HealthCare Roundtable e-News – December 9, 2021

Lawmakers, Lobbying Groups Seek to Avoid Medicare Sequester Cuts Before Year’s End

Congressional leaders are working to avoid Medicare sequester cuts before they are expected to begin in the new year. Relief for Medicare sequesters had previously been cut from the short-term federal spending bill that was passed both by the House and Senate earlier this month and the House voted Tuesday evening to avoid the cuts.

Democrats are blaming Republicans for keeping sequester cuts out of the House’s stop-gap spending bill, infuriating health care providers and lobbying groups who hoped Medicare pay cut relief would be included in the funding package. Providers and lawmakers alike have also been encouraging Congress to clear the so-called PAYGO scorecard that could trigger an additional 4% Medicare cut due to the cost of the American Rescue Plan. (InsideHealthPolicy)

Last week, House Budget Committee Chair John Yarmuth (D-Ky.) released a report calling on Congress to waive the PAYGO scorecard and avert those cuts. The report claims that the exercise “poses a danger to numerous vital programs like Medicare, farm supports, social services, and resources for students and individuals with disabilities, which is why Congress has always intervened and must do so again now.” (InsideHealthPolicy)

House Committee Expected to Hold Hearing on Prescription Drug Pricing Investigation

The House Oversight Committee is expected to hold a hearing on Friday (Dec. 10) to review the findings from a report of its nearly three-year investigation into pharmaceutical price-setting practices. Committee Chair Carolyn Maloney (D-NY) announced the hearing would take place as part of an examination into the need for structural reforms to lower prescription drug prices, including President Biden’s Build Back Better Act and policies enabling Medicare to negotiate for some of the most expensive drugs, if passed.

The ongoing investigation, initiated by the late congressman and former committee chair Elijah Cummings (D-MD) in 2019, has led to a total of eight reports. The most recent report suggested drug makers spend more on stock buybacks, dividends and executive compensation than on research and development, while other reports have focused on Medicare negotiation of drug prices. Remaining reports will focus on the pricing practices of individual pharmaceutical companies, including Amgen, Celgene, Novartis Pharmaceuticals and Teva Pharmaceuticals. (InsideHealthPolicy)

Witnesses in the hearing this week include Mindy Salango, Patient Advocate with Type 1 Diabetes from Morgantown, West Virginia; Dr. Reshma Ramachandran, Physician-Fellow at Yale National Clinician Scholars Program, Co-Chair, Doctors for America Drug Affordability Action Team; Rena Conti, PhD, Associate Professor, Department of Markets, Public Policy, and Law, Questrom School of Business, Boston University; David Mitchell, President and Founder, Patients for Affordable Drugs. 

Health Care Stakeholders Ask IRS, Treasury to Expand Services Covered Pre-Deductible by HDHPs-HSAs

A group of health care stakeholders collectively known as the Smarter Health Care Coalition, is advocating for the Biden administration to let high-deductible health plans linked to health savings accounts (HDHP-HSAs) cover mental health and substance abuse services pre-deductible, citing multiple surveys from insurers and employers that now offer coverage. In a letter written to the IRS and Treasury, the coalition asked both agencies to expand the current list of chronic disease management services that HDHP-HSA plans can cover prior to the deductible.

“Given the mental health crisis that has emerged alongside the ongoing COVID-19 pandemic, the time is now for action to empower employers and health plans to address rising incidence of chronic mental illness,” the coalition wrote in a letter to IRS Commissioner Charles Retting and Treasury Secretary Janet Yellen last month. (InsideHealthPolicy)

Previously, stakeholder groups, including the Smarter Health Care Coalition, have argued that the federal government should allow pre-deductible coverage of treatments that help patients manage their conditions, like insulin, asthma inhalers and statins. Successful lobbying led to an IRS notice establishing a safe harbor in 2019 allowing 14 treatments to be covered pre-deductible, which, according to a 2021 survey, further led to 76% of employers adding pre-deductible coverage due to IRS’ updated guidance. The results, the coalition argues, support the claim that insurers and employers would make additional design changes to pre-deductible policies if they were allowed by the federal government. (InsideHealthPolicy)

In addition to requesting the IRS and Treasury expand the list of services that can be covered pre-deductible, the coalition is also backing legislation that would codify the IRS criteria that permits coverage of care for chronic conditions if the service is low-cost, if there’s medical evidence that the service or item is effective, and if there is a strong likelihood that using the service will prevent the exacerbation of the disease. (InsideHealthPolicy)

Amidst Omicron Variant Unknowns, White House Announces Free At-Home COVID-19 Test Access to All Americans

Following heightened concerns around the coronavirus Omicron variant, the Biden administration announced that it would be making free, at-home COVID-19 testing available to all Americans both with and without insurance. Individuals with private health insurance may be reimbursed for purchased tests; however, OTC tests purchased before the announcement will not be retroactively covered.

The announcement, which came out last week, allows for tests to be provided over-the-counter at no charge. According to the White House’s COVID-19 response plan, those who have private health insurance will be able to get the cost of at-home tests reimbursed for the remainder of the public health emergency. Additionally, those without private health insurance may access OTC tests that will be distributed in more than 20,000 community sites around the country, including health centers and rural clinics. (InsideHealthPolicy)

“More than 150 million Americans on private health insurance will be able to submit receipts for at home tests directly to their health insurance plans,” said Jeff Zients, the White House COVID-19 coordinator. “They can go to their local pharmacy, they can order online and then get reimbursed.”

The White House shared that the administration is not concerned about supply and demand for COVID-19 tests. There are currently eight varieties of tests that are available to the public, with five authorized by FDA in the last three months. (InsideHealthPolicy)