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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 Daniel Payne and Krista Mahr | | | With help from Ruth Reader and Megan R. Wilson
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President Joe Biden speaks about his 2024 budget proposal in Philadelphia on Thursday. | Evan Vucci/AP Photo | PROPOSING PRIORITIES — The health care items in President Joe Biden’s budget proposal offer some movement forward on key policy concerns, including drug costs, the health workforce and access to care, our team reports. The full details of how agencies would be affected by the White House’s plan haven’t yet been released, but the proposal looks to boost HHS’ overall budget by 11.5 percent. The budget proposal’s outline released Thursday includes $150 billion over a decade for Medicaid home- and community-based services, $20 billion for pandemic preparedness, nearly $20 billion for mental health and $10.9 billion for global health. Workforce shortages, long-term care improvements, maternal health, telehealth, family planning and health centers are addressed in the proposal. More details below on how the budget would affect drug pricing, the FDA, mental health and health data. Other issues to watch include: — Long-term care: The budget would make “significant investments” to strengthen long-term care, including $150 billion over a decade for Medicaid home and community-based services. — Pandemic prep: The proposal includes $20 billion for HHS’ pandemic prevention and preparedness efforts, along with other investments in research and the procurement of vaccines, therapeutics and tests in the country’s stockpiles. — Global health: The budget also includes $10.9 billion for global health, including $1.2 billion for preparedness and response to infectious disease outbreaks. Nearly half of that — $500 million — would be dedicated to the Pandemic Fund hosted by the World Bank. Though several health care issues addressed in the budget show some promise for bipartisan agreement, the proposal has little chance of passing a divided Congress without big changes. Some policies build on those from the Inflation Reduction Act, which faced significant partisan headwinds before passing.
WELCOME TO FRIDAY PULSE. What details from Biden’s budget caught your attention? Let us know at dpayne@politico.com and kmahr@politico.com.
TODAY ON OUR PULSE CHECK PODCAST, host Carmen Paun talks with Ben Leonard about the debate over the use of quality-adjusted life years, or QALYs, which is a tool designed to help measure the cost-effectiveness of drugs and other medical treatments. Detractors say the statistic discriminates against people with disabilities by undervaluing how much treatments help them.
| | | | | | | A message from PhRMA: Insurers and PBMs don’t pay full price for your medicines. So why do you? Insurers and PBMs get discounts on medicines. Surprised? These savings can reduce the cost of some brand medicines by 50% or more, but insurers and PBMs aren’t required to share these savings with you. What else don’t they want you to know? | | | | | | | 
President Joe Biden's budget proposals call for subjecting more drugs to Medicare price negotiation. | AP Photo | BUDGET BOOSTS FOR DRUG BARGAINING — Biden’s proposed budget would roughly double the number of drugs subject to Medicare price negotiation and decrease the number of years medicines are excluded from negotiation to five years for both drugs and biologics, POLITICO’s David Lim reports. Details of the expansion of the Inflation Reduction Act’s prescription drug price negotiation powers — not included in Thursday’s top-line budget document — would save the federal government $160 billion over 10 years, according to the White House’s fiscal 2024 budget proposal. The proposal, if approved by Congress, would empower CMS to negotiate 20 Part D drugs in 2026 and 40 Part B and Part D drugs each subsequent year. FDA FUNDS — The proposed budget asks for $372 million in new money from taxpayers for the FDA, David and our Katherine Ellen Foley report. The FDA’s funding consists primarily of two buckets: taxpayer funds appropriated by Congress and user fees collected from industry. Biden is asking for the FDA’s funding to increase by $521 million. Most new spending is proposed for food safety, tobacco oversight and the agency’s drug programs.
| | | | 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. | | | | | | | | A MENTAL HEALTH BOOST — The White House’s budget looks to put big money into mental health care, Ruth reports. The budget calls for bigger bucks for the administration’s roll out of Certified Community Behavioral Health Clinics, more money for HHS’ Substance Abuse and Mental Health Services Administration and the 988 crisis line, plus an extra $200 million for the National Institute of Mental Health. It also boosts funding for the National Institutes of Health to facilitate more spending on research into the opioid and mental health crises. Congress will ultimately have its say in how much to spend, and the Biden budget is unlikely to survive intact. But key lawmakers share the president’s desire to combat mental illness. PUSH FOR 'ROBUST' CANCER RESEARCH FUNDS — The American Cancer Society Action Network is ready to push for more cash to research cancer following the release of Biden's budget request, Megan reports. The ACS’ high-powered advocacy arm referred to the proposed increases to the National Institutes of Health and its National Cancer Institute as “modest.” Its leader, Lisa Lacasse, said money to fund the administration’s new health research agency known as ARPA-H “should not come at the expense of basic and clinical research” at other agencies. Biden’s request would give the NIH a $920 million boost, including a proposed increase of $500 million for the NCI. The Biden budget request also proposes $1 billion for ARPA-H. The ACSAN spent $4.86 million on lobbying last year, making it one of the top 10 highest-spending groups and organizations. Biden also wants to reauthorize the Cancer Moonshot, requesting $716 million in discretionary resources within NIH in 2024 and proposing a mandatory reauthorization through 2026. This brings that total budget request for the program to $3.6 billion through 2026.
| | | | 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. | | | | | | | | DATA DOLLARS — The budget proposal would give HHS’ Office for Civil Rights, which regulates health data security, a significant funding bump, POLITICO’s Ben Leonard reports. The proposed budget is $78 million in fiscal 2024, up from $40 million. The agency says it needs more partly because it doesn’t expect civil monetary settlement funds paid by companies who violate agency regulations to cover as much of its budget as in the past. The office said it plans to use $5 million in civil monetary settlement funds in fiscal 2024, down significantly from $30 million in 2023. Speaking of that office… CEREBRAL INVESTIGATION — The Office of Civil Rights is investigating Cerebral, a telehealth company, over a health information breach that affected 3.1 million customers, Ruth reports. Earlier this week, the company emailed its customers to notify them of the breach. The company said the breach report was filed as a result of a change in the Department of Health and Human Services guidance on what constitutes protected health information. In a statement, the company said that under the clarified guidance, sharing basic user contact information gathered on a company’s website is considered protected health information. The company is also reportedly under investigation by the FTC for unfair and deceptive marketing practices.
| | | 340B ALERT: HOSPITALS PUSH BACK — The American Hospital Association is pushing back against a new coalition advocating for changes to the 340B program, which gives steep discounts on drugs to hospitals and health centers that serve low-income populations. Megan reported about the pharma industry-led group, called the Alliance to Save America’s 340B Program, or ASAP 340B, that has united longtime adversaries — drugmakers and community health clinics — on the issue. Aimee Kuhlman, the vice president for government relations at the American Hospital Association, vowed to fight the proposals and changes sought by ASAP 340B, charging that drugmakers have no interest in reforms and are trying to kill the program “because it makes a small dent in their sky-high profits.” “No amount of Orwellian language can hide the fact that the real victims of this self-interested proposal will be the millions of patients and communities that 340B hospitals serve each day,” Kuhlman said.
| | | | A message from PhRMA:   | | | | | | GOP BLASTS CMS PROPOSAL — Senate Finance Committee Republicans are urging the Biden administration to abandon the development and deployment of a Center for Medicare and Medicaid Innovation payment model that aims to incentivize timely confirmatory clinical trials, David reports. The policy proposal, one of three planned drug-pricing models unveiled in February, would be a mandatory model. The CMS says it could reduce spending on drugs that don’t have a confirmed clinical benefit by adjusting payment to Medicare Part B fee-for-service providers for drugs that have been granted accelerated approval by the FDA. MORE BILLS ON THE WAY — Several other bills were introduced this week, including: — The Women’s Health Protection Act of 2023, which would guarantee a right to an abortion nationwide. The bill was introduced by Democratic senators. — The Safe Step Act of 2023, reintroduced by a bipartisan group of senators, would limit the use of “step therapy,” which requires patients to try certain treatments before others. — The Physicians for Underserved Areas Act, the Specialty Physicians Advancing Rural Care Act and the Resident Education Deferred Interest Act — all aimed at boosting the health workforce — were introduced with bipartisan backing. — The Connected Maternal Online Monitoring (MOM) Act, introduced with bipartisan backing, would require CMS to recommend devices that can be used to monitor a pregnancy by remotely measuring blood pressure, blood glucose and pulse rates.
| | | STAT reports on the Biden administration’s plan to end hepatitis C. The Atlantic writes about a key factor in teen anxiety that’s often overlooked.
| | | | A message from PhRMA: Insurers and their PBMs don’t want you to see that you could be paying more than they are for your medicines. Rebates and discounts can significantly lower what insurers and PBMs pay for medicines. These savings can reduce the cost of some brand medicines by 50% or more. But insurers and PBMs aren’t required to share those savings with you at the pharmacy counter.
They don’t want you to see that they use deductibles, coinsurance and other tactics to shift more costs on to you. Or that the three largest PBMs control 80% of the prescription drug market. Or that last year they blocked access to more than 1,150 medicines, including medicines that could have lowered costs for you at the pharmacy.
PBMs and insurance practices are shrouded in secrecy, they need to be held accountable. | | | | | | | Follow us on Twitter | | | | Follow us | | | | |  |
