Controversial Louisiana health official tapped as no. 2 person at CDC

Louisiana Surgeon General Ralph Abraham — who ordered his health department to stop promoting mass vaccinations this past winter and has promoted certain discredited treatments — has been named principal deputy director at CDC, according to a spokesperson for HHS.

Currently, CDC does not have a permanent director. Over the summer, CDC Director Susan Monarez was ousted by HHS Secretary Robert F. Kennedy Jr. and HHS Deputy Secretary Jim O'Neill has served as acting CDC director since. As a result, Abraham would essentially be running the agency in his position, the Washington Post reports.

During his time as surgeon general in Louisiana, Abraham drew criticism for instructing health officials to stop promoting vaccines, including flu shots, and instead emphasize personal choice and consulting with providers. Abraham also said during a legislative hearing last year that he regularly sees patients injured by COVID-19 vaccines and that these alleged adverse reactions were being covered up. He has also supported research into the claim that vaccines can cause autism.

Before serving as surgeon general, Abraham spent decades as a physician and a veterinarian before winning a congressional seat representing Louisiana in 2014. In 2020, he retired from Congress.

During the COVID-19 pandemic, Abraham promoted hydroxychloroquine and ivermectin as COVID-19 treatments, two drugs that have been shown to be ineffective against COVID-19.

(Sun, Washington Post, 11/25; Mandavilli, New York Times, 11/27)

US announces new negotiated drug prices

The Trump administration last week unveiled new, lower prices for 15 common or high-priced medications. The new prices are a result of price negotiations between Medicare and drugmakers established under the Inflation Reduction Act in 2022.

In a press release, CMS announced that new prices on the 15 drugs, which include widely used inhalers,  treatments for cancer, diabetes, depression, and the GLP-1 medications Ozempic and Wegovy, would have saved Medicare $12 billion in 2024 and reduced its spending on those drugs by 44%. Prices for drugs on the list have been cut by between 38% and 85%, CMS said.

The new prices are slated to take effect in January 2027.

In a statement, AARP CEO Myechia Minter-Jordan said the lower drug prices "will bring meaningful relief to millions of people."

(Robbins, New York Times, 11/25; Vinall, Washington Post, 11/26; Dunleavy, Fierce Healthcare, 11/26; CMS press release, 11/25)

CMS proposes overhaul of Medicare Advantage star ratings

CMS last week issued draft regulation that proposed overhauling the Medicare Advantage star ratings system by eliminating 12 quality measures and removing a health equity award.

Specifically, CMS proposed cutting 12 metrics that focused on administrative processes where health plan performance is usually high and beneficiaries aren't able to distinguish between different offerings, as well as cutting the Excellent Health Outcomes for All reward, which was designed to incentivize plans to improve care for low-income or disabled enrollees.

The draft regulation also invites public input on how CMS should overhaul risk adjustment and other policies related to Medicare Advantage. CMS said the request for information aims to ensure smaller and newer insurers, as well as insurers that cover a higher proportion of sicker people, are not disadvantaged.

(Early, Modern Healthcare, 11/25; Olsen, HealthcareDive, 11/26; Tepper, Modern Healthcare, 12/1; Morse, Healthcare Finance, 11/26)

HHS makes changes to vaccine advisory committee ahead of next meeting

HHS on Monday announced that Martin Kulldorff, the chair of the Advisory Committee on Immunization Practices (ACIP) at CDC, will be moving to an official role within HHS.

Kulldorff is a Swedish biostatistician and previous member of ACIP's vaccine safety subgroup and FDA's Drug Safety and Risk Management Advisory Committee. Kulldorff helped develop statistical tools for CDC's Vaccine Safety Datalink project, which tracks adverse vaccine effects.

He also cowrote the Great Barrington Declaration, alongside NIH Director Jay Bhattachrya, in 2020, in which he and his coauthors advocated for lifting lockdowns to build herd immunity to COVID-19. Kulldorff became a leader at the Brownstone Institute in 2021, a think tank based on opposing COVID-19 restrictions that has also published articles disputing the safety of COVID-19 shots and other vaccines.

Kulldorff was named chair of ACIP earlier this year after HHS Secretary Robert F. Kennedy Jr. fired and remade the entire committee.

"Martin Kulldorff transformed ACIP from a rubber stamp into a committee that delivers gold-standard science for the American people," Kennedy said. "I'm glad to welcome him to my team to help develop bold, evidence-based policies to Make America Healthy Again."

Kirk Milhoan, a pediatric cardiologist and former U.S. Air Force flight surgeon, will replace Kulldorff as chair of ACIP. Milhoan has also been a prominent vaccine critic and previously argued vaccines were ineffective and that only natural immunity could end the COVID-19 pandemic.

The move comes ahead of ACIP's next meeting, where the panel seems poised to make significant changes to the childhood vaccination schedule. ACIP members may also question the safety of certain ingredients like aluminum salts that are present in many childhood vaccines.

(Choi, The Hill, 12/1; Mandavilli, New York Times, 12/2)

WHO releases its first guidelines on GLP-1s

The World Health Organization (WHO) on Monday released its first-ever guidelines on the use of GLP-1 medications for treating obesity as a chronic illness.

In a release, WHO said the guidance aims to help reduce "skyrocketing health costs" associated with obesity, which are projected to cost the global economy $3 trillion by 2030.

WHO's guidelines state that GLP-1s can be used for the long-term treatment of obesity in adults, excluding pregnant women. The recommendation is "conditional" since there is currently "limited data on their long-term efficacy and safety."

WHO Director-General Tedros Adhanom Ghebreyesus said that GLP-1s should not replace the need for a healthy diet and physical activity.

"These new medicines are powerful clinical tools offering hope to millions. But let me be clear: medicine alone will not solve the obesity crisis," he said. "Obesity is a complex disease that ... has many social, commercial, and environmental determinants requiring action in many sectors — not only in the clinic."

(Choi, The Hill, 12/1; Monaco, MedPage Today, 12/1)

CMS to phase out 'inpatient-only' list

As part of CMS' Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rules for 2026, which were finalized last week, CMS said it will phase out the Medicare Inpatient-Only List over the next three years, which includes codes that Medicare only reimburses in inpatient settings.

The inpatient-only list currently contains 1,731 billing codes for procedures that CMS deems appropriate only in inpatient settings. Procedures are assigned to this list when CMS determines their invasiveness, complexity, and recovery time require inpatient care and monitoring.

The first stage of the phase-out plan will allow outpatient providers to bill for 285 musculoskeletal codes that are currently only reimbursable for inpatient hospitals.

Ultimately, eliminating the list will allow outpatient providers like ASCs to be paid for an array of services. "CMS believes that the evolving nature of the practice of medicine allows more procedures to be performed on an outpatient basis with a shorter recovery time," the agency said in a press release. "This policy allows for these services to be paid by Medicare in the hospital outpatient setting when determined to be clinically appropriate, giving physicians greater flexibility in determining the most appropriate site of service."

Shannon Bibbins, director at Optum Advisory Services*, said the changes for the inpatient-only list "suggest a phased approach to removing certain procedures from the [inpatient-only] list over time."

"This gradual implementation aims to allow hospitals, providers, and case management teams to adapt to new billing, clinical, and documentation requirements. The changes could impact hospital revenue streams, increase administrative workload for providers, and require case management teams to update workflows and ensure appropriate patient status determinations," Bibbins said. "Overall, the proposal is expected to promote flexibility but may also present operational challenges for healthcare organizations as they adjust to the revised guidelines."

*Advisory Board is a subsidiary of Optum. All Advisory Board research, expert perspectives, and recommendations remain independent.

(Early, Modern Healthcare, 11/26)