By Chelsea Cirruzzo and Ben Leonard

Presented by PCMA // Pharmaceutical Care Management Association

With Katherine Ellen Foley and Kelly Hooper

Some health care advocates are puzzled as to why President Joe Biden hasn't reversed a Trump-era policy that they say protects insurers from rising costs but raises premiums for patients. | Evan Vucci/AP Photo

AN ICHRA UPDATE — The Biden administration has gutted many of former President Donald Trump’s health care policies, but there’s one that the White House has yet to touch, Kelly reports.

It’s a 2019 Rule that expanded individual coverage health reimbursement arrangements, or ICHRAs, which allowed employers to provide tax-exempt subsidies to help workers purchase Obamacare plans.

The Biden administration’s lack of action puzzles left-leaning health care advocates, who say the Trump rule lets employers dump sicker, more expensive employees onto the Affordable Care Act exchanges, raising premiums for everyone else.

They worry that if President Joe Biden doesn’t reverse the ICHRA expansion soon, the rule could become entrenched and impossible to scrap. In June, the House passed the CHOICE Act — which would codify Trump’s ICHRA rule. That legislation is going nowhere in the Senate, but some fear that it could end up in a year-end package as an inducement to bring Republicans on board.

The White House declined to comment. HHS didn’t respond to a request for comment.

Employer uptake of ICHRA has been slow, but interest is growing as companies face soaring health costs. ICHRAs can save employers money by protecting them from rising insurance costs, and proponents argue that employees like the option because they choose a plan tailored to their needs.

Brian Blase, a former Trump policy adviser who helped shepherd the ICHRA rule, argues the arrangements bolster the ACA by bringing younger, healthier workers into Obamacare plans. He contends the Biden administration hasn’t touched Trump’s ICHRA rule because it would be a “major undertaking” to unwind the regulation, and “they would have to go through very time intensive notice and comment rulemaking.”

“They don’t have the bandwidth, time or motivation, and why would they want to rescind a rule that expands Obamacare coverage?” Blase said. “It would make some of their past positions just totally look hypocritical.”

WELCOME TO THURSDAY PULSE. If the Republican presidential debate kept you up last night, might we recommend a pumpkin spice latte this morning? Send your tips, scoops and feedback to [email protected] and [email protected] and follow along @_BenLeonard_ and @ChelseaCirruzzo.

A message from PCMA // Pharmaceutical Care Management Association:

Big Pharma is the link between patients and high drug prices. Don’t fall for Big Pharma’s “delinking” blame game. Weakening tools pharmacy benefit companies use to lower drug costs gives Big Pharma more power to keep drug prices high. The Big Pharma bills to end so-called “delinking” hand billions of dollars annually to drug companies, while costing patients and payers billions. “Delinking” means employers lose out on savings and employees pay more for prescriptions.

TODAY ON OUR PULSE CHECK PODCAST, host Alice Miranda Ollstein talks with POLITICO health care reporter Kelly Hooper about her report on the Biden administration's seeming reluctance to act on a Trump-era health rule that pushes a type of insurance plan that can save employers money but not necessarily employees.

HHS wants states to train foster parents in caring for LGBTQ youth and providing a safe environment for them. | Wilfredo Lee/AP Photo

PROTECTING LGBTQ FOSTER KIDS — HHS proposed a rule Wednesday that would require states’ child welfare agencies to train foster parents in providing for LGBTQ children in their care, Chelsea reports.

The proposal, part of a slate of actions the Biden administration took Wednesday to expand the child welfare system, follows an executive order signed last year amid a rise in anti-LGBTQ state laws.

Background: Under an Obama-era rule, federally funded foster and adoption agencies cannot discriminate based on sexual orientation or gender identity, though actions taken under the Trump administration made it easier for faith-based agencies to turn away same-sex foster couples, a position that the Supreme Court upheld in 2021.

Last June, President Joe Biden directed HHS in an executive order to take actions to “help address and eliminate disparities in the child welfare system experienced by LGBTQI+ children, parents, and caregivers.”

What it means: Under the proposed rule by HHS, child welfare agencies would be required to ensure every LGBTQ foster child is given a “safe and appropriate placement and services that help them thrive,” per an HHS press release. Caregivers would also be required to be trained in caring for LGBTQ youth.

HHS also finalized a regulation to simplify the process for family members to become foster care providers and receive the same financial support as other foster families.

What’s next: The proposed rule will be open for comments for 60 days.

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INSURERS: VACCINE COVERAGE FIXED — Major health insurers told HHS today they have largely resolved issues with coverage of new Covid-19 shots, Chelsea writes.

The meeting follows days of back-and-forth between the administration and payers as the first commercial rollout of Covid vaccines hit road bumps, from people unable to find vaccines to reports that vaccines weren’t being covered by insurance.

In a letter to the administration, a group of major insurers promised they’re fully covering Covid shots when consumers go to in-network providers or, when no other option is available, out-of-network providers.

Vaccine supply issues have been steadily shrinking daily, HHS spokesperson Jeffrey Nesbit told POLITICO in an email. Still, most jurisdictions aren’t expected to receive pediatric vaccines until early October, the National Association of County and City Health Officials previously told POLITICO.

A message from PCMA // Pharmaceutical Care Management Association:

WH PANDEMIC CHIEF: WE’RE TRUTHFUL — The White House’s inaugural head of its new Office of Pandemic Preparedness and Response Policy says rebuilding trust with Americans is among the administration’s top priorities when it comes to responding to biological threats, Chelsea reports.

Dr. Paul Friedrichs, who previously served on the National Security Council, said at a Johns Hopkins University event Tuesday that one of his office’s biggest challenges is “convincing people that we are being truthful.”

“Whenever we failed, when we struggled, it was because we forgot to be transparent and truthful and collaborative and collegial,” he said.

Friedrichs’ comments echo those made by CDC Director Mandy Cohen, who recently told POLITICO that her agency wants to regain trust following a loss of faith in it during the pandemic.

Both officials have said they’re particularly focused on the fall vaccination campaign, which, for Friedrichs, means “making sure that the transition from a government vaccination and therapeutics program to the more traditional commercial program is successful.” Cohen has traveled around the U.S. to promote vaccines.

He said his office will work on policy related to restocking and boosting the Strategic National Stockpile, addressing recurring threats like Covid-19 and recovering from future pandemics.

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FENTANYL OVERDOSE DRUG TO HIT MARKET — Indivior, the maker of the first FDA-approved product capable of reversing synthetic opioid overdoses, anticipates the drug will begin distribution on Monday, Oct. 2, Katherine reports.

Dr. Jerome Adams, a former U.S. surgeon general speaking on behalf of Indivior, said he sees Opvee as a tool for first responders, who often use multiple doses of naloxone, a less-potent opioid overdose reversal, as they treat patients who have overdosed on potent substances like fentanyl. “We're at a place where fentanyl is in everything,” he told POLITICO. “Instead of being the exception, fentanyl is the rule.”

More than 80,000 individuals in the U.S. died of an opioid overdose in 2021, according to the CDC. Data from the University of California, Los Angeles, shows that the newest wave of the ongoing epidemic is characterized by fentanyl mixed with illicit stimulants.

Indivior priced a single-use package of Opvee at $37, though as a prescription, it will be covered by most insurance. Adams said at least 10 states had already included the drug in standing orders, which act as blanket prescriptions to make the drug readily available at sites like those that offer needle exchange programs.

Opvee is a nasal spray version of nalmefene. It works like a stronger, longer-acting version of naloxone and decouples opioids from their receptors in the brain.

FIRST IN PULSE: CAREGIVING RANKINGS — AARP is set to release a long-term health care services and supports scorecard today measuring state performance, with Minnesota and Washington topping the best-of list, Ben reports.

The findings measuring performance tied to nursing care and other services come ahead of the fall respiratory virus season and vaccination campaigns and after Covid ravaged long-term care facilities. The sector faces workforce shortages, and the Biden administration recently proposed setting federal minimum staffing levels at nursing homes.

“COVID-19 tested our long-term care systems, and they failed. Now is the time to take the lessons we’ve learned to fix them for the sake of saving lives,” Susan Reinhard, senior vice president of the AARP Public Policy Institute, told Pulse.

A message from PCMA // Pharmaceutical Care Management Association:

Why would Congress let drug companies boost their own profits at the expense of patients and taxpayers? Big Pharma is the link between patients and high drug prices.

Big Pharma is pushing for so-called “delinking” bills that would give them a profit windfall of $10 BILLION in Medicare alone, forcing patients, taxpayers and employers to pay as much as $18 billion more annually for prescription drugs.

What problem is Congress trying to solve? If the goal is to lower drug costs for patients, taxpayers, and employers, the Big Pharma “delinking” plan is the wrong approach.

“Delinking” means employers lose out on savings and their employees pay more for prescriptions they need.

Get the Facts.

Sam Spencer is now manager of public affairs at Novant Health. He previously was communications director for Rep. Alma Adams (D-N.C.)

The Washington Post reports that more than 9 million prescriptions for weight-loss drugs were written in the last three months of 2022.

ProPublica reports on the company Phillips' continued sale of breathing machines despite warnings about contamination.

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