“It was like, we’re going to take off your head, we are going to come after you,” said Seema Verma, the Centers for Medicare and Medicaid Administrator in the Trump administration, during an on-stage interview at the 2023 Asembia Specialty Pharmacy Summit.
In an on-stage interview with Adam Fein, Ph.D., the drug pricing guru who enjoys headliner status at the Asembia Specialty Pharmacy Summit meetings, Seema Verma, M.P.H., talked about Medicare costs, value-based care, interoperability and the other kind of serious topics you would expect a former administrator of the Centers for Medicare and Medicaid to hold forth on.
Verma is now an executive with Oracle, which acquired Cerner, the electronic health record company, last year and she said her belief in the benefits of technology and interoperability was one reason she is working for Oracle.
“I think we got to get the system to work better and (improve) that flow of data so people have their information at the right time and at the right place,” she told Fein and a large audience on Tuesday.
Less expected were her remarks on her experience serving in the Trump administration. Verma was embroiled in a series of controversies and ethical problems as CMS administrator. Fein steered clear of asking specific questions about those issues in the friendly interview format but did get Verma to open up about her subjective experiences.
“It was a tough environment. Make no mistake. It (was) not a normal work environment where you disagree with somebody and it is disagreement. Over there, it was like, we’re going to take off your head, we are going to come after you. It (was) a pretty toxic environment. Every day, you are kind of like ‘what is going to happen today?’”
Verma said she stopped watching TV: “There was so much drama that it got to the point where I couldn’t watch TV anymore. My daily life had so much drama in it that watching TV was boring.”
Verma said she was motivated overall by a desire serve her country and improve healthcare. Comparison with people in the military, “who were getting shot at” put her difficulties in perspective: “I am going to tolerate, I am going to deal with it.”
Verma drew an analogy to her experience as a new mother to illustrate what her experience as CMS administrator was like. “Those early days of parenting. ‘Oh, I just had a baby, this is wonderful,’ and you are hopeful and you are excited. And then you get pooped on, you are waking up every two hours, you get thrown up on. But you are keeping that big picture — isn’t this great — but you are getting pooped on everyday. It is kind of like that.”
The audience laughed and then applauded.
Fein quipped, “Now you know what it is like working at CMS.”
In discussing value-based care, Verma said that the many models that CMS had launched didn’t work very well, resulting in no savings and mixed results on quality. Even so, she said the government should move more aggressively toward making some models required.
“For a lot of folks I think they have analyzed it and figured out that it is not worth it or it is too much of change, they don’t want to do it. I think we need to get there as a system, so maybe a larger push.”
Fein and Verma also discussed value-based payment for drugs, and
Verma mentioned some of the logistical and other difficulties with tracking patients and outcomes. She said that a value-based payment scheme for CAR-T cancer drugs was put together over a year’s time when she was CMS administrator but was shelved.
“We got that sucker all the way through,” said Verma, “got everybody to agree, got OMB, which is always the really hard folks, and everybody was aligned. And then one of the more political people said, ‘Gosh, you know, CAR-T is coming out at half a million, is this then an implicit endorsement of these very (high-priced) drugs.'"
Prompted by Fein to comment on the accelerated drug approval and Aduhelm (aducanumab) in particular, Verma was critical of the Biden’s administration decision to making Medicare coverage contingent on enrollment in a clinical trial. She said she had worked with FDA commissioners during the Trump administration on the concept of “coverage with evidence” that would depend on patient registries to track outcomes but that requiring clinical trial enrollment went too far and had the effect of undermining the FDA’s approval decision.
“I think it is a real problem when you have group of scientists conflicting with another (group) in the same agency,” she said.