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—Sen. Bernie Sanders is releasing a new version of “Medicare for All” legislation this morning.

—The top three insulin makers and pharmacy benefit managers step into the hot seat today at a congressional oversight hearing on the rising costs of the diabetes treatment.

FACT: Europe used to be the global leader in medical innovation. In 1986, biopharmaceutical R&D investment in Europe was 24% higher than in the US. Today, after adopting reference pricing, Europe trails the US by over 40%. Foreign reference pricing could hand America’s global leadership to someone else. Learn More.

Welcome to Wednesday PULSE, where your author is reminding everyone that congressional spring break (err, recess) is just around the corner. Dan Diamond will be back at the helm tomorrow. Greet him with tips at

SANDERS TO UNVEIL ‘MEDICARE FOR ALL’ BILL – Sen. Bernie Sanders will unveil a revamped version of his Medicare for All legislation this morning, switching the Washington health care conversation back to the progressive plan dividing Democrats – and away from President Donald Trump's efforts to tear down Obamacare.

The Sanders bill will largely be similar to the version he introduced in September 2017. And it again comes with the support of several high-profile colleagues, who are now also running for president.

What's changed: The bill will now include coverage for long-term care services, bringing it in line with the House version, H.R. 1384 (116), introduced in February. The bill has lost one co-sponsor since 2017 who's still in the Senate: Jeanne Shaheen of New Hampshire, who said she's backing more incremental plans to expand coverage.

What hasn’t changed: Four candidates for the Democratic nomination are again expected to co-sponsor the bill – Sens. Kirsten Gillibrand, Elizabeth Warren, Cory Booker and Kamala Harris.

TODAY: THE INSULIN PRICE SHOWDOWN – The three top insulin makers and the three largest pharmacy benefit managers testify about the diabetes medicine’s soaring cost in front of the House Energy and Commerce’s oversight subcommittee this morning. While there have been a slew of drug pricing hearings this year, this will be the first to jointly call up pharmaceutical companies (Eli Lilly, Novo Nordisk and Sanofi) and the middlemen (CVS, Express Scripts and OptumRx). That sets up a brawl about insulin’s steadily climbing list prices (700 percent over 20 years) and the heavy rebates that drugmakers argue are driving the trend.

The three major PBMs on Tuesday were at the Senate Finance Committee, where senators grilled them — along with relatively smaller PBMs, Humana and Prime Therapeutics — on rebates and whether the middlemen benefit from higher prices. PBMs denied that they discouraged slashing prices, and some pledged to get on board with legislation to provide their rebate data to congressional advisers. More for Pros.

Meanwhile both sides scale up insulin access efforts. Sanofi announced it would expand a savings program allowing patients with high out-of-pocket costs to pay $99 per month for 10 boxes of insulin pens, or 10mL vials, dropping down from $149 for a box of pens in the same program last year. Sanofi’s plan comes one week after Cigna announced a deal with all three drugmakers to cap monthly insulin costs for its commercially insured consumers at $25.

BRAIN DRAIN IN CMS’ MEDICAID DIVISION – Two career staffers are leaving the CMS office overseeing Medicaid and the Children's Health Insurance Program, the latest in a string of departures at the agency, POLITICO’s Rachana Pradhan scoops. Including the latest exits, at least five people have decided to leave the Center for Medicaid and CHIP Services since the start of the year.

Who’s out this time: Michael Nardone, who joined CMS in early 2016 and ran the Medicaid division's Disabled and Elderly Health Programs Group, is retiring from the agency this month. Jim Golden, who reports to Nardone and is responsible for policy implementation and oversight of Medicaid managed care companies, is also leaving. More for Pros.

PRIMARY CARE ANNOUNCEMENT COMING APRIL 22 – The CMS Innovation Center director, along with HHS Secretary Alex Azar and CMS Administrator Seema Verma, invited stakeholders to an “exciting discussion on primary care delivery, including care for the complex, chronically ill” at the American Medical Association’s office, according to an invite CMMI Director Adam Boehler sent stakeholders and obtained by your author. A CMS spokesperson confirmed that an event is scheduled for April 22, and it will be open to the press, though the spokesperson didn't confirm the event's contents.

Provider groups have been anticipating a primary care announcement for months. It's been known that CMMI has been working on a new track to an existing primary care model, as well as developing a project to test direct contracting. POLITICO recently asked Boehler if the two concepts would be merged into one model or separated. He responded that they're different, but, “the way we thought about them together is when we do talk about these, I want to make sure we announce a broad spectrum. If you just look at one thing, then someone may not know the other options.”

COURT GRANTS WISCONSIN’S REQUEST TO DROP OUT OF TEXAS V. AZAR – Wisconsin’s request to be dropped from the federal lawsuit seeking to strike down all of Obamacare has been granted by a federal appellate court. Wisconsin was a co-leader on the lawsuit when the state's previous Republican attorney general filed it with 19 other GOP-led states last year. The state's withdrawal won't have a practical impact on the lawsuit going forward.

FEDS CHARGE 24 IN TELEMEDICINE FRAUD SCHEME – A series of payments were allegedly made to physicians and telemedicine companies to get them to prescribe medically unnecessary back, shoulder, wrist and knee braces, according to a DOJ announcement. Medicare was reportedly billed $1.7 billion, of which $900 million was paid out in one of the largest fraud schemes HHS and the FBI have investigated together. More for Pros.

INNOVATIVE APPROACHES TO HEALTHCARE: Socioeconomic status, housing affordability, access to quality food and public safety have a huge influence on health outcomes. In Philadelphia, many of the city’s doctors, hospitals, health care providers and community groups experiment with alleviating social conditions for their patients in order to improve care. Join POLITICO in Philadelphia on Tuesday, 9/24 to explore the innovative approaches we’re seeing in Philadelphia to improve health outcomes among the city's most vulnerable residents. RSVP NOW.

FDA announces new opioid label requirements. The changes are intended to help health care providers safely decrease the dose in patients who are physically dependent on pain medications. They were spurred by reports of serious harm, including withdrawal symptoms, uncontrolled pain, psychological distress and suicide in opioid-dependent patients who abruptly had their medicines discontinued or the doses rapidly decreased, the agency said. More for Pros.

Indivior indicted over opioid treatment – A federal grand jury indicted the drugmaker Tuesday in a nationwide scheme to allegedly boost prescriptions for Suboxone Film used to treat opioid addiction. The company is accused of increasing prescriptions by deceiving health care providers and benefit programs into believing the medication is “safer” and “less susceptible to diversion and abuse” than other similar medications, according to the indictment.

IDAHO LIMITS VOTER-BACKED EXPANSION – Idaho Gov. Brad Little signed legislation to add work requirements to the Medicaid expansion voters approved in November. The state follows Nebraska and Utah, which also placed limits on an expansion approved by a ballot initiative.

But Little, a Republican, noted his concerns about the idea, citing “costly lawsuits” over similar work requirements that were recently struck down in Arkansas and Kentucky. More for Pros.

TEXAS SENATE PASSES BILL TO MOVE SMOKING AGE TO 21 – A bill (TX SB21 (19R)) prohibiting sales of tobacco products and e-cigarettes to people under the age of 21 got preliminary approval from the Republican-led chamber on Tuesday after a short debate. Senators attached an amendment that would exempt active duty military personnel from the ban. Similar legislation (TX HB749 (19R)) unanimously passed a House committee last month. If it passes, Texas would join a handful of states – mostly blue ones – raising the tobacco age to 21.

CAP examines underlying problems with the long-term care workforce: A new report from the liberal Center for American Progress highlights several shortcomings with the country’s current system for providing long-term care services. It provides suggestions for lawmakers, like increasing workers’ wages, and funding workforce development opportunities. Read the report here.

STAT’s Andrew Joseph reports on how donations to Tufts University School of Medicine advanced the interests of Purdue Pharma. More.

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The New York Times explores how misinformation is driving the measles outbreak among ultra-orthodox Jews in New York. More

Bowing to pressure from the Trump administration, the Texas Tech University Health Sciences Center has agreed to stop using race in medical school admissions, The Washington Post reports. More.

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