Legislative Policy and Analysis. She most recently has been deputy and acting director of the FDA’s Office of Congressional Appropriations.
| | The Wall Street Journal reports on Medicare’s bid to hire drug price negotiators. Healthcare Dive writes that health system CommonSpirit laid off more than 2,000 workers and reported $1.4 billion in operating losses.
| | | | A message from PCMA // Pharmaceutical Care Management Association: Why would Congress let drug companies boost their own profits at the expense of patients and taxpayers? Big Pharma is the link between patients and high drug prices.
Big Pharma is pushing for so-called “delinking” bills that would give them a profit windfall of $10 BILLION in Medicare alone, forcing patients, taxpayers and employers to pay as much as $18 billion more annually for prescription drugs.
What problem is Congress trying to solve? If the goal is to lower drug costs for patients, taxpayers, and employers, the Big Pharma “delinking” plan is the wrong approach.
“Delinking” means employers lose out on savings and their employees pay more for prescriptions they need.
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