> By Evan Mintz and Juliana Keeping, Arnold Ventures
Congress accomplished its most basic duty this week with the passage of the omnibus spending bill, which will keep the federal government operating for another fiscal year. While $13.6 billion in support for Ukraine may grab the headlines, buried among thousands of pages in the $1.5 trillion measure are authorizations and support for evidence-based policies that can help maximize opportunity and minimize injustice.
These programs will help people reintegrate back into free society after incarceration, provide support for victims of crimes, and support local governments implementing violence reduction strategies. Even as irresponsible fearmongers in the media continue to perpetuate a partisan divide over criminal justice reform, the omnibus shows routine bipartisan agreement can be found.
The omnibus bill also established a $5 million Postsecondary Student Success Grant program, which will incentivize institutions of higher education to create evidence-based practices and programs, such as the Accelerated Study in Associate Programs (ASAP) at the City University of New York, which can help more students complete their college educations.
Pharmacist Prescriptions Increase Access to Birth Control
By Torie Ludwin, communications manager
Right now 19 million women in the United States live in contraception deserts — places with less than one health center or provider offering the full range of birth control methods per 1,000 women relying on publicly funded contraception. That means that 97 percent of people who qualify for subsidized birth control must travel to another county to fully access the range of birth control methods.
What’s Happening: Several states are beginning to implement laws that will allow pharmacists to prescribe birth control, and it makes access remarkably easy compared with getting a doctor’s appointment.
“I think a lot of our patients are now in that boat now where finding a primary [doctor] means you have an appointment three to six months from now,” explained Tesia Buszkiewicz, pharmacist at Duran’s in Albuquerque. “With birth control, that's really not something we want our patients to go without for that long.”
Why it Matters: Pharmacies offer access and flexibility that doctor’s offices often can’t. They tend to be open outside traditional health clinic hours — including evenings and weekends — and are familiar places people visit regularly to pick up medicine and groceries. Barriers like the need for child care are also lower when parents can go to a pharmacy instead of a doctor’s office to get birth control or follow up with issues like side effects or adherence issues.
What’s Next: Legislators continue to pass laws permitting pharmacist-prescribed birth control, states are working on implementation, and pharmacies are working with insurance on payment.
The Continuing Fight Over Drug Approval Evidentiary Standards
By Juliana Keeping, communications manager
What’s Happening: In June 2021, the FDA approved Aduhelm, an expensive new drug to treat the early stages of Alzheimer’s disease. It quickly became a flashpoint in the national debate about the tradeoffs between low-quality evidence and high prices. As the Drug Prices team at AV writes this week, it was not the first. The FDA approved Eteplirsen, the first treatment for Duchenne Muscular Dystrophy amid swirling debate that struck a similar chord.
Why it matters: Aduhelm gained FDA approval despite evidence of severe clinical harms, without clear evidence of clinical improvements in patient cognition and despite being rejected by the FDA’s independent advisory committee based on the trial evidence. Three of 11 committee members resigned after the decision. Its approval raised very serious questions about the FDA's accelerated approval pathway, under which Aduhelm was approved. The FDA asked Eteplirsen's manufacturer to conduct confirmatory studies by 2021, but to date, no evidence of that drug's efficacy or safety has been made public.
“Instead of fostering trust in the drug approval system and ensuring protection for patients, the accelerated approval pathway is raising very serious questions about patient safety and evidence standards as well as whether the drug industry is taking advantage of the pathway for its own financial benefit," said Mark E. Miller, Executive Vice President of Health Care for Arnold Ventures.
What’s next: Reforms are needed for the Accelerated Approval Program to deliver what it was intended to: access to promising therapies now with the promise of future confirmatory evidence of direct patient benefits.
Jefferson County used to rely on punitive pretrial release conditions that largely resulted in failure for people awaiting trial. That changed when Peggy Galloway became director and sole employee for the Diversion Services and Pretrial Release in the rural Nebraska county.
What's Happening: Galloway has explained to county leaders the need for assistance with substance use and mental health, and begun implementing voluntary supportive services to promote pretrial success. This involves addiction and mental health services, but also helping people meet basic needs by helping them apply for Medicaid, find a job, or obtain a driver’s license.
Why it Matters: The majority of crimes in Jefferson County are drug-related, and common pretrial requirements such as drug tests and check-ins didn’t promote success.
"You can’t expect someone who has been addicted to drugs for years to suddenly be drug tested twice a week and pass without any support services in place,” Galloway said.
What's Next: All across the country, innovative pretrial services leaders are increasingly adopting supportive services to promote pretrial success. Like many other pretrial leaders, Galloway is always keeping her eyes out for grants to fund other programs and hopes that she’ll receive federal funding for services, especially those related to treatment for methamphetamine addiction.
“Most of these people don’t want to live this kind of life. They just don’t know how to get out of it,” Galloway said.
How to Reduce Overpayments
in Medicare Advantage Plans
By Steven Scarborough, communications manager
In a comment letter to the Centers for Medicare and Medicaid Services (CMS), Arnold Ventures is urging CMS to change how Medicare Advantage plans calculate reimbursement to reduce overpayments.
What’s happening: There is clear evidence that Medicare overpays Medicare Advantage plans for providing Medicare coverage to beneficiaries enrolled in the program despite plans’ apparent ability to provide care more efficiently. This is in part because Medicare Advantage plans aggressively code beneficiaries’ diagnoses to make them appear sicker, thereby generating higher payments. This week, Arnold Ventures issued a comment letter to the Centers for Medicare and Medicaid Services urging the agency to do more to address excessive payments to Medicare Advantage plans.
Why it matters: Excessive payments to Medicare Advantage plans due to upcoding cost taxpayers about $12 billiona year, and with growing enrollment into the program, this problem is only getting worse. With the Medicare Hospital Insurance Trust Fund facing insolvency in 2026, we cannot afford this level of overpayment. By instituting changes to better account for MA plans’ aggressive coding behavior, we can ensure payments to MA plans are more accurate and reduce Medicare spending, thereby extending the solvency of the Medicare Hospital Insurance Trust Fund.
Judi Greenwald: Protecting the Climate for Future Generations
For Women's History Month this March, we're recognizing the women who are making history today by working to impact policy change for the future.
By Torie Ludwin, communications manager
Throughout her 35-year career in energy and environmental policy, Judi Greenwald has focused on how the world can decarbonize via public policy, technology innovation, human behavior, and markets.
"I have worked on many aspects of climate solutions over the years, depending on where I could add the most value," Greenwald said. "I’m focusing now on advanced nuclear energy because it’s a very exciting climate solution that could be a real game changer; it just needs more policy attention and investment."
Medicare Part D enrollees' average out-of-pocket costs for 11 of 54 orally administered cancer drugs in 2010 v. 2019. The price of Congressional inaction on drug pricing during these inflationary times continues to harm patients and families.
$46.2B v. $88.4B:
Medicare Part D spending nearly doubled between 2007 v. 2019. Congressional inaction on drug pricing is driving wages lower and tax bills higher.
$297B over 10 years:
The CBO estimates that drug pricing reforms under consideration by Congress - including Medicare negotiation - would reduce the deficit by $297B over 10 years.
Inaccurate initial reporting about crime, even if later proven false, can be used to justify harmful expansion of ineffective ‘tough-on-crime’ policies and rollbacks of effective reforms, writes M.K Kaishian in a New York Daily News op-ed.
A Scottish court is refusing to extradite prisoners to Texas after finding that the state's prisons potentially constitute an international human rights violation, Keri Blakinger writes in The Marshall Project.
HCPLive summed up a recent study by Guttmacher showing that the COVID-19 pandemic negatively impacted access to contraception and reproductive health care; that impact was disproportionately greater for those also experiencing financial or employment instability.
The Kaiser Family Foundation issued a brief on the role of Medicaid for low-income women in obtaining and financing family planning services, noting the provision of services changes state to state based on waivers and amendments as well as access to clinicians.
The Better Care Playbook recently spoke with Dennis Heaphy, a policy analyst and health justice advocate at the Massachusetts Disability Policy Consortium, to explore the impact of involving people with disabilities in care planning, based on a study of Massachusetts One Care Program members. One Care provides comprehensive, integrated, coordinated care for dually eligible individuals under 65.
For state employee health plans, high health care prices financially burden state budgets and increase health care costs for employees. A new cost containment toolkit from The National Academy for State Health Policy highlights resources for these plans to address prices and lower costs.
A new interactive map from The Commonwealth Fund and the Georgetown University Center on Health Insurance Reforms highlights how states and the feds are taking on enforcement of the No Surprises Act to protect patients from surprise medical bills.
In Higher Ed Dive, Natalie Schwartz reported on details about the recent proposal for a Gainful Employment rule from the U.S. Department of Education. The draft proposes two metrics to evaluate career education programs: One compares graduate earnings to their student loan debts, and the other compares graduate earnings to those of high school graduates living in the same state.
The newly restarted enforcement unit within the U.S. Department of Education issued a warning this week to colleges after a federal review found that college advisers had led veterans to believe the government would pay fully for their education, only to find out later they needed student loans, reported Chris Quintana in USA Today.
The National Conference for State Legislatures’ Center for Results-Driven Governing released a second evidence brief in its “Investing in What Works Series,” which is focused on options for states on ways to use their American Rescue Plan funds on workforce development programs. The series recommends workforce training program Per Scholas, which has shown success in rigorous evaluations.
The New York Times profiled Kathryn Murdoch on her work supporting open primaries and ranked-choice voting as changes to the election system. “[Candidates are] terrified of being seen as bipartisan,” said Murdoch. “And that’s absolutely the wrong thing for the American people.”
The Daily Energy Insider outlined the $36 million award by the U.S. Department of Energy’s Advanced Research Projects Agency-Energy (ARPA-E) for 11 projects to limit waste produced by advanced nuclear reactors. “Developing novel approaches to safely manage nuclear waste will enable us to power even more homes and businesses in America with carbon-free nuclear energy,” said U.S. Secretary of Energy Jennifer Granholm.
Save the Date
On Thursday, March 31, from 3-3:45 p.m. ET, Director of Higher Education Kelly McManus will be moderating a virtual panel entitled, “Leveraging State and Local Relief Funds to Increase College Completion Rates,” co-hosted by TICAS, SHEEO, and Results for America. The discussion will highlight how states and localities are using these funds to invest in proven programs aimed at increasing college persistence, graduation, and lifetime earnings. Register here.
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