HealthCare Roundtable e-News – July 8, 2020




Last month, CMS revealed in a special trends report that more 892,000 people in states that use healthcare.gov have signed up through an existing special enrollment period, or about 188,000 more than during the same time frame in 2019. The agency produced the report on the country’s enrollment trends after Democrats requested SEP updates for the month of June.

Among other key findings, the report highlights that the number of consumers gaining coverage in states with Exchanges using the HealthCare.gov platform through the loss of MEC SEP is higher for the 2020 coverage year than for any of the prior coverage years. Approximately 487,000 consumers have gained coverage through the loss of MEC SEP, an increase of 46 percent from the same time period last year.

“These enrollment numbers show that individuals who lost their jobs or experienced other qualifying life events due to the COVID-19 pandemic are using existing SEPs to enroll in coverage through HealthCare.gov,” CMS notes in its report. “As Americans consider their health insurance options during this crisis and as the country re-opens, CMS will continue to provide assistance to help inform those choices. CMS strongly encourages individuals to visit HealthCare.gov to explore their coverage options.”

CMS has noted that it is unclear how many people will eventually turn to the exchanges to replace the loss of coverage, particularly as it remains unknown when individuals or partners will return to work throughout the COVID-19 crisis. (InsideHealthPolicy)

Senators Introduce Bill to Pay Doctors to Use Biosimilars

Sens. John Cornyn (R-Texas) and Bennet (D-Colo.) introduced a bill last week that would enable Medicare to test sharing drug savings with doctors who prescribe biosimilars over brand-name drugs. Similar to a bill introduced by Rep. Tony Cárdenas (D-Calif.) earlier this year, the Increasing Access to Biosimilars Act would address the high cost of prescription drugs for seniors by promoting competition, increasing access to biosimilar medications, and encouraging physicians to prescribe biosimilars with lower out-of-pocket costs. The bill would also require CMS to create Medicare demonstrations running for five years.

“Prescription drug costs have drastically increased in recent years, placing a major financial burden on seniors, minority communities, and millions of Americans living on fixed incomes who require their prescribed medication to live their life,” said Sen. Bennet in the press announcement. “This bipartisan legislation would share lower-cost biosimilars with patients, saving them and our health care system billions of dollars.”

The Congressional Budget Office has not estimated the budget impact of the legislation, but Avalere Health estimated that the policy could save taxpayers up to $3 billion over a decade. The bill has been backed by brand drug makers lobbying group Biosimilars Forum, whose research the CBO’s estimate is loosely based on, as well as generic drug maker Mylan. (InsideHealthPolicy)

Senators Ask Administration Agencies to Expand COVID-19 Telehealth Flexibilities

A bipartisan group of Senators, led by Sens. Tina Smith (D-Minn.) and Bill Cassidy (R-La.), wrote to HHS and CMS last week to ask for the agencies’ assistance in codifying and expanding the telehealth flexibilities offered by the Trump administration during the COVID-19 pandemic. The letter asks HHS and CMS what permanent telehealth flexibilities they hope to put in place, and which parts can be done administratively, and which require congressional action. (InsideHealthPolicy)

“We appreciate your recognition that, due to the COVID-19 pandemic, more patients and providers see the value of telehealth. We believe telehealth is an important tool that enhances patient care and can provide efficiency in health care delivery…While telehealth may not be able to replace all in-person care, we believe it should continue to be an option to meet individual care needs” the Senators wrote.

The senators’ actions come after another bipartisan group of senators sent a letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.) last month asking that provisions from the CONNECT for Health Act included in previous COVID-19 legislation be extended after the public health emergency is over. Now, members from the Senate mean to pressure Congress to act on guidance from the pandemic to ensure that consumers who have become reliant on telehealth continue to get the same care on a permanent basis.

CMS proposed a rule in a June 25 notice to make emergency rules enacted on March 30 to address the coronavirus pandemic permanent. CMS’ Emily Yoder said at a recent congressional briefing that the big changes sought by stakeholders, like removing the point of origin and geographic restrictions, would need congressional action. (InsideHealthPolicy)

CMMI Looks to Roll Out Updated Models By End of 2020

Center for Medicare and Medicaid Innovation Director Brad Smith announced during a virtual summit that the agency hopes to release updated models later this year. CMMI is seeking to adjust its models after the impact of the COVID-19 pandemic and plans to reopen a number of models to new applications for those still dealing with the effects of the crisis.

Smith told Global Health Care LLC’s Virtual Summit attendees that the institute is looking at “a handful of other models” that they are considering rolling out. CMMI plans to roll out a number of models stemming from stakeholder conversations, including regional contracts. The institute is currently focused on implementing the previously announced payment models, a CMS spokesperson confirmed. (InsideHealthPolicy)

Smith, who was named head of CMMI earlier this year, confirmed during the summit that he is currently reviewing the institute’s internal processes in an effort to determine how the agency might develop models more efficiently. Smith also noted that the review will help the group to improve how it sends data to participants. (InsideHealthPolicy)

PWC Medical Cost Trend Report Projects Employer Plan Increases from 4% to 10% in 2021

Analysts at PWC’s Health Research Institute (HRI) recently released their Medical Cost Trends report for 2021, monitoring projected health care spending amidst the uncertainty from the COVID-19 pandemic. Data from the report was collected from information based on three potential utilization scenarios with outcomes ranging from a 4% to a 10% increase in per capita costs for medical services and drugs.

HRI is projecting 2021 medical cost trend relative to 2020 estimated healthcare costs while adjusting for COVID-19. The institute spoke with actuaries from 12 national and regional payers, who said they remain unsure about the pandemic’s impact on spending for the rest of 2020 and for 2021, but ultimately must decide on a cost trend to use despite the uncertainty. (InsideHealthPolicy)

The first of the three scenarios used to calculate cost trends is a high-spending scenario in which spending grows significantly higher in 2021 after being down in 2020. The second scenario speaks to medium-spending trends, in which spending grows at roughly the same rate in 2021 as it did from 2014 to 2019 and was expected to in 2020. The third scenario involves spending remaining dampened in 2021.

The report notes that HRI expects to see more variation in medical cost trends geographically as different parts of the country continue to grapple with the virus. Continuous drops in healthcare utilization this past year from COVID-19 have complicated the institutes calculations, with many employers still unsure of how long the impact of the pandemic will have on businesses.