Capitol Perspectives

The Capitol Perspectives column is written by John McManus, president and founder of The McManus Group, a consulting firm specializing in strategic policy and political counsel and advocacy for healthcare clients with issues before Congress and the administration. Prior to founding his firm, McManus served Chairman Bill Thomas as the staff director of the Ways and Means Health Subcommittee, where he led the policy development, negotiations, and drafting of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Before working for Chairman Thomas, McManus worked for Eli Lilly & Company as a senior associate and for the Maryland House of Delegates as a research analyst.
  • Trump Unveils Drug Reforms: Rebates To PBMs At Risk
    Trump Unveils Drug Reforms: Rebates To PBMs At Risk

    After months of delay and suspense, in a Rose Garden ceremony, President Trump and HHS Secretary Alex Azar announced a comprehensive approach to prescription drugs, which they claimed would address major challenges.

  • Congress Tackles The Opioid Crisis

    After passing a gargantuan appropriations bill that balloons the deficit by hundreds of billions and funds the government through October, the conventional wisdom in Washington is that Congress is done legislating for the rest of the year, save one major issue: addressing opioids.

  • Vertical Mergers Of Rx Supply Chain Spark Antitrust Concerns

    The recent announcement of two vertical mergers ­— the $52 billion acquisition of Express Scripts, the largest pharmacy benefit manager (PBM) in the country, by Cigna, and the $69 billion purchase of Aetna by CVS Health — raise significant antitrust concerns over how these megacompanies will impact patient access and pharmaceutical pricing.

  • Republicans Forsake Fiscal Restraint And Market-Based Healthcare

    In an incredible show of profligacy, Republicans forsook any notion of fiscal conservatism by substantially increasing discretionary spending by over $2 trillion over the next decade, less than two months after cutting taxes by $1.5 trillion over that same time period.

  • Government’s Absurd View Of The Healthcare System

    The absurdity of the U.S. government’s perspective on the implementation of government-run health programs came into focus recently in the Republican tax overhaul bill as well as the rollout of the new Medicare physician payment system.

  • CMS Opens Path To Reform Of Part D

    Pressure had been building for more than a year for something to be done about drug prices, and specifically inflated list prices to the patient at the pharmacy counter that do not reflect the substantial rebates manufacturers are providing. Where was all the money going? How could the list price and patient copays for drugs keep rising when the net prices — accounting for manufacturer rebates — stayed level?

  • Trump Surprises: 340B Reform And Pharmaceutical Exec For HHS

    Policymakers recently have focused on the 340B program as its size increased. Whole cottage industries have been created that instruct how hospitals and contract pharmacies can profit from the loose regulations, to the point that the drug industry can no longer overlook the market inefficiencies Yet despite several oversight hearings by the House Energy & Commerce Committee, Congress could not come to a consensus on how to reform it.

  • Republican Dysfunction Could Result In Radical Democratic Health Agenda

    Many analysts believe the Republican base’s frustration with the inability of the party to repeal Obamacare makes a Democrat takeover of Congress in 2018 a real possibility. An examination of Democratic health priorities is therefore in order.

  • What Does The Trump Pivot Mean For Healthcare?

    Frustrated with congressional Republican inaction on major pieces of his agenda, President Trump cut deals with Democrats on a short-term increase in the debt ceiling and funding the government. Then to the surprise and consternation of his base, Trump agreed to work on a deal to extend DACA, a Democratic priority. But what does Trump’s new interest in working with Democrats mean for healthcare policy-making? That is not yet clear.

  • Part D Is Due For A Tune-Up

    Lost in the hubbub over drug pricing has been the flat and declining spending recently in Part D. The Congressional Budget Office’s (CBO) June 2017 Baseline projections show that Part D spending stabilized at $95 billion annually for 2016 and 2017 and will decline to $92 billion in 2018.

  • 340B Reform Gets A Kick Start

    This month, our Washington D.C. insider discusses the 340B drug discount program and the 340B Hospital Outpatient proposed rule. “Notwithstanding the hoopla over the CMS proposal, a proposed rule does not necessarily mean it will become finalized policy.”

  • Path Forward On Obamacare Replacement?

    After the House of Representatives passed The American Health Care Act — the bill that would replace Obamacare — by a razor-thin margin, consideration moved to the Senate, where Republicans have only two votes to spare to secure passage.

  • Drug Costs Moderating, But Growing Copays Fuel Ire

    At a Stanford University conference last week, Office of Management and Budget (OMB) Director Mick Mulvaney said President Trump keeps asking him what he is doing to address the high cost of pharmaceuticals.

  • Provider Consolidation Raising Costs And Undermining Competition

    As Republicans attempt to recover from their face-plant on repealing and replacing Obamacare, policymakers are grappling with how to address the growing problem of healthcare provider consolidation, which appears to be raising costs and undermining competition.

  • Repeal & Replace Confronts Trump’s Base

    To understand the political peril Republicans confront in their effort to repeal and replace Obamacare, it is worth noting that many of the areas that gained the most coverage from Obamacare are the working-class districts carried by President Trump with the largest margins.

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