HealthCare Roundtable e-News – September 25, 2018

Opioid Package Negotiations Conclude, Likely Vote This Week

Last week, the Senate passed a comprehensive package of opioid legislation, The Opioid Crisis Response Act of 2018, by a vote of 99-1, and latest reports suggest House and Senate leaders have completed negotiations on their final opioid bill. Chairman of the Senate Health, Education, Labor and Pensions Committee Lamar Alexander (R-TN) said the goal is to have all the language in a combined bill ready vote on this week before heading to the President for signature.

The House and Senate will likely not include a PhRMA-backed provision to curb Medicare costs for pharmaceutical companies or any version of the CREATES Act, a bill intended to encourage the creation of cheaper biosimilar drugs, in the final version of their opioid bill, according to multiple sources with knowledge of the bill. Congress is still in the process of negotiating the two chambers’ versions of the bill before sending it to the president to be signed into law.

The opioid bills overwhelmingly passed each chamber, but the pharmaceutical manufacturers worked to get lawmakers to attach a provision opposed by many Democrats, plans and seniors’ advocates. The $4 billion measure would reduce the brands’ share of Part D donut-hole costs from 70 percent to 63 percent. PhRMA also is trying to avert the Part D cliff, which would benefit both drug makers and seniors.

The bill also reportedly included an IMD exclusion bill sponsored by Sen. Rob Portman (R-Ohio) allowing Medicaid dollars to temporarily fund treatment for substance use disorders in residential facilities. The legislation will not include a bill to roll back patient privacy rules that conceal addiction treatment history records, which had widespread support from hospitals and physicians.

The opioids legislation is expected to be voted on this week and Roundtable senior staff will keep members up to date on ongoing negotiations.

Senate Votes to End Pharmacy Gag Order, Protecting ‘Patients’ Right to Know’

The Senate voted 98-to-2 late last Monday to pass a bill that would effectively end “gag clauses” that bar pharmacists from telling consumers when it would cost less to pay cash for a prescription without insurance. Drug companies will also be required to file biosimilars patent settlements with the FTC to increase the agency’s visibility into pay-for-delay agreements between makers of brand biologics and biosimilars.

The National Community Pharmacists Association (NCPA), and other groups who supported the Patient Right to Know Drug Prices Act (S.2554), have argued that the gag clauses interfere in their relationships with their patients. Douglas Hoey, Chief Executive Officer of the NCPA, said in a statement, “As trusted healthcare providers whose aim is to get and keep patients well, pharmacists should be free to properly advise their patients about medication costs. That cost-even an insurance copay-can often be an impediment to patient access and adherence.

Senators Mike Lee (R-UT) and Rand Paul (R-KY) opposed the bill, with Lee voting against because he does not believe the federal government should regulate commercial markets except for self-insured plans. Lee offered an amendment that would have limited the gag-order ban to self-insured plans, but that amendment was defeated.

The bill will move to the House, where representatives will vote on gag order bans in the Medicare and commercial markets. Although the House version of the gag order ban bill does not include the biosimilars proposal, Rep. John Sarbanes (D-MD) introduced a bill this summer to mandate the filings.

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Midterms Loom for Republicans Looking to Change Perceptions of Stances on Pre-Existing Protections

With high-stakes mid-term elections looming in November, Republicans are scrambling to convince voters they will protect people with pre-existing conditions.
Most Republican candidates have been challenged to diffuse the growing angst around the party’s efforts to repeal Obamacare, as well as a lawsuit supported by the Trump administration that seeks to overturn protections under the law for people with pre-existing health conditions.
A recent poll from the Kaiser Family Foundation found increased public concern over pre-existing conditions, with 75 percent of voters saying it’s “very important” to keep Obamacare insurance protections. A Morning Consult/Politico poll this month found that a large majority of voters, 71 percent, including 66 percent of Republicans, said insurers should be barred from charging people with pre-existing conditions more, a key provision of Obamacare.
With the Trump administration’s support for a Texas lawsuit putting pre-existing protections in jeopardy, many Republicans will have to put in the extra mile to change public perceptions about their stances on such issues. Although others, such as Sen. John Barrasso (R-Wyo.), are more convinced that Republicans, “know a better solution is to give Americans more options and let them choose the coverage that works best for them.”

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Former CMS Officials Discuss Pressure Officials Face in Negotiating Drug Prices

Medicare were to negotiate drug prices, and they said the current system is preferable.
For years key congressional Democrats have said Medicare should be given authority to negotiate prices with drug companies, but Republicans have traditionally opposed the policy. President Donald Trump has said wants drug makers to bid for government business, which most people understood to mean he favors government price negotiation, but HHS Secretary Alex Azar said the administration’s proposal to move Part B drugs into Part D fulfills that campaign promise.
Tom Scully, who served as CMS administrator under George W. Bush, said “When you have a system where you make these kinds of calls, you get a call from the Hill, you get calls from companies, people run ads. You can’t make a rational decision,” he said. “Politics play into this stuff all the time, and you’re much better off having hopefully a thoughtful pharmacy director at Anthem make this call than somebody in a political system sitting at CMS who has no rational economic factors,” Scully added.
Blum echoed Scully’s comments, though he pointed out that Part D is a government entitlement program with multiple taxpayer-backed protections for private plans that administer the drug benefit, so it isn’t a free market. He said it is much more challenging for CMS staff to determine drug prices than it is for drug makers and plans to negotiate prices.

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