| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | | | | | 
Today's Supreme Court hearing focuses on whether access to abortion pill mifepristone should be curbed, which could affect telemedicine prescriptions. | Olivier Douliery/AFP via Getty Images | ABORTION AT SCOTUS — The Supreme Court is set to hear oral arguments today in a case that could curtail access to abortion pills nationwide, POLITICO’s Alice Miranda Ollstein and Josh Gerstein report. It’s the first major reproductive-rights-related case before the high court since the Dobbs ruling sent abortion rights back to the states, prompting many states to roll back access to the procedure. That’s driven more use of mifepristone, one of two pills used in medication abortion, which now made up about two-thirds of abortions in 2023. Here’s what you need to know about FDA v. the Alliance for Hippocratic Medicine: What the case centers on: Anti-abortion groups and conservative lawmakers have asked the court to roll back rules the FDA put forward in 2016 and 2021 expanding access to the pills, including allowing telemedicine prescription and mail delivery. The court could strike down rules allowing the drug to be prescribed online, mailed to patients and dispensed at pharmacies. Could the court ban mifepristone? Most likely not. The challengers asked the court to hear arguments on the FDA’s approval of mifepristone more than two decades ago, but it declined and only agreed to hear arguments on the agency’s more recent eased rules. But the anti-abortion groups and others behind this case have tried to prompt the court in briefings to consider even more sweeping restrictions — including some, like full enforcement of the 150-year-old Comstock Act, that would function as de facto federal bans. Who are the key justices? The court’s three liberal justices are likely to uphold the FDA’s authority, so the Biden administration will likely need two more justices to join them in overturning a lower court ruling imposing restrictions on the pills. Expect Elizabeth Prelogar, the Biden administration’s solicitor general, to focus on Chief Justice John Roberts along with Justices Brett Kavanaugh and Amy Coney Barrett, all of whom have sent signals of moderation in some recent cases. Justice Neil Gorsuch might also be in play, although his deep skepticism of federal agencies’ power could make him a tough get for the Biden administration. WELCOME TO TUESDAY PULSE. We can’t wait until MLB Opening Day on Thursday. Reach us and send us your tips, news and scoops at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo.
| | |  Kristen Waggoner, CEO of the Alliance Defending Freedom, seen here speaking outside of the U.S. Supreme Court in December 2022, wants the American public to know that support exists for "women to choose life." | Anna Moneymaker/Getty Images | Q&A WITH THE GROUP BEHIND DOBBS — The Alliance Defending Freedom, a conservative legal group that led the effort to overturn Roe v. Wade, is also behind the abortion pill challenge at the Supreme Court today, representing the plaintiffs. Kristen Waggoner, the group’s CEO, told POLITICO’s Ian Ward that the lawsuit is part of a broader legal plan to curtail abortion access. She also defended her belief that the 14th Amendment guarantees equal protection to all embryos from the moment of conception. If the courts endorsed her belief, it would likely amount to a constitutional ban on all abortions. Waggoner provided no significant details on the movement’s next steps. With abortion rights ballot efforts overwhelmingly succeeding post-Dobbs, Waggoner didn’t signal that the anti-abortion movement should change its approach. “The abortion industry is very, very powerful, and there’s been significant misinformation about what’s at issue,” Waggoner said. “It’s going to take more than a minute to demonstrate to the American public that the support exists for women to choose life.” You can read the Q&A here.
| | WHILE THE COURT IS IN SESSION — President Joe Biden and Vice President Kamala Harris are scheduled today to talk health care in North Carolina, which recently expanded Medicaid under the Affordable Care Act. The choice is telling. This is a state that former President Donald Trump won twice, but the Biden campaign is hoping its support of Obamacare will resonate with the nearly 400,000 residents who’ve signed up for Medicaid since expansion launched late last year.
| | | | HHS REJECTS CYBERATTACK PORTRAYAL — Sen. Bill Cassidy (R-La.) is pressing HHS on why it didn’t notify Congress about a cyberattack against the agency, but the department disputes that it was a cyber victim. The backstory: Bloomberg reported in January that the agency had $7.5 million stolen in a 2023 attack, including grant funding for those in rural areas. Cassidy, ranking member of the Health, Education, Labor and Pensions Committee, pushed HHS on Monday about why it didn’t tell Congress about the incident or acknowledge it publicly, saying the agency is required under federal law to report major breaches to Congress. “HHS’ lack of transparency and communication regarding this breach … undermines the public trust and suggests that the Federal government is not prepared to protect patients against cybersecurity attacks,” Cassidy said in a statement. What HHS is saying: An HHS spokesperson told Pulse it was the victim of a “targeted fraud campaign” against its payment system, not a cyberattack. The spokesperson said HHS “promptly” reported the incident to HHS’ inspector general. “As federal stewards of the taxpayer dollar, we take this issue with the utmost importance,” the spokesperson said. The agency is working with grantees to ensure they have access to awards. The HHS spokesperson didn’t respond to a question about whether grantees currently have those funds.
| | MEDICARE GLP-1 SPENDING EXPLODING — Medicare spending on GLP-1 drugs — often used for weight loss — prescribed for diabetes took off between 2018 and 2022, according to a new KFF analysis of CMS data. Annual spending on Novo Nordisk’s Ozempic grew from $56.8 million in 2018 to $2.6 billion in 2021, a total that nearly doubled in 2022. That meant Ozempic, in 2022, was the sixth-costliest drug in Medicare based on total gross spending, according to KFF. After the FDA approved Novo Nordisk’s Rybelsus for diabetes in late 2019, spending grew quickly, going from $73.4 million in 2020 to $454.6 million in 2021 and $974.9 million in 2022. Mounjaro, FDA-approved for diabetes in May 2022, saw $144 million in Medicare spending that year.
|  | | Medicare is banned from covering the drugs for weight loss but can cover them for conditions like diabetes. Last week, CMS released guidance allowing Medicare to cover weight-loss drug Wegovy — but only when prescribed to mitigate heart attack risk. “The fact that covering GLP-1s under Medicare Part D for authorized uses is already making a mark on total Part D program spending could be a sign of even higher spending to come,” KFF wrote. View from Congress: Some lawmakers have proposed lifting Medicare's ban on covering weight-loss drugs, an effort by Reps. Brad Wenstrup (R-Ohio) and Raul Ruiz (D-Calif.) and Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.) that’s garnered support from close to a quarter of the House and Senate. The Congressional Budget Office earlier this month said it expects that HHS would pick semaglutide, sold under brand name Ozempic, for price negotiations in Medicare under the Inflation Reduction Act “within the next few years.”
| | RACIAL DIFFERENCES IN VIRTUAL CARE — Virtual-care use differed substantially among racial groups during the pandemic, according to a new study published in JAMA Health Forum. The details: Researchers from Massachusetts General Hospital, Harvard, the RAND Corporation and others examined Medicare claims data between March 2020 and February 2022. In unadjusted analysis, Black and Hispanic patients had more virtual visits per person than white patients, but when controlling for geography and clinical factors, Black and Hispanic patients had significantly fewer telemedicine visits. “Our study results implied that telemedicine visit rates are higher among many individuals of racial and ethnic minority groups primarily because they are more likely to live in communities that have embraced telemedicine,” the researchers wrote. “Telemedicine’s association with long-standing differences in utilization of care will depend on how it is implemented.” They intentionally didn’t use the word “disparities” when comparing usage and instead used “differences,” writing that the geographic differences could be due to personal preference. They said “generous” payment for virtual care in areas disproportionately serving minority groups and working with community organizations could be interventions to evaluate. The big picture: As lawmakers weigh the future of virtual care with eased Medicare and commercial market rules set to expire at the end of the year, some have said they hope to avoid reinforcing health disparities. They’ve also been hungry for more data.
| | Alye Mlinar, a former health staffer for House Majority Leader Steve Scalise (R-La.) and principal at Mehlman Consulting, was named executive director at Telehealth Access for America.
| | The Wall Street Journal reports on the impact of facility fees on patients. UC Davis’ Mary Ziegler writes in POLITICO Magazine about the “endgame” in the abortion battle. | | | | Follow us on Twitter | | | | Follow us | | | | |
