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Senate votes 99-1 for massive package to combat opioid crisis.  The Senate passed on Monday by a nearly unanimous vote a bill containing 70 measures aimed at fighting the opioid epidemic, setting up a conference with the House of Representatives to reconcile differences between the versions and send legislation to President Trump. The Senate’s Opioid Response Act includes measures that range from expanding access to treatments for opioid addiction to changing the packaging of opioids to prevent overuse. The measure passed 99-1, with Sen. Mike Lee, R-Utah, being the lone dissenting vote. “Opioids are our most serious public health epidemic,” said Sen. Lamar Alexander, R-Tenn., a lead sponsor of the legislation, on the Senate floor before the vote. Alexander said he hopes to hold a quick conference with the House and produce a final version by Friday. Then the House, which is out this week, will vote on the final version next week and the Senate the week after. Then the bill would go to President Trump, who has voiced support for some pieces of the legislation. The legislation is devoid of new funding for the crisis, but an appropriations bill that passed the Senate earlier this month included nearly $4 billion to boost grants to states to combat the epidemic.

White House touts bill’s passage: “This critical bipartisan legislation is a major step forward in the whole-of-government approach to combating drug demand and the opioid crisis,” the White House said in a statement. “The president and his administration continue to work toward and implement effective policies to address the opioid crisis and save lives.  The administration looks forward to working with both chambers as the legislative process continues to get a bill to the president’s desk to mitigate this crisis next door.”

Welcome to Philip Klein’s Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19).  Email [email protected] for tips, suggestions, calendar items and anything else. If a friend sent this to you and you’d like to sign up, click here. If signing up doesn’t work, shoot us an email and we’ll add you to our list.

Editor’s note: The newsletter will not be published on Wednesday in observance of Yom Kippur. We will resume on Thursday. May those observing have a meaningful fast.

Senate advances bill to end pharmacy ‘gag clauses.’ The Senate overwhelmingly passed a bill on Monday that would prohibit a controversial practice through which insurers and drug middlemen prevent consumers from paying less at the pharmacy counter on prescription drugs. Monday’s legislation, which passed by a 98-2 margin, would prohibit insurers and drug middlemen called pharmacy benefit managers from inserting “gag clauses” into contracts with pharmacies. The clauses prohibit pharmacists from informing consumers it is cheaper to buy a drug out-of-pocket rather than through their insurance.  The Senate earlier this month passed a bill that stopped private plans from inserting such clauses into Medicare Part D drug plans. The House Energy and Commerce Committee is considering its own version of the legislation to prohibit gag clauses for private plans. Pharmacy benefit managers oversee drug plans for an employer or union-sponsored insurance. Senators have targeted practices like gag clauses as part of a larger effort to boost transparency in the healthcare system.

Trump officials and Congress eye healthcare fraud and abuse rules. Medical providers have been pressuring Congress and the Trump administration to take a fresh look at conflict of-interest and anti-kickback rules, which they say have gotten in the way when different parts of the healthcare industry try to work together. It’s one of the grievances health officials hear about more than anything else. Industry groups say that the way the laws are written are getting in the way of value-based care, and that setting up arrangements to work together can bring about scrutiny and require difficult maneuvering. While the current regulations have dozens of exemptions to allow for some collaboration, healthcare providers say they are ambiguous and complex, requiring them to pay expensive fees to attorneys to make sure they aren’t running afoul. Trump officials are listening. The Centers for Medicare and Medicaid Services queried healthcare providers about potential changes to conflict-of-interest regulations, and the Health and Human Services Inspector General is gathering feedback on the anti-kickback laws. Proponents of keeping the laws in place say they are necessary to protect patients and government funds.

CMS unveils latest effort to reduce doc paperwork. The Centers for Medicare & Medicaid Services released on Monday a proposed rule aimed at curbing what it deemed burdensome and excessive Medicare compliance requirements for facilities. The agency claims the proposed rule would save healthcare facilities an estimated $1.12 billion annually. It is the latest move by the agency aimed at curbing burdensome regulations. Many of the proposals seek to “simplify or and streamline Medicare’s conditions of participation, conditions for coverage and other requirements for participation for facilities,” said CMS administrator Seema Verma in a statement.

Chuck Grassley announces Monday hearing to air Kavanaugh accusation. The Senate next Monday will hold a public hearing to give a “full airing” to accusations by a woman who said Supreme Court nominee Brett Kavanaugh sexually assaulted her at a party when the two were in high school. Senate Judiciary Committee Chairman Chuck Grassley, R-Iowa, said both Kavanaugh and his accuser, psychology professor Christine Blasey Ford, will testify. The move will delay a planned Thursday vote to advance Kavanaugh’s nomination and it comes after Democrats refused to participate in a Monday evening staff call with Kavanaugh and Ford, held separately. Grassley didn’t say when the vote might be rescheduled. Kavanaugh told Sen. Orrin Hatch, R-Utah, in a Monday phone call he was not at the party the accuser described and said it may have been a case of mistaken identity. Democrats sent a letter to the FBI Monday, asking the bureau to re-open a background probe into Kavanaugh. They want the FBI to handle the investigation, not Congress.

Obamacare insurers drastically lower proposed rates in Maryland after state moves to prop up marketplace. Maryland’s Obamacare insurers have dramatically slashed proposed rates for 2019 after the state took action to prop up the law’s insurance marketplace, from an average 30 percent increase to a nearly 14 percent decline. Maryland’s new proposed rates, which the state must still finalize, were disclosed during a public hearing on Monday. The state got federal approval to create a reinsurance program and passed a law to help stabilize the individual market, which includes Obamacare’s insurance marketplaces. With reinsurance, the state covers the highest medical claims from Obamacare insurers, thus creating an incentive to lower premiums overall. All of the state’s four Obamacare insurers lowered rates compared to their initial request earlier this year. CareFirst BlueChoice lowered their rate request from an 18.5 percent increase to a 22 percent decline. Kaiser Permanente plans also had asked for a hike of 37 percent and now asked for a decline of 6.3 percent. Some plans are still calling for rate hikes but at substantially lower rates. For instance, CareFirst BlueCross BlueShield had called for a rate hike of 91 percent for one plan but is only now calling for a 17 percent hike.

Justice Department approves $60 billion Cigna-Express Scripts merger. The Department of Justice on Monday approved a $60 billion merger between Cigna and Express Scripts, a transaction that could help reshape the healthcare industry at a time when the Trump administration is focused on lowering drug costs. The deal between the top insurer and middleman pharmacy benefit manager is expected to close by the end of 2018 but clearance is pending in several states, the companies said in a statement. In reviewing the deal, the DOJ said it analyzed whether the merger would hinder competition among pharmacy benefit managers or raise costs for rival health insurance companies who rely on the middlemen to create drug formularies and negotiate price discounts, among other services. “The merger is unlikely to lessen competition substantially in the sale of PBM services because Cigna’s PBM business nationwide is small,” Assistant Attorney General Makan Delrahim said in a statement. “The proposed transaction is unlikely to lessen competition substantially in markets for customers because at least two other large PBM companies and several smaller PBM companies will remain in the market post-merger.”

Activist investor Paul Singer may ditch bid for Athenahealth: Report. Activist investor Paul Singer’s Elliott Management is reportedly dropping its $160 per-share bid for Athenahealth, and other potential buyers are said to be reconsidering an offer. Singer might still make a smaller bid, potentially as low as $150 per share, the New York Post reported on Monday. As interest in the firm wanes, Athenahealth extended the final offer deadline to Sept. 27, according to the Post. Spokespersons for Athenahealth and Elliott did not immediately respond to a request for comment. Athenahealth previously pushed back against Singer’s claim that the company’s shareholders supported the hedge fund’s takeover attempt. The firm released a statement in May saying it would review the offer despite “attempts to publicly pressure the board and management team.” Soon after, co-founder Jonathan Bush — a cousin of former President George W. Bush — stepped down from his role as chief executive officer and board member, and the company launched a review of potential sale or merger offers.

RUNDOWN

Washington Post The health dangers don’t stop with a hurricane’s churning. They can get worse.
New York Times Can paying for a health problem as a whole, not piece by piece, save Medicare money?

Modern Healthcare Senator proposes federal curbs on balance billing

STAT News In response to critic, NIH alcoholism institute changes online explanation of cancer risk from drinking

FierceHealthcare Judge orders Lee Health to turn over records of sexual assault allegations against staff

Forbes Social determinants impede care of patients, 9 In 10 doctors say

Kaiser Health News Day-tripping to the dispensary: Seniors in pain hop aboard the canna-bus

Baltimore Sun STDs such as syphilis and gonorrhea rising rapidly in Maryland