HealthCare Roundtable e-News – April 16, 2019

Ways and Means Committee Unanimously Votes to Advance Drug Pricing Transparency Bill

Last week, a bipartisan bill created to increase drug cost transparency was advanced by the House Ways and Means Committee. The bill, known as the STAR Act, will require drug manufacturers to publicly justify large price increases and report the total aggregate monetary value and quantity of samples to the Secretary of Health and Human Services. The bill will also require the Secretary to publicly disclose aggregate rebates and other price concessions. CMS will be required to post the information on a regular basis. 

The bill was advanced unanimously by a vote of 40-0 and was celebrated by members of both parties. Rep. Lloyd Dogget (D-Texas), chairman of the Ways and Means health subcommittee, noted the advancement as “a directional signal that reminds us of the need for action and the big obstacles that lie ahead in achieving them,” and other members agreed that some modifications were necessary before bringing the bill to a vote. 

“This bipartisan effort brings sunlight across the health care supply chain, from pharmaceutical manufacturers to pharmacy benefit managers, to help reduce costs for families. There is more work to be done on this bill and on this issue,” said Chairman Richard Neal (D-Mass.) and Ranking Member Rep. Kevin Brady (R-Texas).

Senate Finance Committee Pushes PBMs to Support Transparency Legislation

Pharmacy benefit managers (PBMs) for CVS, Express Scripts, OptumRX, Humana and Prime Therapeutics were summoned to a Senate Finance Committee hearing last week to discuss supply chain transparency and other pieces of legislation. PBMs are responsible for managing prescription drug benefits for employers and insurance companies and, as a result, control the medication purchases of millions of patients all over the country. 

“They’re kind of a secret organization,” said Senate Finance Committee Chair Chuck Grassley (R-Iowa) of the PBMs. “I ask people to explain what they’re doing and nobody seems to give you the same answer twice.” 

Three of the summoned PBMs agreed to back legislation supporting a Medicare and Medicaid ban on spread pricing, while OptumRX chose not to take a position. Several executives from each of the PBMs deflected the blame for the industry’s price hikes to Big Pharma and so-called “backdoor deals” between drug makers. 

White House Looks to Fast-Track Health Plan Ahead of 2020 Campaign Debate Seasons

The White House announced last week that they will unveil a plan to replace the Affordable Care Act ahead of schedule – the administration previously announced that they would unveil their ACA replacement proposal in time for the 2020 campaign policy debates. Acting White House Chief of Staff Mick Mulvaney said the administration would release a plan to replace the ACA “fairly shortly.” (InsideHealthPolicy). 

“We are actually expecting to have a broader version of our plan by this summer – although even that deadline may have been accelerated by the president’s remarks!” Galen Institute President Grace-Marie Turner said. (InsideHealthPolicy). 

Trump recently announced his support for a Texas Federal judge who struck down the ACA’s constitutionality. The administration pledged to replace the law with a new Republican plan before the 2020 election, although other members of the Republican Party rebuked the idea. Democrats have vowed to protect the ACA through the 2020 elections and recently proposed a series of bills aimed at bolstering the current state of the law, despite criticisms from the Republican Party.

CMMI to Host Primary Care and Chronic Illness Stakeholder Meeting

Stakeholders have been invited to a discussion on primary care and chronic illness with CMS’ innovation center at the American Medical Association next Monday (April 22). According to an email from HHS sent to stakeholders, CMS Administrator Seema Verma, HHS Secretary Alex Azar and Center for Medicare and Medicaid Innovation (CMMI) Director Adam Boehler will lead an “exciting discussion on primary care delivery, including care for the complex, chronically ill.” 

CMS officials say the meeting will address models currently under consideration at CMMI. A senior CMS official recently said staff, “have talked publicly about doing additional models in primary care and serious illness and thinking about how they can come together.” She hinted the meeting would further the conversation on how the two can be combined and “how we can build out our portfolio.” 

She added CMS is interested in “providing more opportunities for both physician specialists or physicians to have an alternative payment model for them” to address both primary care and chronic illness. 

The official also said the center has heard feedback from stakeholders, particularly accountable care organizations, that the agency should make new models known sooner, so potential participants can be aware of the “universe of options available.”