HealthCare Roundtable e-News – August 18, 2020


You Can Support Our Effort to Oppose the Administration’s Rebate Proposal

As you know, President Trump recently issued an Executive Order directing his Administration to re-visit their proposal to eliminate a provision in current law that provides a safe harbor for entities to negotiate rebates in Medicare Part D and Medicaid managed care.

Last year, the Roundtable actively opposed the original proposal based on serious concerns that it would have a negative impact on our members’ ability to utilize rebates to reduce the cost of their drug benefits. 

Our comments were largely based on the results of a survey we conducting last March.


As part of our renewed effort to stop this proposal, the Roundtable is seeking to update – and hopefully expand upon – last year’s survey results. We are working with a broad-based coalition to oppose this rule; the data we’re able to provide is very valuable to this coordinated effort.

Whether your plan is a Roundtable member or not, we would appreciate the following information on your plan:

1. What is your total membership:

a. Medicare:        __________

b. Commercial:    __________

2. What was the total value of your drug spend for the following years:

2019: $ __________

2018: $ __________

2017: $ __________

3. What was the total value of your drug rebates for the following years:

2019: $ __________

2018: $ __________

2017: $ __________

4. How does your plan administer rebates? Please describe any arrangements to pass rebates back to the plan or members.

5. What impact does your current rebate arrangement have on premiums?

6. What impact does your current rebate arrangement have on generic prescribing rates?

7. What other information is important for the Roundtable to know in writing our response to the rebate proposal?

If you’re able to provide this information, I would appreciate receiving it by Monday, August 31st.

Thank you for your assistance as we work to once again advance the strongest argument on behalf of the Roundtable’s view.

Tom Lussier

Roundtable Administrator

Please send your responses to: Tom@HealthCareRoundtable.org


Uncertainty Around COVID-19 Relief Bill Negotiations Looms, CMS Unveils Pay Rule Proposals

Stalled negotiations between lawmakers and the White House are leading analysts to anticipate the next COVID-19 stimulus bill to be passed in the September timeframe. An Alston & Bird analysis says lawmakers’ inability to agree on the terms of the next bill might result in a smaller, narrower relief package that leaves some emergency aid items for later this year, potentially after the election. President Trump had released his own executive order to tackle COVID-19 relief, though the timeline on when these directives might be implemented is unclear.

CMS also released later-than-planned pay rule proposals for the physician fee schedule and hospital outpatient departments last week. The agency is telling key stakeholders that they would be expected to implement the new rules only 30 days after they are finalized, an accelerated timeline that the agency says is a result of the COVID-19 pandemic. The American Medical Association and other groups are asking Congress to avert the large-scale cuts proposed by CMS for certain physician specialties and waive budget neutrality requirements. (InsideHealthPolicy)

More than 120 organizations also are urging the president to quickly require HHS to finalize physician self-referral, or Stark, and anti-kickback statute reforms. In a letter to the president, the groups state that they are “especially concerned that without your timely support, the hard work of the agency and the significant benefits of these reforms will be lost.” (InsideHealthPolicy)

Humana Joins Other Insurers in Lawsuit Against HHS for Scrapping ACA Cost-Sharing Payments

Humana is the latest to join a group of health insurers suing the Trump Administration over Affordable Care Act cost sharing reduction (CSR) payments that were scrapped by HHS in 2017. The law had previously required insurers to lower out-of-pocket costs for low-income consumers who enroll in silver-level plans, which HHS would then be required to make periodic payments to reimburse plans for the additional value provided to those enrollees.

When it was passed, the ACA did not include an appropriation, so the Obama administration opted to use the money from the advanced premium tax credits to cover the CSRs. The GOP-led House, at the time, argued that the administration was illegally allocating funding that had not been appropriated and ultimately won a lawsuit in 2016 for the administration to continue paying the reimbursements. This continued until 2017, when the Trump administration abruptly stopped the funding. As a result, regulators and insurers began suing in the Court of Federal Claims to recoup the lost funds they’d expected for the final months of 2017. InsideHealthPolicy)

A group of several insurers had won their cases back in the fall of 2018, demanding that the government pay each back for the millions owed not only from 2017, but in 2018 as well. In 2019, U.S. District Judge Margaret Sweeney ruled in the Common Ground class action suit in favor of insurers, judging that the government was obligated to pay insurers for funds lost in both 2017 and 2018. (InsideHealthPolicy)

“If the insurance companies get-indirectly or directly from the government-all the money that they were deprived of in the cost sharing, should they still get, in effect, a double recovery? Legally, that seems to be the question,” Judge William Bryson said.

Biden and Harris Seek Drug Pricing Reforms, Public Option in 2020 Campaign

Last week, Former Vice President Joe Biden, the Democratic nominee for President of the United States, officially selected the U.S. Senator Kamala Harris (Calif.) as his running mate, and the two are ramping up their campaign efforts around health insurance reform and lowering drug prices. Both candidates had differed in their stances on health care earlier in the election season, when Kamala Harris herself was a candidate for the Democratic nominee, but are now focusing their campaign efforts on promoting a public option.

Throughout her campaign for the presidential nominee, Harris supported tying drug prices in the United States to drug prices internationally, as well as a 10-year Medicare for All transition plan, which aligns with Biden’s proposed health care plan. Harris is also a champion of maternal health and marijuana reform legislation, which are two areas the Biden campaign has not had a significant focus on since he began his 2020 campaign. (InsideHealthPolicy)

Critics and experts have been closely observing how the Harris VP nomination impacts Biden’s efforts to win over progressive and moderate democratic voters. Dan Mendelson, founder of Avalere Health, says that the campaign choosing Harris “solidifies the platform squarely in the center. As opposed to if he chose Warren or some others. She is practical, tough, and rational.” (InsideHealthPolicy)