budget battles

PBM reform efforts are over, and over again

Committee heads in the House and Senate came close to an agreement on an impressive health care package over the weekend that was destined for an annual government spending bill. That deal seems to have unraveled since, two congressional aides told John Wilkerson. 

This dispatch might sound familiar to DC Diagnosis regulars. Three weeks ago, STAT reported that Congress had abandoned PBM reform in an earlier spending package — a first tranche. 

As it worked on the second tranche, congressional committee negotiators found agreement on PBM reforms, including some in the commercial market — long a sticking point. Those pharmacy benefit manager reforms were supposed to pay for other priorities, including funding for community health centers and other health care programs. There was also agreement on a hospital price transparency measure, a five year extension of an opioid-addiction treatment program and an extension of pandemic-preparedness policies. 

There was some disagreement over whether to require off-campus hospital outpatient departments to include a national provider identifier on Medicare claims. That disagreement might’ve come from Senate Majority Leader Chuck Schumer (D), whose state of New York includes many hospitals that oppose the policy. Schumer’s office didn’t respond to questions about that measure. 

Instead, Schumer blamed House Speaker Mike Johnson for opposing any health care package. Johnson’s office didn’t respond for this item.

in the courts 

SCOTUS wary of curbing govt efforts to limit misinformation 

Most of the Supreme Court’s justices on Monday seemed to question states’ arguments, in Murthy v. Missouri, that the Biden administration coerced social media giants to regulate Covid-19 content and thereby violated Americans’ freedom of speech.

Biden’s lawyers argue they were well within their rights to flag misinformation and use the White House’s “bully pulpit” to press social platforms to regulate false or harmful information. The lawyer arguing for plaintiffs, Louisiana Solicitor General J. Benjamin Aguiñaga, said that amounted to coercion and censorship of Americans.

Yet several of the justices, including conservative appointees, seemed to poke holes in that assertion. They also questioned whether those social media users were directly harmed by officials encouraging those restrictions — and drew some comparisons to regular government contact (and sometimes disputes) with media outlets. More from me.

War on Recovery 

Mapping the evolving business of methadone clinics

Private equity firms have acquired stakes in nearly one third of all methadone clinics in recent years, gaining outsize control of the U.S. addiction treatment industry even as the country’s opioid epidemic has developed into a full-fledged public health crisis, Lev Facher reports in the third installment of his yearlong investigation into barriers to addiction medications.

Private equity’s surging interest in the methadone treatment industry adds a new layer to the fraught and fast-shifting debate over access to addiction medications. While a broad coalition of patients, lawmakers and some doctor groups are calling for methadone access that bypasses clinics, the providers are pushing back forcefully, citing safety concerns. Critics say it’s actually about their bottom lines.

It’s like trying to negotiate with a “cartel,” Rep. Donald Norcross (D-N.J.) told Lev. Norcross and Sen. Ed Markey (D-Mass.) co-authored a bill that would let trained physicians prescribe methadone, bypassing the clinics. A campaign against the bill, called “Program, Not a Pill,” is backed by PE-run clinics.

In 21 states, at least 50% of all methadone clinics are owned either by private equity firms or by Acadia Healthcare, founded by a private equity group. In some states, 100% of the clinic options are owned by private equity or Acadia, according to a first-of-its-kind analysis of the national clinic landscape. Read more on what that means for patients.