June 20, 2024
Reporter, D.C. Diagnosis Writer

Hello, and happy Thursday! Time truly flies, as we are officially one week out from the first presidential debate. Send your best list of debate topics (and news tips) to rachel.cohrs@statnews.com.


A win for FTC

A major not-for-profit health system in North Carolina abandoned its plans to acquire two hospitals north of Charlotte after the Federal Trade Commission signaled its intent to appeal a decision that would have allowed the deal to proceed, my colleague Bob Herman reports

Federal regulators, state officials, and economists were worried the deal could have given Novant Health a monopoly in the region. It’s the latest in a winning streak of challenging hospital deals. More from Bob


Ding, ding, ding! Medicare negotiation oral arguments, Round 3

The next battleground for the Biden administration’s Medicare negotiation program will kick off in Connecticut this morning, following arguments in Delaware and New Jersey in other cases. 

This case was brought by Boehringer Ingelheim, and is a grab bag of many of the big constitutional and procedural arguments we’ve seen drugmakers make across the country. The judge hearing the case, Michael Shea, is a Barack Obama appointee. In case you’re keeping score, these legal contests have not gone in the pharmaceutical industry’s favor so far. 

If this case is appealed, it could go to the 2nd U.S. Circuit Court of Appeals, while the other cases that have been argued so far would route through the 3rd Circuit. That’s important because if circuit court decisions split, that makes it more likely that the Supreme Court would hear the case.


An insulin cap fact-check

As I’ve been writing about the issue of insulin costs in the presidential campaign this year, I came across several instances in which major national publications misrepresented how the Inflation Reduction Act’s insulin cost caps moved through Congress. I get it! Health care is complicated, as is congressional procedure. However, I’ll take the liberty of indulging my soapbox here. 

Here are three examples I found of campaign coverage blaming Republicans for $35 monthly copay caps on insulin being limited to Medicare, instead of applying to Americans with insurance through their jobs. I’m not linking the articles, as the point isn’t to embarrass anyone. 

  • “The Inflation Reduction Act, the 2022 legislation that contains the insulin measure, originally capped the price of insulin for everyone with health insurance. But Republican holdouts in the Senate demanded that it only apply to older adults.
  • “When it passed in 2022, it was scaled back by congressional Republicans to apply only to older adults.”
  • “Biden is calling to extend the mandatory $35 monthly cap to Americans with private health insurance. In 2022, a proposal to do that failed in the Senate because of opposition from most Republican senators.”

The actual reason that the insulin copay caps were limited was that Democrats tried to make an exception to Senate rules, and Republicans wouldn’t break decades of precedent to go along with it. 

Democrats didn’t pass their massive domestic policy legislation through normal legislation — they used a special expedited process called reconciliation that has extremely specific rules. And because applying insulin cost caps to the commercial market didn’t have enough of an impact on government spending, the Senate’s rules referee decided it was out of bounds. Senate Majority Leader Chuck Schumer (D-N.Y.) knew this was a possibility, and had started sounding the alarm six months before the legislation ultimately passed. 

So what Republicans were actually voting on was whether to make an exception to what could be included in this special process. If they had voted for even a politically popular policy, it could have opened the door for virtually any policy to be advanced on party lines in the future. In this case, it was more about precedent than policy. And Schumer hasn’t forced Republicans to take an actual vote on the policy alone.


Context on the pharma industry’s 9 v. 13 debate

It’s the time of year when STAT is compiling our summer reading list (stay tuned!) and spoiler alert: my submission is going to be “The Wolves of K Street” by Brody Mullins and Luke Mullins. I know, I know. A nonfiction book about work? In the summer? Believe it or not, I have inhaled this book. 

The book spans the history of lobbying across decades and many different industries, but unsurprisingly spends time digging into the pharmaceutical industry’s lobbying history on Capitol Hill. The authors, who are brothers, recount scenes including Roche’s frantic lobbying battle after a congressman’s son died by suicide while taking Accutane, Roche’s scheme to sell more Tamiflu by playing off fears of an avian influenza outbreak (how relevant!), and Genentech’s team-up with Democratic lobbying legend Tony Podesta to advance FDA reforms during the Clinton administration.

Another anecdote that resonates today is about former Rep. Henry Waxman’s proposal that biologics and small-molecule medications be given the same amount of market exclusivity. Back then, the industry lobbied hard to ensure that biologics got a longer exclusivity period at 12 years. These days, the pharmaceutical industry is clamoring for equal wait times before Medicare negotiation for small-molecule drugs and biologics. Interesting how times change.

More around STAT
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What we’re reading

  • How a network of nonprofits enriches fundraisers while spending almost nothing on its stated causes, ProPublica
  • Substance use experts are sounding the alarm on another addiction: gambling, STAT
  • Cyberattack led to harrowing lapses at Ascension hospitals, clinicians say, NPR
  • How a Baltimore neuroscience study is rewriting Black America’s relationship with medical research, STAT

Thanks for reading! More next week,

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