It’s not looking good for Covid and monkeypox funding, problems ahead for PrEP, & the not-so-historic Juul settlement

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Republicans pan White House Covid, monkeypox funding request

GOP senators, to put it politely, aren’t too enthusiastic about the White House ask to pair Covid-19 and monkeypox response funding with a government funding bill before Sept. 30. Officials are asking for $22.4 billion for Covid-19, and $3.9 billion for monkeypox. I asked Republicans whether that’s something they could support, since even moderates in the GOP had soured on the prospect of emergency funding this summer. Here’s what they told me in the Capitol hallways:

Sen. Roy Blunt (R-Mo.): “Their credibility on this is not what it needs to be to pass a big bill with big numbers without a whole lot more specificity. And then on the Covid issue, the other thing is at some point, now that all the vaccines have been fully and finally approved, there’s no reason for the government to be the only payer for vaccines.” (Side note: New Omicron-specific boosters are authorized for emergency use, not approved.)

Sen. Mitt Romney (R-Utah): “I’m happy to discuss things, but we had a proposal together on a bipartisan basis, a $10 billion proposal, which had offsets. The current request in the White House has no offsets. It’s a very heavy lift, and it’s very unlikely that I or other Republicans would be inclined to support it.” (The White House argues that Republicans have supported emergency funding without offsets in the past, under presidents of both parties).

Sen. John Cornyn (R-Texas): “There’s all sorts of money floating around here from Covid that hasn’t been spent … that could be reprogrammed. So a bunch of new appropriations and deficit spending would be nothing but gasoline on inflation, which is something I think we would all want to avoid.”

Sen. Shelley Moore Capito (R-W.Va.): “They said before they didn’t have enough money for Covid and [they] didn’t get any more money, and they’ve been coping with it, so I think that’s questionable.”

Prepping for PrEP problems

The ACA was supposed to make pre-exposure prophylaxis — a highly effective HIV prevention drug known as PrEP — and all PrEP-related lab work and doctor’s visits completely free. But it has not always been free for patients, and access issues are playing out on both the Hill and in court this week. A new ruling from a conservative judge also jeopardizes the entire premise of making that care free.

Congress wants to know whether insurers are living up to their obligations to cover PrEP and related care. Five Democratic senators — Jeff Merkley, Tina Smith, Chris Van Hollen, Elizabeth Warren, and Bernie Sanders — today are sending a letter to Matt Eyles, the CEO of AHIP, giving him, health insurer’s primary lobbying group. They are giving Eyles 30 days to explain how insurance companies are complying with the ACA to cover PrEP at no cost and how AHIP and its members are working with people who have been “wrongfully charged.”

But even the baseline legal protections are under attack. Judge Reed O’Connor in Texas, a George W. Bush appointee who has ruled against the ACA whenever he’s had the chance, said yesterday the ACA violates religious freedom law by requiring insurers to cover PrEP. It’s highly likely HHS will appeal O’Connor’s decision. The Supreme Court shot down O’Connor’s most recent attempt to scuttle the ACA. HHS told STAT it “does not comment on litigation,” and if someone thinks they have been denied PrEP, “we would encourage them to file a complaint with the Office for Civil Rights.”

Blockbuster Juul settlement may not be a game changer, after all

A settlement two decades ago with states and cigarette companies transformed the way tobacco companies marketed their products forever — but Juul’s recent $438.5 million settlement with 30 states may not have the same impact, my colleague Nicholas Florko reports.

With this settlement, it doesn’t look like we’re going to get juicy internal document dumps, and there’s no guarantee that the settlement money will be used to tackle youth vaping. While the agreement does appear to include a number of restrictions on where and how Juul can advertise its products, Juul has already voluntarily agreed to many of the same restrictions or never used those tactics in the first place.

The full legal settlement documents aren’t released yet, but Nick’s got a great rundown of what to watch for to see if it will actually have any teeth.

There’s surprisingly little telehealth fraud in Medicare

A government watchdog isn’t too worried about large amounts of telehealth fraud, after all, my colleague Mohana Ravindranath reports in a new story this morning. Just a small fraction of telehealth providers billed Medicare in a way that suggests potential fraud or abuse, the HHS OIG found.

Another recent OIG report found some demographic trends among patients likely to use telehealth: urban Medicare beneficiaries were more likely than rural ones to use virtual care, for instance.

Lobbying groups welcomed the findings. “These reports add to the growing body of evidence showing that telehealth meaningfully expands access to care, and that long-term telehealth expansion is feasible with some limited steps to ensure continued oversight and evaluation,” the Alliance for Connected Care said in a statement.

Read more from Mohana here. And get more health tech news in your inbox by subscribing to STAT’s twice-weekly Health Tech newsletter, here.

The political dilemma of allowing tests for fentanyl

There are tools to help people detect fentanyl if it’s present in other drugs, but more than a dozen states have kept them illegal, my colleague Lev Facher writes.

The debate highlights a fundamental divide in U.S. drug policy. Conservatives, including law-enforcement officials, have long argued that tools used to test substances effectively condone drug use. Many health officials, researchers, and harm-reduction advocates, however, say that attitude misses an obvious reality: For millions of Americans battling addiction, quitting cold turkey is simply not an option.

The fentanyl test trips are illegal in 19 states, concentrated particularly in the South. Lev, who is a familiar name to D.C. Diagnosis readers, has more in his first deep dive for his new post as STAT’s first addiction reporter.

What we’re reading

• UnitedHealth signs a deal with Walmart for a new Medicare Advantage plan, STAT
• “The human psyche was not built for this:” How Republicans in Montana hijacked public health and brought a hospital to the brink, ProPublica
• Tobacco giant Philip Morris is investing billions in health care. Critics say it’s peddling cures for its own poison, STAT
• Pandemic readiness lobby draws in biotech, government members, Bloomberg
• Stress and depression are better long Covid indicators than physical comorbidities, new study says, STAT
• Pharma donations to patient charities may violate the ‘spirit’ of anti-kickback laws, STAT