HealthCare Roundtable e-News – July 2, 2020


In a letter addressed to Congressional leaders, the Roundtable has joined a diverse group of employer groups, consumer and health care advocates, and leading unions to urge Congress to prioritize surprise medical billing protections in the next COVID-19 package.

The text of the group letter can be found here.   



Federal Judge Rules in Favor of HHS, Upholds Hospital Price Transparency Rule

Last week, a District of Columbia federal judge upheld a mandate for hospitals to share publicly the rates they negotiate with health insurers. The decision is a boost to the Trump administration’s efforts to enact health care policy after the district judge determined that HHS acted within its authority to order the disclosure, rejecting claims that the mandate violated hospitals’ and insurers’ First Amendment rights. Hospitals and insurers that violate the rule could be fined up to $300 per day.

“The agency’s rule is exacting, but the demands flow from the congressional determination about the role of price transparency in bringing down health care costs and the reality of hospital billing,” wrote U.S. District Judge Carl Nichols, who was appointed by Trump in 2019 and viewed the rule as a tactic to empower patients.

Cynthia Fisher, founder of patientrightsadvocate.com, which filed an amicus brief in support of HHS, commented that the ruling “rejects every claim to keep the secret hidden prices from consumers until after we get care,” comparing the new experience for patients to how individuals shop for groceries, knowing the price ahead of time.

More information on the rule can be found here.

States Explore Ways to Spend CARES Act Funds Leftover from COVID-19 Pandemic

Several states are looking to get creative with their excess CARES funds from the early days of the COVID-19 pandemic, with some exploring methods of using the funds to support local governments and community-building initiatives. While the stimulus funds can be used for nearly any COVID-19 related cost, the funds cannot be used to make up for other budget shortfalls, according to the Department of the Treasury, which is still looking to finalize its guidance and answer states’ questions on how the funding can be used. (InsideHealthPolicy)

“It’s extremely flexible and helpful for new expenditures due to the pandemic but does not keep states from having to cut essential services due to lost revenue,” explained Shelby Kerns, National Association of State Budget Officers executive director.

The National Governors Association also confirmed that state agencies might consider using stimulus funds for natural disaster response during the pandemic, as several states begin to prepare for rapidly approaching hurricane and wildfire seasons. Some states, like Illinois, are looking to use the funds to support mental health facilities, create business grants and deliver meals to seniors. (InsideHealthPolicy)

PCORI Updated Drug Research Initiative to Include Impact of Patients’ Costs

Last week, the new head of the Patient-Centered Outcomes Research Institute (PCORI), Executive Director Nakela Cook, addressed the organization’s plans to research the impact of drug costs on patients after a recent law change directing the group to consider the positive aspects of drugs for patients. The organization, created by Congress to support the Affordable Care Act, must also study the impact on patients of insurance cost sharing and coverage restrictions under the adjusted law. Funding for the organization was renewed by Congress late last year prior to Cook stepping into the role in January 2020.

The updated law states “clinical and patient-centered outcomes shall include the potential burdens and economic impacts of the utilization of medical treatments, items, and services on different stakeholders and decision-makers respectively.” Economic impacts that are included are medical out-of-pocket costs, non-medical costs to the patient and family, including caregiving, effects on future costs of care, workplace productivity. (InsideHealthPolicy)

“It’s important to note that the reauthorization doesn’t remove the prohibition that PCORI has on conducting cost-effectiveness analyses as well as the development of what’s typically termed ‘volume thresholds,'” Cook said in the announcement, noting that she is often asked about the addition of cost to research criteria.

The PCORI Board of Governors also announced last week that it had approved allocating up to $50 million in additional research funding in response to the COVID-19 crisis. The research will help provide answers to difficult COVID-19 related questions faced by patients, providers and health systems.

EU Medicines Committee Recommends Conditional Approval of COVID-19 Treatment Remdesivir

Last Thursday, the European Union’s medicines committee (CHMP) announced their recommendation for granting Gilead Science’s remdesivir a conditional marketing agreement to treat COVID-19 across the continent. This is the first major milestone for the drug in Europe, a process that requires the European Commission to approve the recommendation before doctors can look to prescribe remdesivir.

In their press announcement, CHMP noted that data on remdesivir had been “assessed in an exceptionally short timeframe through a rolling review procedure, an approach used by EMA during public health emergencies to assess data as they become available.” In late April, CHMP began assessing the quality of manufacturing, preliminary clinical data and drug safety prior to announcing their recommendation.

Remdesivir has not yet been approved for use in the United States outside of emergency use to treat COVID-19 patients, but data results on the drug continue to be reviewed, as well as in other countries across Asia. Giliead has not released pricing for the drug while it is not in the market, though Phil Hogan, the European Commissioner for Trade, suggested several weeks ago that the EU consider compulsory licensing to keep down the cost of coronavirus treatments and vaccines and ramp up production. (InsideHealthPolicy)