‘Inflation Reduction Act of 2022’ Poised to Invest in Clean Energy; Make Tepid Changes to Prescription Drug Pricing

While bills pass or fail in the US House of Representatives with a simple majority, it generally takes 60 votes to get bills through the US Senate. An exception is that votes for ‘budget bills’ can pass with a simple majority. But, to qualify as a budget bill the Senate Parliamentarian must decide the elements of a bill fit the standards as a ‘budget bill’.

If the Parliamentarian agrees then the bill can sidestep the self-imposed Senate filibuster rule. Budget bills are often referred to as Reconciliation bills.

Last week Senators Schumer & Manchin announced a surprise deal on a FY 2022 reconciliation package that includes climate and clean energy provisions, reform to drug procurement within Medicare and some adjustments to tax policy. The bill, called the Inflation Reduction Act of 2022, is expected to be voted on in the Senate next week.

The draft agreed to by Schumer and Manchin invests approximately $370 billion in clean energy over the next 10 years – less than the $555 billion hoped for in the original Build Back Better legislation – but would be the largest climate investment in U.S. history.

While analysts are modeling the legislation now, sponsors of the bill suggest the bill would put the U.S. on a path to roughly 40% emissions reduction by 2030. President Biden praised this development and gave remarks on the bill earlier today encouraging Congress to pass and send to his desk immediately.

Revenue in the deal includes a 15% corporate minimum tax on book income and changes to carried interest treatment. Cost savings are booked due to tepid prescription drug pricing reform. Added expenses include energy and climate-related investments and an extension of Affordable Care Act premium subsidies.

Before the Senate can vote on the package the Senate Parliamentarian will need to certify that the bill qualifies as a budget bill (meaning it’ll just need 50 votes to pass).

Senate leadership hopes to pass the bill before recess (August 4), but procedural delays could make floor action slip into the following week. It is unclear if the House Speaker will call the House back into session in mid-August to pass the bill or wait until after Labor Day (if it passes the Senate).

Arizona Opioid Prescribing Rules Being Modified

ADHS is considering making changes to the opioid prescribing rules they promulgated a few years ago. Their draft rulemaking eliminates some of the more burdensome provisions of the rule that have been shown to be unsupported by evidence. Here are some of the highlights:

  • eliminates the requirement that a hospital obtain informed consent from an inpatient before the administration of an opioid.
  • grants hospitals more flexibility in how inpatients are educated on the risk and benefits of opioids.
  • grants hospitals more discretion on whether to conduct a substance use risk assessment on an inpatient who may receive opioids as part of treatment.

The rule incorporates the new law that passed last session allowing patients with chronic, intractable pain who have an established relationship with the prescribing medical practitioner to be able to get more than the 90MME cap.

Comments on the draft rule are due July 31 through an online survey found here.  

2022-07-20 PPAZ’s Response to AG’s Rule 60(b) MT FILED – DocumentCloud

More Meaningful Prescription Drug Price Reform That Could Have Been

The US House of Representatives previously passed a measure called “H.R. 3, the Lower Drug Costs Now Act of 2019” which would require HHS to negotiate the price of between 25-125 brand-name drugs without generic competitors. That negotiated price would be available Medicare, Medicaid, and private payers. Importantly, HR 3 also provides negotiating leverage to HHS.

It would have set an upper limit for the negotiated price equal to 120% of the Average International Market price paid by Australia, Canada, France, Germany, Japan, and the UK.

It would have also imposed financial penalties on drug companies that don’t comply with the negotiating process. Manufacturers that don’t negotiate would face an escalating excise tax on the previous year’s gross sales of the drug in question, starting at 65% and increasing by 10% every quarter to a maximum of 95%.

President Biden’s plan went even further than H.R. 3 by allowing Medicare to negotiate drug prices across the board, not just on 25–125 drugs (ending the drug companies into a panic).

He proposed allowing Medicare to negotiate a fair drug price for all drugs – including the costs of the research and development and a reasonable profit. Drug companies could then only set prices based on the rate of inflation after it’s determined how much they’ve invested and what a reasonable profit constitutes. Once Medicare negotiates a lower drug price, employer-based plans would get access to the same drug for the same price as Medicare.

Sadly, deep-pocketed lobbyists have the upper hand in the Senate- and if drug pricing reform happens this session in Reconciliation- it’s likely to be the watered-down version negotiated by Senator Sinema that makes some changes to drug pricing but is far less transformational than H.R. 3 would have been.

Is A Deal to Reduce Prescription Drug Prices Finally Here?

For the last 20 years, all Americans have been getting ripped off by pharmaceutical companies. The heist began when a prescription drug benefit was added for Medicare enrollees (Medicare Part D). Drug company lobbyists made sure Congress wrote the law to prohibit Medicare from negotiating drug prices.

As a result, Medicare pays 300% more for prescription drugs than in Europe or Canada, and close to 10x higher than in developing nations. That means every American who gets a paycheck is paying way more than necessary for prescription drugs.

We’re ALL being scammed, not just Medicare beneficiaries, because Medicare is financed with a (regressive) payroll tax.

Medicare Part D is financed by Medicare Trust Fund payroll tax revenue (71%), Part D premiums (17%) and state payments for people dually eligible for Medicare and Medicaid (12%)Employers & employees each pay a 1.45% tax on wages up to $200,000 (2.9% total) into the Trust Fund. Individuals (not employers) pay a 0.9% tax on income above $200,000 per year (no upper limit).

Because Medicare is paid for by a payroll tax, everybody who earns a paycheck is getting ripped off by drug companies- even if they’re not enrolled in Medicare and even if they don’t even take prescription drugs!

Negotiations are currently underway in DC to include reform of drug pricing through the budget reconciliation process. The details of the negotiations are being kept under tight wraps, but last October a negotiated compromise had been circulating that would make some modest prescription drug pricing reform (although it was watered down from the President’s proposal).

Previous AzPHA Blog Posts:

The plan that was shopped around last October would have reduced some out-of-pocket costs for seniors enrolled in Medicare Part D, but the Medicare Trust Fund will continue to be fleeced.

Here’s a summary of what the weakened October 2021 compromise bill included:

The first changes would come in 2023 when there will be a limit on annual price increases for existing drugs and out-of-pocket cost limits for insulin for Medicare beneficiaries.

There would be modest penalties if companies raise prices faster than inflation. The formula for penalties will consider prices charged to private health insurance to prevent them from shifting exorbitant prices to private health insurance.

In 2023, Medicare enrollees with diabetes would only have to pay $35 monthly copays for all insulin products covered by their prescription plan. People with private insurance would be able to also have their insulin co-pays capped a $35 copay.

Note: This policy will help the actual patients but will raise private health insurance premiums because the actual price that the drug companies charge health plans will continue to be unreasonable.

In 2024, there will be a cap on out-of-pocket costs for people enrolled in Medicare Part D (the prescription drug part of Medicare). The people that will benefit the most from the out-of-pocket caps will be folks with cancer, diabetes, multiple sclerosis, rheumatoid arthritis, and those who take combinations of expensive medicine for complicated health problems. Out-of-pocket caps would be $2,000 a year (the current annual out-of-pocket average for Part D people is $3,200 (2019).

A year later (2025), Medicare would FINALLY begin to be able to negotiate price with drug companies on a handful name-brand drugs, but drug companies will still be able to set launch prices for new meds. Medicare would only be able to negotiate the price for 10 drugs that year. The number of medicines with negotiated prices would slowly grow over time reaching 100 in several years.

For the 10 drugs that would be able to be negotiated under last October’s proposal, there will be a ceiling on the Medicare price that’s 60% of the existing market price. If the drug manufacturer doesn’t accept the negotiated price, the federal government can take up to 95% of the gross receipts from all sales (not just Medicare). But remember, this provision only applies to 10 of the thousands of drugs Medicare covers.

The drug company lobbyists were able to get to certain members of the Senate to get huge concessions on what would have otherwise been a strong bill:

  • Drug companies will still be able to set launch prices for new meds under Medicare;
  • Drug companies were able to limit the number of drugs whose prices can be negotiated (10 drugs beginning in 2025, but slowly increasing to more drugs over the years);
  • Numerous super-expensive medications are exempt from negotiation (half of the top 25 Medicare drugs care can’t be on the negotiation list); and
  • The first negotiation start date was pushed back several years (to 2025).

The October ’21 proposal didn’t use drug prices in the G7 nations as Medicare’s yardstick (greatly weakening the ability of Medicare to use overseas drug costs as a yardstick to compel honest negotiations).

The negotiations last October would have achieved tepid pricing reform. Not what we could have achieved, but it’s better than nothing.

World Health Organization Declares Monkeypox a Global Health Emergency

The Director-General of the World Health Organization declared monkeypox a global health emergency yesterday. Tedros Adhanom Ghebreyesus (the Director General) made the decision despite the fact that the WHO’s expert committee didn’t reach a consensus on whether to apply the highest level of alert to the virus.

Ghebreyesus made the decision despite a lack of consensus among the WHO committee (the Director General called himself the “tiebreaker”). Note: This is the first time a U.N. health agency chief has unilaterally made such a decision without an expert recommendation.

While a global emergency is the organization’s highest alert level, it doesn’t always mean a disease is highly transmissible or lethal. Similar declarations were made for the Zika virus in 2016 in Latin America and the ongoing effort to eradicate polio.

It’s unclear what exactly the designation will do to help mitigate monkeypox, but it might spur more investment in combatting the disease with vaccines etc. International collaboration among the member nations of the WHO generally improves when an emergency is declared.

WHO Recommended Control Measures

Monkeypox on the Rise in Arizona: What You Need to Know

Maricopa County Department of Public Health issued a press release this week announcing an increasing number of monkeypox cases.  While there are just a couple dozen cases under investigation (29 cases statewide as of this morning), there are probably many more in the community that are going undiagnosed. When a case is reported to MCDPH they do a case investigation and contact tracing.

Close (sexual) contacts of people who tested positive for monkeypox are offered the JYNNEOS smallpox/monkeypox vaccine (JYNNEOS is approved for both smallpox and monkeypox). Because the vaccine is given after the exposure, it’s called post exposure prophylaxis.

Why is the Monkeypox Vaccine in Short Supply When There Are 100 Million Doses in the Strategic National Stockpile?

Finding cases is harder than you might think. It’s unlikely than primary care and urgent care providers have ever seen a monkeypox case in their career. There’s also a learning curve for them when they do suspect a case because they need to figure out how to collect a specimen for laboratory testing, how to package it and where to send it. Complicating matters, in this outbreak, the rash is presenting in the genital/anal area.

There’s more and more evidence for pre-symptomatic spread- which is always an impediment for implementing effective control measures. In fact- whether there’s pre-symptomatic spread of monkeypox is probably a determining factor whether this outbreak can be stopped or whether this becomes an endemic illness.

Note: We badly need a new MMWR from the CDC to answer some of these key questions so county health departments and clinicians know how to proceed.

County health departments are urging clinicians to consider monkeypox in their differential diagnosis for patients who have a rash consistent with monkeypox and epidemiological risk factors for exposure to monkeypox (CDC link). 

Monkeypox testing is now commercially available.  Quest DiagnosticsLabCorp and Mayo Clinic Laboratories offer commercial testing, but clinicians need to can contact their commercial laboratory provider to determine the logistics for testing. 

Specimen collection involves swabbing a lesion vigorously with two sterile synthetic swabs with a plastic, wood, or thin aluminum shaft (no cotton swabs). Break off the end of each swab’s applicator into a 1.5-or 2-mL screw-capped tube with O-ring or place the entire swab in a sterile container. Store in a refrigerator or freezer within an hour of collection.

Here’s the laboratory specimen collection guidance for LabCorp, Quest Diagnostics, Mayo Clinic or CDC

Most people with monkeypox virus have a self-limiting disease course without treatment, however, a drug called Tecovirimat is approved by the FDA for the treatment of smallpox in adults and children and may be effective for the treatment of severe monkeypox virus.

WHO chief: Monkeypox now a global emergency

Mysterious Entity Files Lawsuit to Keep the Predatory Debt Collection Protection Act Off the Ballot this November

An entity named ‘Protect Our Arizona’ filed a lawsuit last Thursday afternoon trying to stop the Arizona Predatory Debt Collection Protection Act from being on the November ballot.

Who is this ‘Protect Our Arizona’ group?

The tradename ‘Protect Our Arizona’ was filed with the Secretary of State as a tradename for a political action committee by a guy named Youssef Khalaf of “100 Squared Financial” a couple of months ago.

It’s not registered with the Arizona Corporation Commission, so there are no statutory agents to identify, nor is there a way to tell who is funding ‘Protect Our Arizona’s’ action (that I know of). The only name I can find associated with this mysterious entity is Youssef Khalaf. Note: Yousseff Khalaf is also the treasurer for the Kari Lake campaign.

The lawyer filing the suit on behalf of this nebulous political action committee is a familiar name: Kory Langhofer – the very same flamboyant guy who was the lawyer for the Arizona Senate in the Arizona election audit boondoggle.

Read the Complaint

The suit alleges that the 100-word summary of the initiative is misleading and that some of the petitioners missed a detail or two on their submission forms. After reading the complaint it seems like Langhofer is splitting hairs & grasping at straws. But it doesn’t matter what I think- it only matters what a Maricopa Superior Court Judge thinks and potentially the Court of Appeals and maybe the AZ Supreme Court.

Note: The Arizona Public Health Association is publicly supporting the Arizona Predatory Debt Collection Protection Act because of the protective effect it will have on public health.

Read: Our Take: Vote YES On the ‘Predatory Debt Collection Protection Act’


AZ Behavioral Health Corp. Accepting Applications for the 2022 Eric Gilbertson Advocacy Institute

WHAT: Six-day overview of Arizona’s behavioral health system

WHERE: Recovery Empowerment Network, 212 E Osborn Rd, Phoenix, AZ

WHEN: Saturdays 9:30am to 4pm 

  • September 10, 2022
  • September 24, 2022
  • October 8, 2022
  • October 22, 2022
  • November 5, 2022
  • November 19, 2022

WHY: To better navigate the behavioral health system and obtain skills for self-advocacy & systematic change!

For an application, visit https://azabc.org/eg_institute/or call 602-712-9200 (ext. 208). 

Completed applications are due by Friday, August 19th and can be e-mailed to JodiH@azabc.org or mailed to ABC, 501 E Thomas Road, Phoenix, AZ 85012.

Note: There is a $10 non-refundable application fee and, for those accepted into the class, a $75 program fee.

AzPHA Webinar: “Arizona’s Bipartisan FY 2023 State Budget: Is It as Good as the Hype?”

Session Summary

Arizona’s state lawmakers recently passed a nearly 18-billion-dollar budget for state fiscal year 2023. The Governor hailed the bipartisan plan, saying the investments therein “will truly leave Arizona better than we found it.” The plan’s significant investments in water, education, and border security have made headlines – but what does it mean for public health?

View the 45-Minute Webinar
View Zaida’s PowerPoint

Zaida Dedolph Piecoro (Zeta DEE-Dolf Puh-COR-oh, pronouns she/her) is the director of health policy at Children’s Action Alliance and AZPHA’s policy director. Through her work in public health policy and advocacy, Zaida strives to promote community-driven solutions that promote health justice and access to care.

Zaida holds a BS in Anthropology and Bioethics from Loyola University Chicago and an MPH from the University of Arizona. Outside of (and sometimes during) work, she tries her best to wrangle a three year-old, several cats, and a giant tortoise.

Open Seat on the Arizona Asthma Coalition Board of Directors

The Arizona Asthma Coalition is interested in adding a member to our board who has skill and experience in public policy and advocacy. As part of our effort to improve the health and quality of life for all asthmatics in Arizona, this new board member’s portfolio will include:

  • Networking and building relationships with coalitions and partners
  • Informing the Board and stakeholders about emerging public policies that would have an impact on people with asthma
  • Advocating for public policies which support clean air, access to healthcare and best practices for preventing and treating asthma

The successful candidate will bring a strong public health policy perspective to our board. It currently includes physicians, nurse practitioners, a school nurse manager, respiratory therapists, asthma educators, program administrators and academic faculty in pharmacy and public health.

Relevant types of experience may include:

  • Participation in local and/or statewide public health coalitions and partnerships
  • Analyzing and summarizing public policy issues in writing
  • Sharing information about policies with a statewide audience
  • Tracking proposed legislation and sharing its relevance with stakeholders
  • Representing your organization’s policy positions in presentations, media or testimony

If you are interested in being considered for this position, please send a cover letter and CV to Lisa Rascon at lrascon@peds.arizona.edu.