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The Timekeepers

Hot Topics | November 19, 2021

From getting to work on time to helping satellites stay in geosynchronous orbit, timekeeping is an essential function of modern life. In the United States, the responsibility of maintaining the master clock from which all other clocks are set falls to the United States Naval Observatory (USNO) located in Northwest D.C. At the facility, dozens of independent cesium atomic clocks and hydrogen maser clocks work together to provide a time so accurate, it does not change by more than 100 picoseconds (0.000 000 000 1 seconds) per day. While the atomic clocks are tucked away inside the facility, the USNO maintains a master clock display for the public at the gates on Massachusetts Ave NW and 34th Street NW.

Now for the healthcare stories that made headlines this week:

Drug pricing reform: back from the dead

  • Efforts to include drug pricing reform in the Democrat’s social spending bill came back to life this week. The majority caucus agreed on a measure that would permit Medicare to negotiate drug prices in select situations, cap out-of-pocket drug costs for seniors on Medicare at $2,000 annually, and prevent drug companies from raising prices faster than inflation. Drugs eligible for negotiation would include small molecules that are more than nine years old and complex biologics more than 12 years old. (The Hill, Axios)
    • Read more: STAT’s Washington Correspondent Rachel Cohrs breaks down who wins and who loses under this policy. (STAT)

Coming soon to a pediatrician near you

  • On Tuesday, the Director of the Centers for Disease Control and Prevention (CDC) advisory committee unanimously approved the FDA advisory committee recommendation to authorize the Pfizer/BioNTech COVID-19 vaccine for children ages 5 to 11 years old. CDC Director Walensky quickly followed course signing off on the policy within hours. The director’s action paves the way for these shots to be administered as soon as this week, with the pediatric vaccination campaign reaching full capacity next week. (STAT, Axios)

More on mandates

  • The Biden Administration announced that the Occupational Safety and Health Administration (OSHA) will begin enforcing the COVID-19 Vaccination and Testing Emergency Temporary Standard. The policy covers two-thirds of all U.S. workers, and will require covered workers to be vaccinated against COVID-19 by Tuesday, January 4, or face weekly testing. There are limited exceptions, and 17 million healthcare workers will not have the option to undergo weekly testing. (Axios, The Washington Postfull text below)

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The Curious Capitol Columns

Hot Topics | November 12, 2021

You’ve just left the National Bonsai & Penjing Museum at the National Arboretum, and a few hundred yards in front of you stand 22 Corinthian columns supporting nothing but air atop a grassy knoll. You’re looking at the National Capitol Columns, though perhaps ex-Capitol Columns would be a more appropriate name.

From 1828 to 1958, the columns had a structural purpose and graced the East Portico of the Capitol. The columns were removed when the east side of the Capitol was expanded to correct an aesthetic (not structural) oversight in the building’s design. After the columns were removed from the Capitol, benefactress Ethel Garrett campaigned to establish a permanent home for the columns at the National Arboretum.

Thank you for making us your home for the healthcare stories that made headlines this week:

Califf for Commissioner

  • President Biden nominated Dr. Robert Califf, a cardiologist, to serve as Commissioner of the Food and Drug Administration (FDA). If confirmed by the Senate, Califf would return to the job he held in the last few months of the Obama administration and have another opportunity to execute his goals of transforming the way stakeholders across healthcare use data. However, Califf’s confirmation process may not be smooth, as Senators Joe Manchin (D-W.Va.) and Richard Blumenthal (D-Conn.) publicly voiced concerns over the Dr. Califf’s approach to regulating opioids. (STAT, Endpoints News)

Your guide to mandate madness

  • It’s been a busy week for President Biden’s vaccine mandate. Last Saturday, the Fifth Circuit Court of Appeals temporarily blocked the mandate from going into effect. (POLITICO) The Administration responded by encouraging businesses to implement the mandate of their own accord, while the Department of Justice filed a brief arguing the mandate is legal. (The Hill [1], The Hill  [2]) As the legal challenges make their way through the courts, many American businesses are unsure of whether they should make preparations to implement the mandate. (Roll Call, The Hill)

Moderna’s patent problem

  • A public disagreement regarding the development of Moderna’s COVID-19 vaccine intensified this week when Dr. Francis Collins, Director of the National Institutes of Health, told Reuters the company “made a serious mistake” by asserting three NIH scientists did not help invent a key component of the vaccine. Moderna has stated the company “reached the good-faith determination that these individuals did not co-invent” the component of the vaccine in question. The dispute may now go to court. (Endpoints News [1], Endpoints News [2])

Confusion in the courts

  • Federal judges issued two conflicting verdicts on the 340B drug discount program, which requires pharmaceutical companies to offer discounts on all outpatient drugs sold to hospitals and clinics serving low income populations. One judge ruled the federal government did not have the authority to threaten to penalize Novartis and United Therapeutics for reducing 340B discounts. However, another judge asked the federal government to review how some hospitals participating in 340B use contract pharmacies. Following the verdicts, it remains unclear if the Department of Health and Human Services has the authority to force pharmaceutical companies to provide 340B discounts. (STAT)

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Where the Tiny Trees Are

Hot Topics | November 5, 2021

The grandeur of Washington, D.C.’s most famous attractions can easily distract from its smaller gems. Case in point: the National Bonsai & Penjing Museum which is the world’s first (and self-proclaimed finest) museum devoted to Bonsai. Located on the grounds of the National Arboretum in Northeast D.C., the museum has received numerous accolades including “Best Place to Take an Out-of-Towner” and “Best First Date Activity.” The museum boasts a collection that includes examples of Japanese Bonsai, Chinese Penjing and plants native to North America cultivated in these East Asian styles. Oh, and did we mention admission is free?

Now for the big healthcare stories that made headlines this week:

Drug pricing reform: back from the dead

  • Like a corpse on Halloween, efforts to include drug pricing reform in the Democrat’s social spending bill came back to life this week. The caucus agreed on a measure that would permit Medicare to negotiate drug prices in select situations, cap out of pocket drug costs for seniors on Medicare at $2,000 annually, and prevent drug companies from raising prices faster than inflation. Drugs eligible for negotiation would include small molecules that are more than nine years old and complex biologics more than 12 years old. (The Hill, Axios)
    • Read more: STAT’s Washington Correspondent Rachel Cohrs breaks down who wins and who loses under this policy. (STAT)

Coming soon to a pediatrician near you: shots for tots

  • On Tuesday, the Director of the Centers for Disease Control and Prevention (CDC) approved a unanimous recommendation from an advisory committee to authorize the Pfizer/BioNTech COVID-19 vaccine for children ages 5 to 11 years old. The Director’s action paves the way for these shots to be administered as soon as this week, with the pediatric vaccination campaign reaching full capacity next week. (STAT, Axios)

More news on mandates

  • The Biden Administration announced that the Occupational Safety and Health Administration (OSHA) will begin enforcing the COVID-19 Vaccination and Testing Emergency Temporary Standard. The policy covers two-thirds of all U.S. workers, and will require covered workers to be vaccinated against COVID-19 by Tuesday, January 4, or face weekly testing. There are limited exceptions, and 17 million healthcare workers will not have the option to undergo weekly testing. (Axios, The Washington Postfull text below)

If you enjoyed this week’s excerpt from Policy News from Goodfuse, we invite you to email us at [email protected] to sign up for the full weekly “insider only” newsletter featuring fun-to-read round-ups of Hot Topics, breaking news and some quirky facts to make your Fridays Goodfused.

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The Tall Tail of Washington’s Hometown Ghost

Hot Topics | October 29, 2021

Late at night when members of Congress have retired to their crash pad or office for the night, a terrifying specter haunts the halls of the U.S. Capitol. Known as the Grimalkin, Demon Cat or simply DC, the phantom feline is a local legend that has been a fixture in Washington lore since the Civil War.

The first recorded mention of the Demon Cat dates to 1862 when Union troops were defending the Capitol during the Civil War. Soldiers who were assigned night rounds reported seeing an ordinary black cat grow to the size of a tiger before pouncing and disappearing. Since then, additional sightings have coincided with national emergencies such as the assassinations of Abraham Lincoln and John F. Kennedy.

Demon Cat deniers (a.k.a. historians) are quick to point out that the Capitol was historically home to a horde of (non-demon) cats who helped control the rodent population, and the men who were assigned the Capitol night watch were often political appointees and were known to drink on the job.

Now for the not-so-scary healthcare stories that made headlines this week:

Drug pricing reform dies on eve of Halloween

  • President Biden has abandoned efforts to include drug pricing reform in the Democrats’ multi-trillion dollar domestic spending bill. While progressive elements of the Democratic party pushed hard for reforms, a compromise could not be found. Other progressive priorities such as expanding Medicare to include dental coverage have also been removed from the bill. (STAT, The Washington Post)

Shots for tots

  • On Tuesday, the Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee recommended that the Pfizer/BioNTech COVID-19 vaccine be authorized for children aged 5 to 11 years old. 17 committee members voted to issue the non-binding recommendation to authorize the vaccine with one member abstaining. The decision to authorize the vaccine now rests with the FDA Commissioner, who typically accepts the recommendation of the advisory committee. The Director of the Centers for Disease Control and Prevention (CDC) would also have to authorize the shot following a recommendation from a similar advisory committee before doctors could administer the vaccine to children. (STAT, Axios)

Have a spooky and safe Halloween!

  • Dr. Rochelle Walensky, Director of the CDC, went on Fox News Sunday earlier this week to share that trick-or-treating “should be very safe for your children.” Her remarks were similar to those of Dr. Anthony Fauci, Director of the National Institute for Allergy and Infectious Disease, who said the annual Halloween tradition is relatively safe because “You’re outdoors for the most part.” (The Washington Post)

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Old World eerie in a New World city

Hot Topics | October 15, 2021

Did the pandemic dash your dreams of embarking on a religious pilgrimage to Europe or the Middle East? Not to worry, because you can experience the best of Ancient Rome and the Holy Land in the heart of Washington, D.C courtesy of Franciscan monks.

In the late 19th century, the Franciscan Monastery of the Hold Land in America sought to recreate a number of holy sites and relics for Americans who could not afford to see the originals overseas. This included a number of alters, chapels and grottos, but apropos for the month of October are their catacombs. Meant to evoke the early Christian catacombs of Ancient Rome, the Catacombs of Washington, D.C. are a replica of the burial tunnels that lie under the streets of the Italian capital. The catacombs come complete with an official Papal endorsement as well as the bones of Saint Innocent, a child martyr. If you’re looking to get your spook on this October, tours of the catacombs are available.

Before you rebook your European vacation to Washington, D.C., catch up with the healthcare stories that were making headlines this week:

Drug pricing’s Groundhog Day

  • The intraparty stalemate between proponents of drug pricing reform and moderates entered another week. Democratic party leaders are now exploring changes that could potentially break the impasse, but reports indicate there is no guarantee that key moderates could be swayed by proposed changes. (The Hill, The Washington Postfull text below)

FDA first: e-cigarette receives marketing authorization

  • In a first for the agency, the Food and Drug Administration (FDA) granted marketing authorization to some electronic nicotine delivery systems (ENDS), more commonly known as e-cigarettes. In granting the marketing authorization, the FDA said “the potential benefit to smokers who switch completely or significantly reduce their cigarette use, would outweigh the risk to youth” provided the ENDS manufacturer, R.J. Reynolds, complies with the terms of the post-marketing requirements. (FDA Alert, Endpoints News, Associated Press – Washington Bureau)

Update on Commissioner search 2021

  • Sources close to the White House told media this week that President Biden is likely to nominate Dr. Robert Califf to serve as FDA Commissioner. If nominated and confirmed, Califf would return to the position he held for about one year during the second Obama administration. Over the past ten months, Dr. Janet Woodcock has served as Interim FDA Commissioner. (POLITICO, Endpoints News, The Washington Postfull text below)

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Luke! It’s Darth Vader!

Hot Topics | October 8, 2021

Nestled among the leafy streets of Cathedral Heights in Northwest D.C. stands the stately Washington National Cathedral. If you visit the cathedral, you may encounter a famous father on your spiritual journey. We aren’t talking about the Heavenly Father, but the galaxy’s most notorious villain: Carved into the northwest tower of the world’s sixth-largest cathedral is the head of Darth Vader.

Lord Vader holds such a prominent perch upon a place of worship thanks to a boy named Christopher Rader. In 1980, the cathedral held a contest that allowed schoolchildren to design a sculpture to be incorporated into the cathedral’s renovations. Rader, who was in the third grade at the time, submitted a drawing of Darth Vader. As the winner of the third place prize in the contest, Rader’s drawing was incorporated into the cathedral’s renovations as a grotesque. (Since the carving of Darth Vader’s head is not used to drain water, architects refer to the design flourish as a grotesque instead of a gargoyle.)

Stick with us. You don’t have to look to a galaxy far far away for a roundup of public policy news:

NiXing Title X regulation

  • On Monday, the White House revoked a Trump-era rule that prevented clinics from referring patients for abortions if they elected to receive federal funding for family planning. Title X supports healthcare facilities that offer infertility treatment, contraception counseling and routine cancer screenings to Americans with lower incomes. About a quarter of clinics who had previously received Title X funding, including Planned Parenthood, withdrew from the program when the rule was implemented in 2018. The rule is slated to be revoked on November 8. (The Hill, Axios, Roll Call)

Testing, testing, COVID-19 testing

  • President Biden announced a $2 billion investment in rapid, at-home COVID-19 tests. The cash infusion will roughly quadruple the nation’s supply of tests by December, which is likely to be welcome news for the millions of Americans who must undergo frequent COVID-19 testing as part of efforts to reopen the country. The news will also likely be welcomed by the U.S. Senators who questioned the Secretary of Health and Human Services on why affordable, rapid tests were not widely available in the United States. (STAT, The Hill, POLITICO)
    • Read more: Earlier this week the Food and Drug Administration (FDA) authorized another rapid COVID-19 test. (FDA Press Release)

The difficult decision facing Democrats

  • After Democrats reached an impasse on the size of their reconciliation package, the party is now looking to pare back the size of the $3.5 trillion bill to appease Senators Joe Machin (D-W. Va.) and Kyrsten Sinema (D-Ariz.). Representative Pramila Jayapal (D-Wash.), chairwoman of the Congressional Progressive Caucus (CPC), has said CPC lawmakers will accept a bill between $1.5 trillion and $3.5 trillion. The question now becomes what healthcare priorities are included and excluded from the bill. Some moderates have proposed introducing a “means test” that would make wealthy Americans ineligible for Medicare. Others have proposed “sunsetting” certain policies after three to five years as a cost-saving measure. (The Hill, POLITICO)

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Preparing for the Zombie Apocalypse Festival

Hot Topics | October 1, 2021

Welcome to October, ladies and ghouls. This month Policy News from Goodfuse will be sharing the scariest stories to ever emerge from Washington, D.C. and the halls of the U.S. government.

We kick off the month by briefing you on STRATCOM 8888, the U.S. Strategic Command’s plan to combat a zombie invasion, which “was not actually designed as a joke.”  This 16-page unclassified government document addresses threats from various types of zombies including: Pathogenic Zombies, Radiation Zombies, Evil Magic Zombies and Chicken Zombies. According to the document, “although it sounds ridiculous…[the Chicken Zombie] is actually the only proven class of zombie that actually exists.

STRATCOM 8888 was not a Department of Defense April Fool’s joke, but you should know that the fictional scenario was created as a training exercise that would avoid a diplomatic incident by naming real-world countries as the antagonists in a mock wartime scenario.

Or perhaps STRATCOM 8888 isn’t a training exercise and the government really is planning for a zombie apocalypse. A spooky thought to ponder as you read this week’s round up of public policy news:

Drug pricing download

  • Several media outlets published scoops on the rapid developments in the debate on drug pricing reform:
    • The Senate Finance Committee is considering a policy that would exempt small biotech companies from drug pricing reforms. (STATfull text below)
    • The House Judiciary Committee voted to advance three bills that would ban pharmaceutical companies from using certain practices that raise drug prices and prevent competition. (Reuters)
    • The Washington Post analyzed how a handful of moderate House Democrats are imperiling the Biden administration’s plans to reform drug pricing. (The Washington Postfull text below)

 Healthcare spending on the chopping block

  • Ideological differences within the Democratic Party are forcing leaders to explore spending cuts to healthcare priorities in $3.5 billion reconciliation bill. Funding for long-term care services and plans to expand Medicaid are among the line items expected to face the heaviest cuts. (POLITICO, Axios)

White House sides with insurers

  • As part of the implementation of a new law preventing surprise medical bills, the Biden administration has sided with insurers over providers. At issue is how disputes over surprise medical bills are resolved. Independent mediators charged with resolving billing conflicts will be directed to “favor a payment metric related to providers’ existing contracts with insurers.” (STATfull text below)

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Falling for the H Street Festival

Hot Topics | September 24th, 2021

Last Saturday, the 16th annual H Street Festival took place in Washington, D.C.’s historic H Street Corridor neighborhood. The event features artwork across various mediums including visual art, music, dance, performance and poetry. From humble beginnings as a 500-person block party, the H Street Festival has grown 300-fold and now attracts 150,000 participants across 11 city blocks.

The festival has played a role in the neighborhood’s revitalization and economic growth. The core of H Street was hollowed out by the riots that followed Martin Luther King Jr.’s assassination in 1968. The neighborhood struggled to rebound in the later decades of the 20th Century. However, the commercial vacancy rate in the neighborhood has plummeted from 75% to under 5% over the past few years.

Were you at the H Street Festival last weekend? If so, we hope you will find this week’s round up of public policy news as enjoyable as the festival:

Bring on the boosters

  • On Wednesday the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) to the Pfizer/BioNTech COVID-19 vaccine for use as a booster shot in three groups of Americans: seniors aged 65 years and older, Americans aged 18 years and older who are at higher risk of developing a severe COVID-19 infection and workers who face an increased risk of infection in their workplace. (STAT, Roll Call, FDA Press Release) However, on Thursday, a Centers for Disease Control and Prevention’s (CDC) Advisory Committee recommended against authorizing boosters for Americans who may be at increased risk of exposure to COVID-19 in their workplace. (STAT, The Hill) The panel’s recommendations were non-binding, and CDC Director Dr. Rochelle Walensky ultimately decided to recommend boosters for this group in alignment with the FDA. (NPR)

Preparing for a drug pricing jam-boree

  • Democratic leadership in the House is pork-barreling drug pricing legislation into the party’s $3.5 trillion spending package. The move is meant to put moderate Democrats in a jam, as it would be politically difficult to vote down the entire bill. The drug pricing policy in question is House Resolution 3 (H.R. 3), which would allow the Department of Health and Human Services (HHS) to negotiate the price of certain drugs on behalf of Medicare. H.R. 3 is designed to generate up to $700 billion in savings over 10 years, which would help pay for some of the Democrats’ top policy priorities. (POLITICO)
    • Read more: Meanwhile, on the other side of the Capitol, a Senate panel is expanding plans to penalize industry companies who raise drug prices faster than inflation.(STAT).

Testing, testing, 1-2-3

  • A shortage of COVID-19 rapid tests is threatening to undermine President Biden’s plan to deploy widespread testing as a means to curb the latest wave of the COVID-19 pandemic. Pricing could also be an issue, as the cheapest tests still cost at least $15 for a two-pack. The administration has largely been focused on vaccines, but experts are saying the government needs to invest more in testing as the pandemic enters its second winter. (Axios, The Hill)

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One of Washington’s coolest museums

Hot Topics | August 27th, 2021

Are you hungry for some culture? You could head to the National Mall and visit one of the Smithsonian museums, or you could head to The Fridge (capital “T” capital “F”). Located in Southeastern D.C.’s Capitol Hill neighborhood, The Fridge is a gallery specializing in street art. Before you can visit The Fridge, you first have to find it. The museum is located at 516 ½ 8th Street SE, which is halfway down a back alley. You’ll know you’re in the right place if the alley is covered in wall-to-wall street art. Once you’ve located The Fridge, you’ll find exhibitions such as a street art sticker show.

Finding The Fridge might not be easy, but you’re exactly where you want to be if you’re looking for the healthcare public policy stories that were making headlines this week:

Pfinally approved

  • The Food and Drug Administration (FDA) granted full approval to Pfizer’s COVID-19 vaccine (Comirnaty) in people aged 16 or older on Monday. The approval came about nine months after the FDA granted the shot Emergency Use Authorization (EUA). Public officials are hopeful the full approval will help persuade unvaccinated Americans to get vaccinated. (FDA, STAT, POLITICO, Roll Call)

A multitude of mandates are materializing

  • A new wave of vaccine mandates came crashing down on the heels of Comirnaty’s approval. Public sector employees including New York City public school employees and all services members under the Department of Defense are now required to be vaccinated. (Axios, The Hill) The American Medical Association also issued a formal recommendation that both the public and private sectors mandate COVID-19 vaccinations. (The Hill)

How low will guidelines go?

  • Revised screening guidelines are recommending that Americans be screened for certain diseases at ever younger ages. Under new recommendations from the U.S. Preventative Services Task Force (USPSTF) issued earlier this week, Americans should now be screened for Type 2 diabetes starting at age 35. (Axios) Earlier this year, the USPSTF issued updated screening guidelines which lowered the age at which certain Americans should be screened for lung cancer. For a quick refresher, check out our newsletter from March 12.

Doubling down on drug pricing reform FTW

  • The White House is going all-in on drug pricing reform as it seeks to help shepherd a $3.5 trillion reconciliation bill through Congress. Officials in the Biden Administration are touting the popularity of a proposal that would allow Medicare to negotiate prescription drug prices to help ensure Democrats fall in line behind the larger bill. With the White House confronting a number of policy challenges from Afghanistan to COVID-19, drug pricing reform is seen as an issue that can help shore up support for Democrats who are running for re-election in 2022. (POLITICO)

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Where Washingtonians go for Afternoon Delight

Hot Topics | August 20th, 2021

The story of Washington, D.C. singing/songwriting duo Taffy Nivert and Bill Danoff does not end in 1970 after they composed “Take Me Home, Country Roads.” (Read our last edition of Policy News for that tale.) A few years later Nivert and Danoff formed the Starland Vocal Band, which cult fans of 70’s pop music may know from their single “Afternoon Delight.” In this week’s edition of Policy News, we share the decidedly D.C. (and safe for work) origins of everyone’s favorite song about a midday tryst.

The year was 1974, and Bill was dining with friend and fellow Starland member Margot Chapman at Clyde’s restaurant in Georgetown. The two were having a late lunch, and Bill noticed that Clyde’s was serving a menu from three to six called “Afternoon Delights.” After having his fill of spiced shrimp and hot Brie with almonds, Bill went to visit Taffy who was recovering from a cervical cancer operation to explain that he was going to write a song about what afternoon delight “should be.” The song would go on to top the charts in 1976, although as Taffy would later joke: “The song was huge but no one could remember the name of the group!”

And now for this week’s healthcare public policy news, which we hope you’ll find interesting, if not delightful:

Big news on boosters

  • Amid rising infections from the Delta variant of COVID-19, the White House’s most senior health advisors announced on Wednesday that booster shots will be recommended for all Americans eight months after their last dose. The White House would like to begin offering booster shots the week of September 20th, though timing is subject to the Food and Drug Administration’s (FDA) review of clinical trial data and a recommendation from the Centers for Disease Control and Prevention (CDC). (Roll Call, Axios, The Hill)
    • Read more: This decision from the White House is not without its critics. A number of scientists and public policy experts have spoken out against the plan to offer Americans COVID-19 booster shots. (STAT)

A mandate that will impact millions

  • Also on Wednesday, President Biden announced that the approximately 1.3 million workers employed by nursing homes will be required to get vaccinated against COVID-19. Facilities whose workers are not fully vaccinated will have Medicare and Medicaid funding withheld. (The Hill, Axios) Associations representing providers were cool to the idea, expressing concern that the mandate would worsen staff shortages in the industry. (The Washington Postfull text below)

The tussle over drug price transparency

  • The U.S. Chamber of Commerce and the Pharmaceutical Care Management Association (representing the country’s pharmacy benefit managers) have filed a lawsuit against the federal government to stop a Trump-era regulation that would require the disclosure of prices for drugs and medical services. The lawsuit argues the regulation is illegal because of a change made to the proposed regulation that was incorporated into the final rule, as well as a potential conflict with an existing federal law. (Axios)

FDA Faces

  • Former FDA Commissioner Dr. Stephen Hahn gave an interview to the Associated Press (AP) where he advocated for additional safeguards to protect the agency from political interference. (AP – Washington Bureau)
  • Bloomberg reported that Acting FDA Commissioner Dr. Janet Woodcock is no longer under consideration to lead the agency permanently. (Bloombergfull text below)
  • Ellis Unger, the long-time head of the Office of Drug Evaluation-I, has announced he will retire after 25 years at the agency. (STATfull text below)

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