HealthCare Roundtable e-News – February 26, 2020


Roundtable Members Advocate for Retiree Health Care Protections in Washington

On Friday, February 25th, Roundtable members traveled to Washington to advocate for changes to prescription drug pricing legislative proposals in order to protect public sector retirees in Medicare Part D employer group waiver plans (EGWPs). Several Roundtable members along with Roundtable staff met with the offices of Majority Leader Mitch McConnell (R-KY) and Speaker Nancy Pelosi (D-CA), as well with the full team at the Medicare Payment Advisory Commission (MedPAC). 

Members advocated for several alternative policy options to protect against premium increases for public sector retirees in group Part D plans, and plan to follow up with each office in more detail to push for the change.

Thank you for all those members who supported these efforts and participated in meetings in Washington!



FDA Issues Final Rule on “Biological Product” Definition

Last Thursday (Feb. 20), the FDA issued a final rule defining the term “biological product” in an effort to increase patient access to insulin products and to codify the FDA’s interpretation of the statutory term “protein”. The agency says the final rule provides regulatory certainty and clarify the statutory framework of the products’ regulation by defining a protein as a polypeptide with a specific sequence.

“Life-sustaining insulin products are biologics, but to date, there has been limited competition in the marketplace, resulting in fewer choices and higher prices for patients. This transition will open new pathways for manufacturers to bring biosimilar and interchangeable versions of insulin and other transitioning products to market, facilitating greater competition in the marketplace,” said FDA Commissioner Stephen M. Hahn, M.D in a press announcement.

Supporters of the newly defined term say the rule will make it easier to buy cheaper insulin, while critics say the rule will slow down the licensing process of lower-cost drugs.

In addition to the final rule, the FDA also released supplemental documents explaining the transition and including frequently asked questions for patients and providers. The documents note that other drugs, including growth hormone and certain fertility drugs, would also be regulated as biologics beginning on March 23.

Kaiser Family Foundation Poll Shows Continued Party-Line Support for Obamacare at 10-Year Anniversary

According to a recent Kaiser Family Foundation (KFF) tracking poll out that came out last Friday (Feb. 21), a majority of Americans (55%) approve of the Affordable Care Act. The latest poll shows the highest rating since polls were initially conducted to gauge support for Obamacare, which is coming up on its 10-year anniversary.

KFF polls show that 85% of Democrats and 53% of Independents polled have favorable views of the law, while 77% of Republicans still hold unfavorable views. The poll follows recent developments in the U.S. Supreme Court as the justices consider a lawsuit pushed by Republican attorneys general and the Trump administration, but notes in its analysis that the poll suggests “that Republican voters have largely moved on from efforts to repeal the ACA and now rank opposition to a single-payer government health plan like Medicare-for-all among their top health priorities.

Analysis from the poll also shows how few Americans were aware the ACA’s impact on their lives; notably, only 60 percent knew the ACA expanded Medicaid, and only half understood the ACA required insurers to cover all applicants regardless of preexisting conditions. Obamacare’s growing popularity comes as the insurance market for sales of individual Obamacare coverage has improved.

The article states that public support for the ACA could rise if the courts ultimately throw out the law. The justices are expected to discuss whether to review the Fifth Circuit Court of Appeals decision in Texas v. USA, which left into question whether the law should be left intact despite the appeals court finding the ACA’s individual mandate to be unconstitutional. (InsideHealthPolicy).

New Report Shows Rising DIR Fees’ Impact on Pharmacies

According to a recent estimate by Drug Channels, a record level of pharmacy fees in 2019 accounted for 8% of all the rebate-type concessions that insurers receive in the Medicare drug benefit program, with pharmacies paying close to $9.1 billion in Part D fees. According to a National Community Pharmacists Association spokesperson, skyrocketing direct and indirect remuneration (DIR) fees are “the single biggest problem for independent pharmacies.” (InsideHealthPolicy).

To address concerns about how these fees are computed, the Centers for Medicare & Medicaid Services (CMS) has proposed some minimal transparency requirements for monitoring the metrics behind DIR fees. I suspect that the proposal will have no near-term impact on slowing the growth trends,” said Adam J. Fein, PhD, CEO of Drug Channels Institute (DCI), suggesting the proposal is a “baby step”. Fein, who analyzed the results for Drug Channels’ research, admitted that he had been skeptical of pharmacists’ complaints but concluded that it appears PBM price concessions have become a significant economic burden for pharmacies.

A bill proposed by Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), that aims to help pharmacists by requiring Part D plans to include rebates and pharmacy price concessions in drug prices at the point of sale has been proposed in Congress. The National Community Pharmacists Association said that the bill would “put a stop to the predatory practice of imposing fees on pharmacies long after the point of sale and charging patients more upfront for their drugs.” (InsideHealthPolicy).

“Medicare For All” Faces Heat in Nevada Democratic Debate

One of the many hot topics of last week’s Democratic debate in Nevada was Medicare for All, with moderate candidates stepping up their attacks on the policy supported by Sens. Elizabeth Warren (Mass.) and Bernie Sanders (Vt.). Candidates argued that the policy, which would eliminate private and job-based health coverage, would cost trillions, with many attacking the Sanders campaign for failing to offer solutions to cover the full costs of the plan.

Sen. Amy Klobuchar (Minn.), who faced criticism from Warren on the lack of details surrounding her plan for health care, called Sanders’ plan “unrealistic” with its lack of Democratic support in the Senate, noting that two-thirds “of the Democratic senators are not even on that bill.” Meanwhile, later in the debate while defending his platform of “Medicare for all who want it,” South Bend, Indiana Mayor Pete Buttigieg claimed that a majority of Americans are ready to support a Medicare option.

“Do you realize how historic that is? That the American people are ready in a way far beyond what was true even 10 years ago and what was available to President Obama at the time,” said Buttigieg. “There’s a powerful American majority ready to undertake the biggest, most progressive reform we’ve had in health care in 50 years, just so long as we don’t force it on anybody. What is wrong with that?” (InsideHealthPolicy).

The Democratic candidates will have another opportunity to defend their platforms as they gear up for another night of debate tonight in South Carolina.