HEALTH CARE BRIEFING: Insulin Cost Cap Divides Democrats on BBB


By Michaela Ross

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Senate Democrats are testing whether a cap on what many Americans pay for insulin medication can muster bipartisan support, even as advocates for reining in drug prices differ over strategy.

Some vocal advocates for Democrats’ sweeping changes to drug pricing say they’re worried action on one measure could mean leaving the rest of the agenda behind. Broad measures were included in the Build Back Better domestic spending package (H.R. 5376) that’s stalled in the Senate.

Senate Majority Leader Chuck Schumer (D-N.Y.) recently announced that a bill to cap what people with insurance pay for insulin from Sen. Raphael Warnock (D-Ga.) “will be a priority” for Democrats in the weeks ahead. “In Washington if we create a partial solution, we take away from the mission to create a complete solution,” Rep. Susan Wild (D-Pa.) told reporters Wednesday, referring to the insulin legislation.

Others say the insulin bill simply isn’t enough to lower Americans’ drug costs in a meaningful way. The bill would cap consumers’ out-of-pocket insulin costs at $35 per month without changing the price drugmakers charge for insulin.

“Advancing copay caps individually will simply shift costs and lead to higher premiums and taxes for consumers,” said Lucy Westerfield, deputy executive director of Patients For Affordable Drugs Now, a group that’s supported Democrats’ larger drug pricing package. Westerfield’s group wants Democrats to empower the government to negotiate with drugmakers to reduce consumers’ prices, limit year-to-year increases in the cost of medicines, and cap out-of-pocket costs. Read more from Alex Ruoff.

U.S. Presents ‘Buy American’ Plan to Ease Supply Chain Squeeze

The Biden administration announced several new actions today intended to ease supply-chain disruptions that have plagued the economy during the coronavirus pandemic.

The moves by the White House and several cabinet departments would aid domestic manufacturers in order to reduce the U.S. reliance on foreign imports in the coming years, though senior administration officials cautioned that Congress must enact more sweeping changes.

The White House said in a statement that it plans to issue a new “Buy American” rule that would allow the federal government to pay more for certain “critical” domestic-made products. The Export-Import Bank’s board will also vote this spring on a new initiative to provide financing to U.S.-based makers of semiconductors, biotech and biomedical products as well as renewable energy companies.

In addition, the Department of Health and Human Services will create a new program under the Defense Production Act to provide loans and grants to encourage manufacturing of pharmaceuticals and other essential health products in the U.S. A shortage of masks and other personal protective equipment hampered the nation’s ability to stop the spread of the coronavirus early in the pandemic. Read more from Jordan Fabian and Jenny Leonard.

More on the Pandemic

Shots, Drugs Position U.S. to Ease Limits, Fauci Says: Covid-19 vaccines, drugs and tests are putting the U.S. in an improved position to pull back on restrictions such as masking that were enacted to limit the spread of the virus, White House medical adviser Anthony Fauci said. Covid drugs like Pfizer’s Paxlovid that keep high-risk patients from hospitalization and death are becoming plentiful as production ramps up, Fauci said in an interview on Bloomberg TV. Many states have already dropped rules for mask-wearing, and CDC officials are poised to update federal masking guidelines as cases driven by omicron plummet. Read more from Fiona Rutherford.

Covid-19 Aid, Managed Care Top Fraud Priorities for HHS Watchdog: Health-care providers who unlawfully claim Covid-19 relief funds, managed care companies that overbill Medicare, and telemarketers that talk patients into services they don’t need are all investigative priorities for HHS’s top watchdog. The HHS Office of Inspector General is pursuing civil monetary penalty cases for fraud on the Covid-19 Provider Relief Fund, Gregory Demske, chief counsel to the HHS IG, said during the Federal Bar Association’s 2022 virtual qui tam conference on yesterday. It already has settled five such cases, he said. Read more from Lydia Wheeler.

CDC Updates Shot Timing for Some: Younger males and other healthy people under age 65 should consider waiting as long as eight weeks between their first and second doses of an mRNA Covid-19 vaccine, according to revised recommendations from the U.S. Centers for Disease Control and Prevention. The new guidelines, posted to the agency’s website on Tuesday, were spurred by increasing evidence that a longer interval between doses in the so-called primary series could heighten the shots’ effectiveness and reduce the potential for rare heart-related side effects seen most frequently in younger men. Madison Muller has more.

Michigan State Escapes Covid-19 Vaccination Lawsuit: Michigan State University beat a lawsuit over its Covid-19 vaccination mandate because the requirement is rationally related to legitimate state interests, a federal court in the state said. The decision dismissing the case is consistent with similar cases throughout the country. Courts “overwhelmingly” have upheld generally applicable college and university Covid-19 vaccination policies, the court said. Read more from Mary Anne Pazanowski.

Texas Sues Dallas Suburb That Wants Mask Mandate: Texas Attorney General Ken Paxton continued his crackdown on mask mandates with a lawsuit against a city north of Dallas that still requires face coverings among its employees. Paxton said that he is suing Denton, home of the University of North Texas, a day after the city sued him to preserve its mask rule for municipal employees. Read more from Shelly Hagan.

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What Else to Know

Neal Schedules Substance Use, Suicide Risk Hearing: House Ways and Means Chair Richard Neal (D-Mass.) announced a hearing for March 2 on substance use, suicide risk and the U.S. health system.

Medicare Scraps Part of Pilot Program for Rural U.S.: The Biden administration has terminated part of a Trump-era Medicare payment model that was designed to improve the delivery of care to rural beneficiaries. The Centers for Medicare & Medicaid Services removed the accountable care organizations transformation track from the Community Health Access and Rural Transformation (CHART) model. The CHART Model, announced in 2020, was intended to provide new funding opportunities for rural communities and rural accountable care organizations, the groups of doctors, hospitals, and clinicians who work together to provide coordinated care in fee-for-service Medicare. Read more from Tony Pugh.

FDA Plans Interstate Drug Shipment Rules: The FDA will write regulations around interstate shipments of drugs between pharmacies after suspending a standard agreement that’s been caught up in litigation since its release. The agency intends to use the notice-and-comment rulemaking process to “codify provisions” of a memorandum of understanding with states involving shipments of compounded medications, according to a Tuesday filing with the U.S. District Court for the District of Columbia. Compounded drugs are those mixed by a pharmacist for a specific patient based on a doctor’s prescription. Read more from Ian Lopez.

Doctor Speech Rights a Focus in Fight on Trans Kids’ Care: A battle over an Arkansas law that bans doctors from referring transgender kids for gender-affirming care is testing the bounds of free speech protections in the doctor’s office. Arkansas says it has the right to regulate doctors’ professional conduct “even if the conduct incidentally involves speech.” But because the law prevents health-care professionals from speaking—and their patients and parents from hearing—about medically accepted treatments, the ACLU and its Arkansas chapter say it’s unconstitutional. Read more from Lydia Wheeler.

States Ask Sixth Circuit to Bar Biden Family Planning Rule: A Biden administration rule rolling back Trump-era requirements for providers seeking federal money to fund family planning services must be blocked, Ohio and 11 other states told the Sixth Circuit. HHS implemented a rule in 2019 that required grant applicants that provide both family planning and abortion services to physically and financially separate the two. The rule also prohibited grantees from referring patients for abortion. Read more from Mary Anne Pazanowski.

‘Forever Chemical’ Can Harm Thyroid, Liver, EPA Group Finds: A panel of independent scientists is backing the EPA’s conclusion that a type of “forever chemical” found in consumer products can harm thyroid and liver function and human development. The Environmental Protection Agency’s findings about the risks of perfluorobutanoic acid (PFBA)—and its conclusion that even small amounts of PFBA can be hazardous—were based on a well-supported evaluation of science, the EPA advisory panel said during a two-day meeting ending. Read more from Pat Rizzuto.

Emergency Care Providers’ Pay Suit Sent to Texas Top Court: The Texas Supreme Court should decide if emergency health-care providers can sue insurers to get paid at their “usual and customary” rates, as provided for by state law, the Fifth Circuit said yesterday. Under Texas law, insurers must provide a minimum payment to out-of-network emergency health-care workers who treat their insureds. The law defines the minimum as the providers’ usual and customary rate. But the law doesn’t expressly say who may enforce it. Read more from Mary Anne Pazanowski.

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To contact the reporter on this story: Michaela Ross in Washington at mross@bgov.com

To contact the editors responsible for this story: Giuseppe Macri at gmacri@bgov.com; Brandon Lee at blee@bgov.com

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