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Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy. | | | | |  | | By Krista Mahr and Daniel Payne | | | | | | | 
Sen. Bernie Sanders is set to take over the Senate’s HELP Committee. | Joe Raedle/Getty Images | THE BERNIE EFFECT — Lobbyists across the health care sector are steeling themselves for when Sen. Bernie Sanders becomes chair of the Senate’s Health, Education, Labor and Pensions Committee, POLITICO’s Megan R. Wilson reports. The Vermont lawmaker’s well-chronicled antagonism toward lobbyists has some concerned they’ll be unable to blunt criticism of their clients and struggle to gain traction on changes to a drug discount program involving pharmaceutical companies and hospitals or to revisit association health plans after a Trump-era rule around them was voided. Multiple lobbyists representing health insurers, pharmaceutical companies, providers and health systems told POLITICO they’re planning to “bank shot” their advocacy to get their messages across — lobbying other lawmakers on the committee and getting into the ears of progressive policymakers and left-leaning organizations. A shifting agenda: Leading the panel gives Sanders, a longtime proponent of “Medicare for All,” oversight authority over some of his policy priorities. Sanders has talked about working to boost access to primary care, expand early childhood education and the health care workforce and raise minimum wages. He could potentially take on new issues such as climate change’s health impacts and others that don’t sit in the political center, like his Medicare for All. Sanders has said he plans to work across the aisle while seeking to advance his agenda. He’s already met with Sen. Susan Collins (R-Maine) on rural health policy, who says he’ll have more success if he focuses on that than Medicare for All. Many in Washington, D.C., will be closely watching his collaboration with the committee’s incoming ranking member, Sen. Bill Cassidy (R-La.), who also wants to make addressing the nursing shortage a priority. WELCOME TO TUESDAY PULSE — Happy 2023, Pulse readers! In case you are just turning your phone back on, let us be the first to inform you that the New Year’s Resolution Industrial Complex is in full swing, offering copious guidance on how to get happier, become more fit, drink more mindfully, and be married more mindfully. … Are you in? Send your loftiest self-improvement goal, along with your best news and tips, for the new year to kmahr@politico.com and dpayne@politico.com.
| | | | | | | A message from PhRMA: In 2021, Insurers and their pharmacy benefit managers (PBMs) subjected patients to six times the out-of-pocket costs for brand medicines through the use of deductibles or coinsurance compared to patients with only copays — even when these middlemen received a discounted price. That’s not fair. Learn more. | | | | | | | 
Democrats hope the Inflation Reduction Act will pave the way for more government action on drug pricing. | Matt Rourke/AP Photo | AP Photo | DEMS BANK ON DRUG PRICING LAW — Democrats are hoping last year’s passage of the Inflation Reduction Act will pave the way for more government action in the coming years, writes POLITICO’s Alice Miranda Ollstein. Here’s the breakdown of the Democrats’ strategy on drug pricing next year: Defend the law, which will empower Medicare to negotiate drug prices for the first time, from Republican attacks long enough to give Medicare breathing room to begin negotiating with pharmaceutical companies over some of their most expensive drugs. Then focus on new ways to cap prices of certain drugs and bet that, like the Affordable Care Act, the policy pays political dividends down the road. Republicans have introduced bills to undo the legislation, echoing the pharmaceutical industry’s argument that the regulations will prevent “new innovation.” Though the effort’s chances of succeeding are slim with Democrats holding the Senate and White House, conservative lawmakers and their outside allies want to impede the law’s progress before its expansion becomes inevitable.
| | | COVID'S DISAPPEARING TREATMENT OPTIONS — Millions of Americans have been left with limited options if they get sick as monoclonal antibodies no longer work against current Covid-19 variants, POLITICO’s Lauren Gardner reports. The easier-to-administer antiviral drugs like Paxlovid have largely taken their place but aren’t safe for all people who are immune-compromised because they interact with many other drugs. How we got here: The federal government funding that drove drug development in the pandemic’s early days has dried up, and lawmakers have rebuffed the Biden administration’s pleas for more. Without that, drugmakers have little incentive to develop new antibody treatments that could be more effective. Why it matters: Without a government program like Operation Warp Speed to develop second-generation vaccines and treatments, at-risk patients are in danger of developing severe cases of Covid and flooding hospitals when the U.S. health care system is already strained, thanks to an influx of patients with an array of respiratory illnesses, including flu and respiratory syncytial virus.
| | | COVERAGE IN QUESTION ON ALZHEIMER DRUGS — Two highly anticipated Alzheimer’s drugs are poised to hit the market in the first quarter of 2023, but public and private insurance might not cover them for most patients, POLITICO’s Katherine Ellen Foley reports. The FDA is slated to make accelerated approval decisions on treatment candidates from Eisai and Biogen in early January and Eli Lilly in early February. Mid- and late-stage clinical trial data shows the drugs are modestly effective at slowing Alzheimer’s progression but may pose serious side effects. Medicare says it won’t pay for the drugs if they’re granted accelerated approval unless patients are enrolled in a randomized clinical trial, and many major private insurance companies follow federal coverage determinations. Neither drug candidate is slated to have an ongoing trial at the time the FDA will make its accelerated approval decision, leaving patients to potentially pay thousands of dollars a year out of pocket.
| | | | A message from PhRMA:   | | | | | | ALCOHOL, THE PANDEMIC AND THE AFTERMATH — While states made it easier for businesses to sell alcohol during the pandemic, alcohol abuse and alcohol-related deaths among Americans spiked, POLITICO’s Ruth Reader reports. That’s aggravating an existing public health burden: Only 10 percent of the more than 20 million people diagnosed with substance use disorder receive treatment, according to the most recent data from the National Institute on Drug Abuse. There have been some federal efforts to expand access to addiction care. Earlier this year, HHS offered $1 million grants to 15 states to build out Medicaid behavioral health clinics that offer mental health and addiction treatment services, and President Joe Biden has said he wants to strengthen mental health parity laws and incorporate mental health into primary care. But advocates are calling for more help as the problem grows — and restrictions on alcohol sales continue to ease. WILL OTC NALOXONE HELP REDUCE OVERDOSE DEATHS? Public health experts warn that the Biden administration’s latest effort to make some forms of opioid overdose reversal drugs available without a prescription won’t benefit those at the highest risk of overdosing, Katherine reports. The forms of naloxone, the drug used to treat overdoses, the FDA is pushing to be sold over the counter are too expensive for most opioid users. Most people who inject or smoke opioids — and are most likely to experience an overdose — won’t be willing or able to go to a pharmacy and pay for the drugs, they say. Backstory: Last month, the FDA said it would consider approving some forms of naloxone as an OTC drug if manufacturers submitted certain data. The move is part of the Biden administration’s overall strategy to tackle the opioid crisis: Last year, the White House launched the Overdose Prevention Strategy and in 2022 allocated $7.8 billion to various federal health agencies to combat opioid overdoses, which have killed more than 1 million people in America since 2001.
| | | Anali Alegria has departed as communications director for the Senate HELP Committee and Sen. Patty Murray (D-Wash.).
| | | Beijing warns there will probably be more Covid-19 infections during Lunar New Year travel, The Wall Street Journal reports. Stat reports on the promises — and potential limitations — of a new drug used to treat teenage obesity. Dozens of healthcare workers are assaulted on the job every day, but legislation to tackle the problem has stalled, MedPage Today reports.
| | | | A message from PhRMA: Every day, patients at the pharmacy counter discover their commercial insurance coverage does not provide the level of access and affordability they need. New data from a study by IQVIA reveal the harmful practices of insurers and their pharmacy benefit managers (PBMs) can lead to significantly higher out-of-pocket costs for medicines — causing some patients to abandon their medicines completely. Learn more. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |  |
