HealthCare Roundtable e-News – January 15, 2019

HealthCare Roundtable e-News – January 8, 2019

Senate Democrats and Republicans Unveil Separate Drug Pricing and Importation Bills

Last Thursday, Sens. Bernie Sanders (I-Vt.), Cory Booker (D-N.J.) several other Democrats unveiled three new bills to lower prescription drug prices for U.S. consumers, which included measures on importation and direct government negotiations with drug manufacturers. “The people of our country pay by far, not even close, the highest prices in the world for the prescription drugs that they need,” Sanders said at a press conference. “That has got to end, and the legislation that we are supporting will do just that.” Sens. Amy Klobuchar (D-Minn.) and new Senate Finance Committee chairman Chuck Grassley (R-Iowa) also recently introduced a bill to crack down on drug pricing and targeting ‘pay for delay’ tactics. Titled the Safe and Affordable Drugs from Canada Act of 2019, the bill seeks to allow FDA to issue regulations on personal importation of cheaper medicines from approved Canadian pharmacies. Grassley has directly opposed Democrat proposals to have the government negotiate prices with drug manufacturers. “I can work with Democrats on a lot of areas to bring drug prices down, but there is one place where I completely disagree: I don’t want to mess with the private sector,” Grassley said. “The government shouldn’t be negotiating on drugs.” Recent legislation pushes came after the Trump administration summoned top officials to the White House last Tuesday (Jan. 8) to discuss drug prices.

House Democrats Kick Off 116th Congress with Focus on Protecting ACA

Rep. Nancy Pelosi (D-Calif.) made it clear during her first speech as Speaker of the House for the 116th Congress that Democrats have a mandate in order to preserve the Affordable Care Act, lower healthcare costs and protect Americans with pre-existing medical conditions.  Hours after Pelosi’s speech, House Democrats voted to intervene in a lawsuit in an effort to protect the ACA, joining several state attorneys general in appealing the ruling last year of a federal district judge in Texas who declared the law to be unconstitutional. With the Republicans still claiming a Senate majority, Democrats will likely look to hearings to try to influence health policy in the courts. Chiquita Brooks-LaSure, a former HHS official who is now a managing director at Manatt Health Strategies, sees the health policy tides in Washington changing as the newly Democratic-led House pushes to protect the ACA. While the last two years have seen countless threats from the GOP to “repeal and dismantle” the ACA, Brooks-LaSure claims that all of that will soon change. “That energy can now shift to examining what the administration is doing and putting forth other ideas and other proposals, some of which might generate bipartisan agreement,” she said.

Ways & Means Leaders Concerned About CMS/CMMI Transparency on Policy Changes

Democratic and Republican lawmakers in the Ways & Means committee recently called on CMS for more transparency on rulemaking around the Center for Medicare and Medicaid Innovation. Ways & Means chairman Richard Neal (D-Mass.) and Republican ranking member Kevin Brady (R-TX) are asking CMS Administrator Seema Verma to reform the division’s processes “to incorporate greater opportunity for public input.” “Significant policy changes made unilaterally by the executive branch without sufficient transparency could yield unintended negative consequences for beneficiaries and the health care community,” read one of the Ways and Means letters signed by Neal and Brady. The committee leaders claimed the CMMI model development has historically not been clear to Congress and stakeholders and asked CMS to detail how the center fulfilled those requirements for models under consideration. (InsideHealthPolicy). In addition, the committee requested a description of additional activities the government will take to “promote transparency and engage Congress, stakeholders, Medicare beneficiaries and the public” by the deadline of Jan. 23.

Verma Pitches Hospital Pricing Transparency, Praises Health Systems for Going “Above and Beyond”

Last Thursday (Jan. 10), CMS Administrator Seema Verma shared updates to pricing information guidelines for hospitals as a “first step” to helping patients understand health costs. Verma praised three hospitals-UCHealth in Colorado, Mayo Clinic in Minnesota, and University of Utah Health-who have made significant strides to promote price transparency and are encouraging other health systems to go “above and beyond” the recently revised guidelines. The most recent updates now require every hospital in the U.S. to publish a standard list of prices online in a machine-readable format. The American Hospital Association praised the new requirements but expressed their concern about the lack of clarification individuals might receive if the requirements do not include out-of-pocket pricing information for those with insurance. The AHA commented that individuals “are more interested in knowing how much they will need to pay for their care or, more specifically, their out-of-pocket costs. Yet hospitals, health systems and other providers do not have access to detailed data on health plan benefit and beneficiary cost-sharing amounts; rather, insurers hold this information.” (InsideHealthPolicy). Verma has acknowledged that the requirements lack clarification on out-of-pocket fees, but considers the initiative to be a “first step” and encourages provider organizations and third parties to build upon the guidelines’ foundation.