By Megan R. Wilson

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In today’s issue:

• A new coalition hopes to help support the Trump administration’s moves to cover CBD under Medicare
• Medicare leaders aim to assuage insurers’ fears over the lower-than-expected Medicare Advantage rate proposal
• A historical look at how much the final Medicare Advantage payment rates differ from ones finalized by regulators

Good afternoon, and thanks for checking in with the Health Brief newsletter.

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	The Lead Brief

A coalition called the National Compassionate Care Council launched Wednesday to help shape the Trump administration’s move to expand access to cannabis treatments for people in Medicare — and hope to convince policymakers to go along with the policies, armed with research and patient perspectives.

In December, President Donald Trump directed federal agencies to dramatically loosen restrictions on marijuana, increase research on its potential medical uses and pave the way for increased access to hemp-derived cannabinoid products, also known as CBD.

“President Trump has opened new doors for health care and cannabis, creating unprecedented opportunities for innovation, research and investment,” said Sasha Kalcheff-Korn, a member of the coalition and executive director of nonprofit group Realm of Caring. 

“This decision paves the way for hemp-derived cannabinoids to move beyond the retail shelf and into conversations between patients, caregivers and health care providers," Kalcheff-Korn said.

Mehmet Oz, leader of the Centers for Medicare and Medicaid Services, said last year that his agency would be initiating a pilot program that will experiment with covering CBD treatments under Medicare. It would be the first time the government health program for older Americans and people with disabilities has provided coverage for cannabis-based treatments.

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Now, the coalition of medicinal cannabis industry players is working to support the CMS pilot program — anticipated to be released in April. It plans to work with the administration and meet with state and federal policymakers to talk about how the products are being used by patients.

“For millions of patients and the physicians who care for them, these therapies are not theoretical. They are already part of modern medical practice,” said Leigh Vinocur, the chief medical adviser of the National Compassionate Care Council.

Medicare’s CBD pilot program “marks a turning point for patients and the medical community,” the coalition said in the announcement of its launch, adding that it is “committed to the success of those initiatives and ensuring evidence-based policy reform.”

The National Compassionate Care Council describes itself as a bridge between “responsible manufacturers, the medical community and the mainstream federal health care system.”

Shawn Hauser, a partner at the firm Vicente, which is providing legal counsel to the coalition, said its members “are generating the real-world evidence needed to prove that therapeutic cannabis access improves patient outcomes and drives down the cost of care.”

The initial members of the National Compassionate Care Council include: Whole Health Oncology, Medterra, High Tide Inc., Nuleaf Naturals, Realm of Caring, Lazarus Naturals, Constance Therapeutics and Equilibria.

→ CBD products — such as beverages, gummies and creams — are made from a nonintoxicating compound found in cannabis. While some products do contain THC, the high-inducing compound found in the plant, others don’t get a person high and are used to help with pain, sleep, and other health conditions.

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What to watch: In November, Congress enacted appropriations legislation that bans hemp-derived products with levels of THC above 0.4 mg per container — a level that some hemp industry and consumer advocates argue is too low, even for CBD products that don’t produce a high. There’s a one-year phase-in of the language, which started a countdown on the efforts to roll it back.

→ Trump’s executive order from December instructs top White House legislative staff to work with lawmakers on Capitol Hill to update that cap in such a way that Americans benefit from CBD products “while preserving the Congress’s intent to restrict the sale of products that pose serious health risks.”

Director of Medicare Chris Klomp said CMS “cares deeply” about Medicare Advantage and sees it as an essential part of Medicare’s future. (Jabin Botsford/The Washington Post)

	Executive Health Brief

As insurers fret about the meager Medicare Advantage payment rate increase proposed by the Centers for Medicare and Medicaid Services, Medicare leader Chris Klomp on Tuesday wanted to assuage the industry’s fears.

The agency has proposed a .09 percent payment boost for Medicare Advantage plans, which many insurers argue is functionally a cut, with increased medical costs and more patients who are sicker — and therefore more expensive.

Speaking at the Better Medicare Alliance summit, Klomp said he’s seen headlines that insinuate the lower-than-expected proposed rate could signal how CMS feels about the Medicare Advantage program, which he says “would be inaccurate.”

If insurers are looking for reassurance, Klomp offered it: CMS “cares deeply” about Medicare Advantage and sees it as an essential part of Medicare’s future.

He acknowledged that plans need to show predictability and sustainability, both in the near term and over decades, and he said that beneficiaries also need stability. Klomp cited his own father, who has switched Medicare Advantage plans three times in three years as plan offerings cycled in and out of the market.

“That keeps us up at night. We care about that. That lack of stability is not a good thing,” Klomp said.

→ It’s an important point, because insurers have been arguing that the proposed rates — and some other changes to how reimbursements are calculated — would make providing coverage in some places too expensive. This could result in an increase in out-of-pocket maximums for people on Medicare Advantage or plans leaving certain areas entirely.

But predictability must be balanced with stewardship, Klomp said, and argued that lawmakers and beneficiaries must trust that CMS is guarding taxpayer dollars. Critics of the privately run Medicare Advantage plans have argued that they’re overcompensated compared to traditional Medicare.

Medicare Advantage, Klomp said, cannot become a “margin tack-on” to underlying traditional Medicare benchmarks.

Plans must also wrestle with underlying medical costs and deploy benefits toward their “highest and best use,” he added. “Not all benefits are created equal,” he said, pointing to restaurant gift cards that insurance companies will offer as a perk — sometimes to places that serve high-calorie, unhealthy foods. “Maybe that’s not the best thing on a prepaid card for the beneficiary.”

What’s next: The agency will finalize its rate proposal by April 6.

Both Klomp and John Brooks, the chief policy and regulatory officer at CMS, emphasized that they are reading all the comments and taking meetings from outside interests as the rules come together.

→ They both encouraged people to continue to weigh in and bring data to the agency about issues including underlying medical cost trends, and how policy changes impact smaller regional plans compared to national ones.

	Chart check

The federal government revises Medicare Advantage payment rates every year. In most years, the final rate has been higher than the one proposed. What’s unclear is how large the increase could be, if it happens, and whether it will be enough for insurers.

Here’s a great chart created by WP Intelligence researcher Kendrick Frankel detailing the proposed and final Medicare Advantage rates over roughly the last decade.

ICYMI: I snagged this chart from the in-depth report my colleague Rebecca Adams recently wrote that breaks down this year’s Medicare Advantage proposal from CMS. Read it here if you haven’t already.

	What We’re Reading

“Blackstone puts $400M into Teva, Sanofi gut disease drug,” Jonathan Gardner reports for BioPharma Dive.

“Two of the Biggest Patient-Assistance Charities Are Combining,” the Wall Street Journal’s Peter Loftus writes.

“The task force that shapes Americans’ preventive care has not met in a year. Doctors now worry it’s being ‘abandoned’ by HHS.,” Jacqueline Howard and Tami Luhby report at CNN.