HealthCare Roundtable e-News – April 7, 2020



Trump Rejects Special Enrollment Period to Reopen Obamacare Markets During Coronavirus Crisis

The Trump administration continues to face pressure to open a separate enrollment period (SEP) for healthcare.gov as the coronavirus crisis continues. While the president indicated in a Coronavirus Task Force press briefing last Wednesday (Apr. 1) that he was still open to creating a SEP, the administration has since rejected the proposal and instead opting to provide cash payments to providers for treating the uninsured using the $100 billion in funding from the newly passed CARES Act.

Insurers, health experts, beneficiary advocates, lawmakers, and governors have raised their hands in support for creating a SEP as a result of the crisis, including former vice president and Democratic presidential frontrunner Joe Biden. The candidate called on the administration to immediately allow anyone who is uninsured to sign up for insurance through healthcare.gov. When asked about the SEP, the president replied, “We’re doing better than that, trying to get a cash payment to the people. Just opening it up … doesn’t help a certain group of people,” he said. (InsideHealthPolicy)

Since the briefings, Protect Our Care, which supports ACA implementation efforts criticized the president for refusing to use “an available mechanism” to give Americans access to affordable coverage. President of Protect Our Care Leslie Dach alleged that Trump instead wants to create another bureaucracy that will cost individuals and the government more money and still leave people at risk of costs.

Drug Pricing Action Likely to Stall Until Lame-Duck Session

The coronavirus pandemic is leading legislators to abandon drug pricing reform until the lame-duck session this coming December, pending the outcome of the current crisis and the presidential election later this year. Additionally, it’s becoming more likely that conversations around HHS’ International Pricing Index proposal will stall.

Initial talks on drug pricing were linked to Medicare and Medicaid extenders, which had previously been left out of the initial emergency COVID-19 bill but have since been included in Congress’ third stimulus bill. The extenders in the third bill are meant to expire in November, which staffers have indicated is to ensure that health care “will be brought up at the end of the year to carry issues like surprise billing and drug pricing issues,” according to sources. (InsideHealthPolicy)

Michael Zona, a spokesman for Senate Finance Committee Chair Chuck Grassley (R-Iowa), who had been soliciting GOP support for his drug pricing bill, commented that the coronavirus crisis “shows why now more than ever seniors need to be able to afford the prescription drugs they rely on to survive,” he added. “We’re confident that going forward prescription drug pricing and surprise billing legislation will be priorities for President Trump and Congress.”

Experts Fear 90-Day Fill Mandate Will Enable Surge in Drug Demand

Industry consultants are concerned that the latest stimulus bill in the emergency coronavirus package will ultimately create a surge in demand for drugs and drug production being impacted by the COVID-19 crisis. The latest bill bans Medicare drug plans from using formulary tiers when Part D or Medicare Advantage beneficiaries request 90-day fills of their prescriptions.

While lawmakers have concluded that the provision is meant to aid seniors who wish to stay home during the pandemic, experts warn the measure may exacerbate shortages for drugs that are being used to mitigate COVID-19 patients’ symptoms. Some plans have already been adjusted to restrict lupus patients to 14-day refills of hydroxychloroquine, as well as switching other auto-immune patients to alternative drugs. President Trump’s comments on using hydroxychloroquine to help treat the novel coronavirus have influenced insurers’ actions, despite the fact that the drug has yet to be confirmed as an effective treatment for COVID-19. (InsideHealthPolicy)

Michael Ganio, senior director of pharmacy practice & quality at the American Society of Health-System Pharmacists, suggested that for drugs “that are not in short supply due to manufacturing disruptions, 90-day fills or refills may cause temporary stock outages…As products continue to move through the supply chain, those shortages should resolve.”

Study Encourages Employers to Seek Expansion Of Biosimilars

A recent study from the ERISA Industry Committee (ERIC) highlights the potential savings from using more biosimilars; most notably that biologics make up less than 1% of prescriptions but account for 40% of employers’ total drug spending. The study also found that biologics spending accounted for 93% of growth in total drug spending between 2014 and 2017, yet only two biologics today face “meaningful” biosimilar competition. (InsideHealthPolicy)

The study tracked infliximab and filgrastim since both have multiple biosimilars that have been launched in the market. For infliximab, biosimilar users paid on average 12% less (about $300) and filgrastim biosimilar users paid on average 45% less (about $600) out-of-pocket costs per year. The study cited that employers could save up to $1.53 million by switching to the biosimilar of infliximab alone if there was 100% biosimilar uptake.

ERIC President and CEO Annette Guarisco Fildes shared that it’s essential for employers to have a stake in overall spending as plan sponsors because they need to ensure that their employees have access to affordable medications.

“As prescription drug costs rise, employees are seeing an increased burden of out-of-pocket expenditures for the medications they and their families depend on – biosimilars offer a solution,” Guarisco Fildes said.