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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 | | | With Katherine Ellen Foley and Daniel Lippman
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Federal health officials are trying to ramp up nursing home booster rates. | David Goldman/AP Photo | THREE YEARS LATER — America’s nursing homes have been at the epicenter of the Covid pandemic since its earliest days when the nation watched as cases of a new virus spread rapidly through a nursing home in Washington State. Today, nursing home residents remain the most vulnerable group in the country when it comes to Covid, with hundreds of people still dying each week. But ensuring residents and staff have the best protection out there from the unpredictable virus hasn’t been easy, Krista reports. The problem: Just over half of nursing home residents and nearly 23 percent of nursing home staff have received the bivalent booster, a precipitous drop from the more than 85 percent of residents and staff who received the primary vaccine. What nursing home advocates say: The Biden administration’s decision to scale back on two highly successful interventions used for the primary vaccine rollout — thousands of free, onsite clinics at nursing homes and a vaccine mandate for staff — has left the boosting job mostly to facilities, advocates say, with disappointing results. What federal health officials say: Health officials say they’ve been trying to tackle the low booster rate through every angle — education, social media and ad campaigns; reminding nursing homes of requirements regarding vaccine education and administration; and flagging low-performing nursing homes to states, among many other measures. What industry says: Industry representatives say nursing homes are doing everything they can, but demand among residents is stubbornly low, regardless of how or how often they’re offered the booster. “You can send out the National Guard to every nursing home. You’re not going to see the vaccine go up,” said David Gifford, chief medical officer of the American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living communities. WELCOME TO WEDNESDAY PULSE — Good news, Pulse readers: The state of our unions is looking up. Marriages increased 18 percent between 2020 and 2021, across 49 states and the District of Columbia. The most loved-up states? Nevada, Hawaii, Montana, Utah and Arkansas. What’s their secret? Send news and tips to kmahr@politico.com and dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Ruth Reader talks with Daniel Payne about the Biden administration's proposed new rules that would require expanded transparency about the owners, managers and contractors at nursing homes, in part to better understand private equity’s impact on the industry.
| | | | | | | A message from PhRMA: Costly out-of-pocket expenses tied to deductible and coinsurance requirements are a leading concern for patients with commercial insurance. These harmful practices put in place by insurers and pharmacy benefit managers (PBMs) are even causing patients to abandon their medicines. New IQVIA data break down how insurers and their PBMs are impacting how patients access and afford their medicines. | | | | | | | 
Rep. Abigail Spanberger wants the DEA to clarify its post-PHE plan for controlled substances. | J. Scott Applewhite/AP Photo | FIRST IN PULSE: ADDERALL AND THE PHE — Rep. Abigail Spanberger (D-Va.) sent a letter today to the DEA head Anne Milgram, calling for the agency to clarify its plan for telehealth and controlled substances after the Covid public health emergency ends, particularly in light of the ongoing shortage of Adderall, a drug widely used to treat ADHD. The letter, shared exclusively with Pulse, calls for a timeline to finalize a regulation to create a special registry for telemedicine providers; provide guidance to pharmacies, distributors, and patients on how to fill Adderall telehealth prescriptions; provide guidance about how DEA will continue exceptions for practitioners prescribing controlled substances across state lines that have medical licensing reciprocity agreements; and provide information on whether the agency will adjust controlled substance production quotas to meet surges in Adderall demand. MEDICAID AND THE DEBT CEILING BATTLE — Medicare and Social Security look like they’re off Washington, D.C.’s proverbial budget-cutting table in this spring’s debt ceiling showdown, but that could mean Medicaid is vulnerable, Joanne Kenen reports for POLITICO Nightly. Medicaid is a great big pot of money — more than $700 billion in fiscal 2021, though it may decline as the pandemic wanes. So if budget cutting is everyone’s focus this spring, Republicans could very well take a run at it, as they have before. That doesn’t mean they’ll succeed. Medicaid has become a more significant part of the U.S. safety net, and it has a much stronger constituency than it used to. The program grew during the pandemic. More than half of U.S. kids are covered under the program and its sister program, CHIP, and it covers births, long-term care for the elderly and mental health and substance use disorder treatment. In other words, it’s not as easy a target as it once was, and any renewed Republican efforts to chip away at it will likely receive pretty intense pushback. FLYING IN —The Alliance for Headache Disorders Advocacy has kicked off its annual fly-in. The group is set to rally its highest number of advocates ever to meet with lawmakers and staff both in person and virtually. Advocates are urging members to sign on to a letter to the Education Department to demand guidance affirming the potential eligibility of children with severe headache disorders for special education plans. The coalition will also ask lawmakers to support Sen. Tim Kaine’ s (D-Va.) and Rep. Don Beyer ’s (D-Va.) long Covid legislation and to join a new Congressional Headache Caucus.
| | | INDUSTRY: PROPOSED NURSING HOME RULES A ‘DISTRACTION’ — A nursing home industry group called CMS’ recent proposal — to require additional transparency about who owns and runs facilities — a diversion from bigger issues, according to a statement. “This has become a distraction from the real issues that impact the majority of providers, like Medicaid underfunding and workforce shortages,” Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, said in a statement — adding that the group appreciated transparency and the effort to make more information publicly available. The policy would require facilities to disclose whether it’s owned by a private equity company or a real estate investment trust, which AHCA/NCAL said make up about 5 and 12 percent of nursing homes, respectively. More feedback on the rule is expected in the coming weeks through the public comment period and before a final version is released. FDA BEEFS UP ADUHELM WARNINGS — The FDA updated the drug label for a contentious Alzheimer’s drug to include more safety warnings about potential side effects, POLITICO’s Katherine Ellen Foley reports. The label change made last week states that Aduhelm, manufactured by Biogen and Eisai, might lead to brain bleeds larger than a centimeter in diameter, particularly in patients taking drugs to prevent blood clots and those who have a certain type of genetic predisposition that could lead them to produce more amyloid in their brains. Backstory: Aduhelm, which targets the amyloid proteins thought to cause the disease, was the first drug to reach the market through a controversial FDA accelerated approval in June 2021. Expert advisers to the agency voted against approving the drug over conflicting Phase III data on the drug’s benefits to patients. After the FDA approved it anyway, three advisory committee members resigned.
| | | | DOWNLOAD THE POLITICO MOBILE APP: Stay up to speed with the newly updated POLITICO mobile app, featuring timely political news, insights and analysis from the best journalists in the business. The sleek and navigable design offers a convenient way to access POLITICO's scoops and groundbreaking reporting. Don’t miss out on the app you can rely on for the news you need, reimagined. DOWNLOAD FOR iOS– DOWNLOAD FOR ANDROID. | | | | | | | | AAFP TO BIDEN: MAKE A PLAN — The American Academy of Family Physicians sent a letter to President Biden on Monday, urging the administration to publish a plan for ending the public health emergencies in May. The organization, which represents nearly 130,000 doctors and medical students, also made a series of recommendations it wants to see in the plan, including protecting affordable access to Covid-19 vaccines, treatment and testing; ensuring doctors can buy and stock vaccines once they’re in the commercial market; protect access to opioid use disorder treatment by telehealth; and remove barriers for individuals with long Covid seeking care and federal assistance.
| | | | A message from PhRMA:   | | | | | | Derek Brandt is now VP of government relations at the Society of Thoracic Surgeons. He previously was congressional affairs director for the American Academy of Neurology. Alex Norcia joins Altria as a senior manager for regulatory advocacy. Previously, he was a news editor at the harm-reduction magazine Filter. Miranda Lynch-Smith is now the senior official performing the duties of the assistant secretary for planning and evaluation at HHS. She most recently was HHS’ deputy assistant secretary for planning and evaluation.
| | | | STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today. | | | | | | | | College students are counseling each other as demand for mental health services is on the rise, The Wall Street Journal reports. Stat reports why the American Cancer Society has to keep telling a vape maker it doesn’t want the company’s money. Bloomberg Law reports on a Biden administration proposal to protect the privacy of patients seeking reproductive health care.
| | | | 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 | | | | |  |
