HealthCare Roundtable e-News – October 22, 2019



Amendment Supporting Biosimilar Reimbursements Passes House Energy & Commerce Markup

Last week, the House Energy and Commerce Committee added an amendment to The Lower Drug Costs Now Act to temporarily increase Medicare Part B reimbursements for biosimilars. The bill, which aims to lower prescription drug costs by giving the federal government the ability to negotiate the price based on an international pricing index, was previously passed by the Education and Labor Committee. 

The policy was initially introduced as a separate bill, the Bolstering Innovative Options to Save Immediately on Medicines (BIOSIM) Act, last month and is currently the only amendment adopted by the Energy & Commerce Committee during the markup. Biosimilar manufacturers and stakeholders shared their enthusiasm for the amendment’s acceptance. (InsideHealthPolicy). 

“This is a major step forward and the fact it was the only amendment adopted underscores why biosimilars are a clear, recognized and bipartisan solution to reducing drug costs for patients and taxpayers,” said Juliana Reed, the president of the Biosimilars Forum. (InsideHealthPolicy). 

The bill, which was sponsored by Reps. Kurt Schrader (D-Ore.) and Greg Gianforte (R-Mont.), is expected to be marked up by The House Ways and Means Committee later this week with a full House vote later this month, according to reports.

CBO Gives Pelosi’s Drug Negotiation Plan a Significant Savings Score at W&M Hearing

The Congressional Budget Office announced last week at the House Ways & Means Committee hearing that the proposed drug pricing negotiation plan would save taxpayers around $345 billion over seven years. Researchers from the office are expected to increase estimated savings as they continue to analyze the bill further, with some suggesting that savings from combined public and commercial markets could reach $1 trillion over a decade. (InsideHealthPolicy). 

House Democrats praised the preliminary projection, touting how much money Americans could be saving by following the lead of other countries and lowering drug prices to be consistent with an international index. However, House GOP members see the score as confirmation that the Democrats’ plan would likely slow the pace of cure development and restrict drug availability. (InsideHealthPolicy). 

“A manufacturer that was dissatisfied with a negotiation could pull a drug out of the U.S. market entirely, though CBO expects that would be unlikely for drugs already being sold in the United States,” CBO Director Phillip Swagel said in the report.

Senate Finance Committee Chair Chuck Grassley (R-Iowa) praised the scoring of the proposal but stressed the importance of continuing to seek bipartisan support in order for the bill to succeed. Grassley noted that the legislation he co-authored with Sen. Ron Wyden (D-Ore.) is “the only significant, bipartisan legislation to lower prescription drug prices that’s passed a congressional committee.”

House Republicans Look to Include Arbitration to Surprise Billing Fix

Rep. Kevin Brady (R-TX), ranking member of the House Ways & Means Committee, shared with reporters last week that Republicans are seeking to add both a benchmark payment rate and arbitration to a surprise billing fix. The bipartisan bill was passed by the Senate Health, Education, Labor, and Pensions Committee earlier this year and seeks to end patients’ exposure to surprise medical bills for emergency care, but most recently policymakers in the House have been unwilling to compromise over the inclusion of arbitration. 

The inclusion of arbitration has long been one of the most controversial components of the bill since its unveiling. Officials from the Blue Cross Blue Shield Association have said that arbitration “would pass costs to consumers through higher premiums and that such a solution is untenable.” But supporters of the addition say that the inclusion of arbitration would reduce the incidence of out-of-network billing and incentivize network participation. 

Details around the arbitration proposal that members of the GOP will decide on are still unknown, but Brady has said that the final policy will likely be decided in conference between the House and Senate. (InsideHealthPolicy). 

“I think beyond the benchmark there must be a component that accompanies, that allows health care providers, especially doctors, to be able to make the case for rates that focus on the quality of the care, the complexity of the case, maybe the geographic area in which they are,” Brady told reporters on last Wednesday. (InsideHealthPolicy).

Azar Says Administration is Not Currently Preparing ACA Replacement Draft

While a ruling is still pending on the invalidation of the Affordable Care Act by the federal appeals court, White House officials confirmed that President Trump will likely ask the court to delay its ruling until after the 2020 election. The administration currently has no plans to draft an ACA replacement and will instead look to improving and protecting job-based coverage in the interim, which HSS Secretary Alex Azar confirmed during the TIME 100 Health Summit last week. (InsideHealthPolicy). 

Azar spoke on the subject, stating that the administration has “a vision of what the kind of options can look like for an individual market, but what’s realistic is going to depend on who’s in Congress at the time, when does that occur, does that ever occur. Right now, what I’m doing is trying to run the Affordable Care Act as best as we can with the tools that we’ve got.” (InsideHealthPolicy). 

Republicans have supported the delay in a ruling and, as campaigning for the 2020 election season continues, most legal experts expect the decision to come to the Supreme Court for the third time. In this scenario, the justices would hear oral arguments in fall 2020 and handle its decision after the 2020 elections have concluded.

Pelosi’s Drug Pricing Plan Passes in Key House Committee Votes

The House Energy and Commerce Committee last Thursday approved House Speaker Nancy Pelosi’s (D-Calif.) drug pricing negotiation bill by a vote of 30-22. The plan aims to allow HSS to negotiate lower prices on as many as 250 of the most expensive drugs per year and apply those discounts to private health plans across the U.S. Drugmakers who choose not to comply with the negotiation policy would face significant penalties starting at 65% of the gross sales of the drug in question. 

A few changes have been made to the bill since it was originally introduced; the minimum number of drugs to be negotiated each year has since gone up from 25 to 35, and a provision to spread out cost-sharing for beneficiaries with high drug costs has been added. The revised plan no longer includes a provision on 340B drug discounts that concerned nonprofit hospitals. (InsideHealthPolicy). 

Several Republican members of the Energy & Commerce Committee have been vocal about their concerns regarding the bill and its lack of potential to pass a full vote, noting that the bill could discourage innovation for new medicines in the pharmaceutical industry. All Republicans on the Energy & Commerce Committee also voted in favor of an amendment that would have stripped all international reference pricing provisions from the plan. (InsideHealthPolicy). 

The House Education & Labor Committee had previously approved the bill on a 27-21 vote and The House Ways & Means Committee will mark up the bill next week.