POLICY BRIEFINGS

Brad Smith Selected to Lead CMMI


The Trump administration announced last week that entrepreneur Brad Smith, co-founder of palliative care provider Aspire Health, has been selected to lead the Center for Medicare and Medicaid Innovation (CMMI). Smith will also serve as senior adviser to the U.S. Department of Health and Human Services (HHS) Secretary on value-based transformation and innovation. Smith started Aspire Health with former Senate Majority Leader Bill Frist, M.D. (R-Tenn.) in 2013. Aspire Health was involved in the development of a CMMI payment model announced last April designed to improve care for patients with serious illnesses and complex, chronic conditions. Aspire was sold to Anthem in 2018. Smith formerly served as chief of staff at the Tennessee Department of Economic Development, worked as a consultant at McKinsey & Company, and spent time as a staffer for former Sen. Bob Corker (R-Tenn.). CMMI’s previous director Adam Boehler left the office on October 1 after being confirmed to lead the International Development Finance Corp. Career staffer Amy Bassano has served as acting CMMI director in the interim. Smith was chosen for the position by Boehler, HHS Secretary Alex Azar, and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma.


FDA Advisory Committee to Debate New Opioid Approval


During a meeting of the Food and Drug Administration’s (FDA) Anesthetic and Analgesic Drug Products and Drug Safety and Risk Management advisory committees this week, the panels will consider the approval of Nektar Therapeutics’ oxycodegol, a drug intended to manage chronic lower back pain in adults for whom other treatment options are inadequate. The agency will also consider approving the treatment for general long-term pain. Nektar says their drug is designed to cross the blood-brain barrier slowly to reduce the potential for abuse or misuse. Documents prepared by the FDA in advance of the meeting acknowledge the important role of opioids in the treatment of chronic pain, despite the epidemic of abuse and addiction with drugs prescribed for such purposes. The FDA documents also reject the idea of absolute limits on daily doses of opioids for pain management.


Supreme Court to Consider State Regulation of PBMs


The Supreme Court has accepted a request from the state of Arkansas to review an appeals court ruling that blocked the regulation of pharmacy benefit managers (PBMs) on the grounds that such activity is preempted by the Employee Retirement Income Security Act (ERISA). Attorneys general from 31 states and the District of Columbia have also asked the court to reverse the lower court ruling. The 2015 Arkansas law that would have required PBMs to raise reimbursement rates for drugs if they fell below the pharmacy’s wholesale costs was challenged by the Pharmaceutical Care Management Association. State attorneys argue that PBM regulation is critical to a state’s ability to increase access to and improve the transparency of the prescription drug marketplace.


Administrative Health Care Costs on the Rise


The cost of healthcare bureaucracy in the U.S. has increased to $812 billion annually, according to a nationwide study of domestic spending on administrative costs. The report, which was published in the Annals of Internal Medicine, attributes the growth to the expansion of Medicare Advantage (MA) and Medicaid managed-care plans. Administrative costs now accounts for one-third of health care spending on doctor visits, hospitals, long-term care, and health insurance. The study found that the nation spent $2,379 in administrative costs per person in 2017.


Health Care Remains Top Issue for Voters


A new poll from the Bipartisan Policy Center finds that health care is once again a top issue for voters this year, who rank it above the economy, immigration, taxes, and gun control. The poll shows greater support for incremental changes to the current health care system than for sweeping policy changes like repeal of the Affordable Care Act (ACA) or passage of Medicare-for-All. Medicaid work requirements polled favorably amongst Republican respondents, while improving the cost and quality of care has strong bipartisan support.


Nursing Ranks Highest in Assessment of Professional Honesty, Ethics


A new Gallup poll indicates that the nursing profession rates highest for honesty and ethics by Americans for the 18th year in a row. Eighty-five percent of Americans find nurses’ honesty and ethical standards are “very high” or “high.” This is in keeping with nurses consistently ranking higher than all other professions included in the Gallup survey, by wide margins. Medical doctors, pharmacists, and dentists are also rated favorably, with at least 60 percent of U.S. adults assessing high levels of these virtues. Gallup’s complete questions and responses can be found here.


Upcoming Congressional Hearings and Markups


House Energy and Commerce Subcommittee on Oversight and Investigations hearing “A Public Health Emergency: State Efforts to Curb the Opioid Crisis;” 10:00 a.m., 2123 Rayburn Bldg.; January 14

House Energy and Commerce Subcommittee on Health hearing “Cannabis Policies for the New Decade;” 10:00 a.m., 2123 Rayburn Bldg.; January 15



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