InNOvation. Seagen said they aren’t looking at a drug that would treat early-stage bladder cancer because it would be subject to negotiation too soon after approval and wouldn’t have a financial return on the investment. Today the National Pharmaceutical Council published a great piece in Health Affairs that goes deeper into the subject of innovation and the Inflation Reduction Act.

You get the results you design. This week Centers from Medicare & Medicaid Services (CMS) started the patient listening sessions for the drugs chosen for Medicare negotiation. Let’s just say there are probably some lessons learned for those who want to learn them. The slots aren’t filled. The same speakers tend to be on each one. Three minutes is not a lot of time for a patient to tell their story. Patients may not have a great understanding of the Part D redesign and the out-of-pocket changes coming even if their drug isn’t negotiated. But the listening sessions are getting the results they were designed for … what if we did better? To that I look for Joe Vandigo and crew in Health Affairs.

Maybe, maybe not. CMS issued the Medicare Physician Fee Schedule final rule yesterday. The rule had pay cuts (3.4%) for physicians. Also out yesterday was a Senate draft bill that mitigates part of those cuts and extends the alternative payment model bonuses. You know where physicians live and vote? Everywhere.

Part D Fixes. Although the Inflation Reduction Act does a lot to help beneficiaries with their out-of-pocket costs in Part D, there are still issues with the program. The draft Senate bill attempts to tackle the preferred pharmacy issue, ensuring coinsurance based on net-discount prices and biosimilar inclusion on formularies. While odds of passing are probably low, the issues are good ones.

340B.

We get it, no one likes the hard way. Last week the Health Resources and Services Administration (HRSA) issued a formal notice to end the waiver of pre-pandemic registration requirements for off-site clinics’ participation in 340B. So now hospitals have to register the offsite clinics and list them in Medicare cost reports. COVID over, streamline over.

The Remedy. Long story short, CMS cut payment to 340B hospitals. Hospitals sued. Won. Now CMS owes them $9m. Question is how to pay them. Answer – the remedy. Impacted covered entities will get a lump sum payment (including the beneficiary cost-sharing they missed out on.) But with budget neutrality it meant that other hospitals were overpaid during the time period of this cut so CMS is going to be off-setting the payments with an Hospital Outpatient Prospective Payment System 0.5% cut in 2026.

Two more quick things…

Presidential AI executive order includes healthcare.

And thinking through equity and quality measures.