Subject: POLITICO Pulse, presented by National Community Pharmacists Association (NCPA): Fear of antitrust damages could stymie med boards — Health care CEOs to candidates: Stay course on ACA — The behind-the-scenes battle between Anthem and Cigna
From: POLITICO Pulse <[email-masked]>
To: <[email-masked]>
Date: Mon, 23 May 2016 08:03:28 -0600

By Dan Diamond | 05/23/2016 10:00 AM EDT

Anthem and Cigna are battling behind the scenes of their planned merger, and opioid prescriptions have begun to steadily fall after a two-decade surge. But first: How a Supreme Court ruling has put medical boards on high alert.

FEAR OF ANTITRUST DAMAGES COULD STYMIE MED BOARDS - A Supreme Court ruling that could hold individual medical board members liable for antitrust violations has sent shock waves through the boards, whose doctor-officers fear getting socked with immense legal charges, Pro's David Pittman writes.

At least five antitrust lawsuits have been filed against health licensing boards since the North Carolina Dental Board v. Federal Trade Commission decision, which held that licensing boards like those that regulate physicians, nurses and pharmacists are open to antitrust suits if they try to block competitors like telemedicine companies or pain clinics.

More from David for Pros: http://go.politicoemail.com/?qs=42bfbc95aeb6ef54e6b6d7d1dfaca3b7701b984f6b86a071494f5a58fcd94bb8

HEALTH CARE CEOs TO CANDIDATES: STAY THE COURSE ON ACA - That's according to Modern Healthcare's latest poll of 100-plus hospital and health care CEOs. Only 2 percent of respondents explicitly supported repealing and replacing the health law, while 67 percent said they don't want it to go away. 

There's also considerable support for the White House's health care pilot programs: More than 83 percent of CEOs don't want the next administration and Congress to repeal delivery system reforms.

"I wish that the rhetoric about getting rid of the Affordable Care Act would just cease," Allina Health CEO Penny Wheeler is quoted as saying. "Focusing attention on what actual aspects of the Affordable Care Act need to be improved upon would be more of what I'd like people to focus on."

Read the story: http://go.politicoemail.com/?qs=7b6c19c333a6664393cae2c327a92b7c662e24705ef3c8fdb663b5287de9343a 

Two more nuggets
- Nearly three-quarters of CEOs wanted to expand use of health savings accounts
- About 70 percent supported "aggressive measures" to slow rising drug costs

WELCOME TO MONDAY PULSE - Where we're picking the NIHCM Foundation dinner tonight over LeBron, JoJo and the Price is Right in prime time. Tips and Bachelorette recaps to [email-masked] or @ddiamond on Twitter. 

PAYERS HATING - The blockbuster mega-merger between Anthem and Cigna is seething with behind-the-scenes acrimony, the Wall Street Journal reports.

The companies' lawyers have bickered over multiple matters and missed deadlines, which could jeopardize the planned merger, according to letters obtained by the Journal. (Anthem and Cigna executives want their merger to be reviewed at the same time as Aetna and Humana's deal, believing that simultaneous review will boost their chances of success.)

"The finger-pointing ... reflects rancor that is unusual even in the cutthroat world of corporate takeovers," the Journal's Liz Hoffman and Anna Wilde Mathews write. Earlier this month, for example, Cigna told investors the merger might not close until next year. Anthem immediately responded that the deal would go through in 2016 and privately rebuked Cigna for attempting to "spook the market."

54 million. That's how many members would be covered by a combined Anthem-Cigna company - making it the largest private payer, by members, in the nation.

Read the story: http://go.politicoemail.com/?qs=d51b9621d395a0d84a1392bbb25ac07136a5613e122703964dbc79084da97237 

SLAVITT ON MACRA: 30,000 PHYSICIANS ALREADY ENGAGED - The CMS acting administrator took to Twitter this weekend to tout his agency's outreach on the Medicare payment law and share early feedback.

Among the takeaways
. The agency is holding 35 events on MACRA this month; more than 30,000 doctors have already taken part in 10 seminars.
. Physicians have asked about the availability of payment models like medical homes and ACOs under the law, and how CMS can ease the path in to qualify.

See a curated list of Slavitt's comments: http://go.politicoemail.com/?qs=d51b9621d395a0d869ea2380fb3b8ebf1019ed848f562c5caf57cb53f2ef0373 

** A message from National Community Pharmacists Association (NCPA): More transparency is needed into generic drug pricing and reimbursement rates set by drug plan middlemen. Bipartisan legislation (H.R. 244) would enhance oversight of federal health programs and help ensure pharmacy reimbursement for generic drugs reflects market fluctuations. Visit www.ncpanet.org/pharmacyaccess. **

FOR DOCS, MACRA HELP ON THE WAY - The law around Medicare's new physician payment system gives CMS $100 million to provide technical assistance for small and rural practices, the agency's clinical quality director said on Friday. 

Speaking at an Alliance for Health Reform event, CMS's Kate Goodrich said the agency will soon release a request for proposals "relatively soon so that people can apply," Pro's David Pittman reports. Small practices stand to be penalized the most under the law's Merit-based Incentive Payment System, by CMS's own estimates. But the agency says data provided in its proposed rule last month is old and won't be as harsh to small practices as it suggests.

- Minimizing MU under MIPS? According to Goodrich, the law gives CMS the power to make the meaningful use portion of MIPS - called Advancing Clinical Information - count less in a doctor's MIPS score. Currently, it's 25 percent, but CMS can move that down to as low as 15 percent once three-quarters of doctors are considered "meaningful users" under MACRA. "I think we're going to get there pretty soon," Goodrich said.

ICYMI: AFTER TWO DECADES OF GROWTH, OPIOID PRESCRIPTIONS DECLINE - There's been in at least a 12 percent drop in opioid prescriptions since 2012, according to a pair of new reports. Experts say the scrutiny of painkillers may be playing a role: http://go.politicoemail.com/?qs=39f1a98a94a14b2cc9349c7fd54f08910e60dfbf4f01d2e0eb60e150dcb96c21

KLAIN ON ZIKA: AMERICA's POLITICAL SYSTEM HAS FAILED - The former White House Ebola czar castigated lawmakers for failing to reach a Zika funding deal in a high-profile op-ed on Sunday.

"It is not a question of whether babies will be born in the United States with Zika-related microcephaly - it is a question of when and how many," Ron Klain wrote in Sunday's Washington Post. "For years to come, these children will be a visible, human reminder of the cost of absurd wrangling in Washington, of preventable suffering, of a failure of our political system to respond to the threat that infectious diseases pose."

Read the op-ed: http://go.politicoemail.com/?qs=39f1a98a94a14b2c0012550abb45ef7497707ff9381991b9c1cbd6cca0a52daf 

Pulse Check listeners heard it first. Skip to 8:25 of POLITICO's new podcast to hear Klain's thoughts on the Zika funding battle: http://go.politicoemail.com/?qs=39f1a98a94a14b2c7fe8faf78457eeb575164cd79dcd1bdce7d6059c970d9d37 

Here's a quick wrap-up of the health care news from the Sunday shows.

Anthony Fauci warns that local Zika transmission is imminent. America's top infectious disease doctor said on ABC's "This Week" that NIH experts are bracing for the virus to spread within the United States.

"We fully expect that that will happen as we get to the more robust mosquito season in the next month or so," Fauci warned. 

How widely and quickly it will spread, of course, is not clear.

Mark Cuban likes Obamacare. The billionaire investor said on "Meet the Press" that President Obama's decision to expand health coverage was a "positive step" that helped address inequality. 

"From an entrepreneur's perspective, it's [also] given entrepreneurs the chance to leave jobs they were stuck in and get insurance where they otherwise might not have had it," he said.

ICYMI: OKLAHOMA GOV VETOES ANTI-ABORTION BILL - Gov. Mary Fallin on Friday vetoed a bill that would have made performing an abortion a felony punishable by up to three years in prison. The bill, passed by Oklahoma's Legislature Thursday, was vague and would not have stood up to court challenges, Fallin said in a news release.

KANSAS MAKES MAJOR MEDICAID CUTS - Between Gov. Sam Brownback's latest cuts and the loss of federal matching funds, the state's Medicaid program is taking a $120 million hit. 

More from Kansas, plus news from Colorado, North Carolina, Oklahoma and Virginia, in the latest State Week: http://go.politicoemail.com/?qs=42bfbc95aeb6ef54c0e192e47966e368be62703df8a6166682190e7ea8fe5782

WHAT WE'RE READING

How "Humans of New York" raised nearly $4 million for a hospital in two weeks, all through social media: http://go.politicoemail.com/?qs=fd6f5d5aee72d39ef861a92844f46ae8ac6c61eedf5c8e275bd68f26a5fea557 

The Pittsburgh Post-Gazette digs into the connection between physicians' prescription patterns and opioid abuse: http://go.politicoemail.com/?qs=fd6f5d5aee72d39e2f5bed33cc7da5991f4253c70d5284cf6d4e71d73bec9e9f 

A series of criminal trials of health care executives are about to begin, as the U.S. government gets more aggressive with corporate wrongdoing: http://go.politicoemail.com/?qs=fd6f5d5aee72d39e7340a75bb780bd95c55a6946842cb224c52058de3d70d6aa 

No more car "accidents": Safety advocates want them referred to as "car crashes" instead, especially with roadway fatalities surging. http://go.politicoemail.com/?qs=fd6f5d5aee72d39ed46e976491b98963e34c6cdb68eaf43676d6680b0d46e18b 

Judy Stone makes the case for the Rio Olympics to be delayed for public health reasons: http://go.politicoemail.com/?qs=f6bdfbd47ea71c3c75bc0347e5e6eff7e14644e74294025af9bc6709d9dc63aa

** A message from National Community Pharmacists Association (NCPA): While approximately 80 percent of prescription drugs dispensed are generic drugs, the reimbursement system for these medications is largely unregulated and a mystery to pharmacists and patients. The lack of transparency also raises questions as to whether drug plan middlemen, pharmacy benefit manager (PBM) corporations, are overpaid by Medicare and other federal health programs. Moreover, when generic drug prices spike, PBM corporations are slow to update reimbursement rates, leaving community pharmacies with payments that don't cover costs and unsustainable financial losses. H.R. 244 would increase transparency and
 facilitate timely payment updates. Learn more at www.ncpanet.org/pharmacyaccess. **

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