HealthCare Roundtable e-News – September 4, 2019



Ways & Means Democrats Discussing Drug Pricing Legislation, Senate Finance Text Likely to be Released this Month

According to sources, Ways & Means and Finance Senate Committees are planning separate meetings this month to discuss drug pending pricing legislation. Although there are talks of a potential mid-month markup, there is speculation as to whether or not left-aisle members of Ways & Means will push for government price negotiation, or if they will settle on bipartisan legislation passed by Senate Finance.

While the GOP is less than enthused with the Finance committee’s bill, Sen. Majority Leader Mitch McConnell has asked the chairs of the Finance, Judiciary and Health, Education, Labor & Pensions committees to compromise on drug pricing legislation as a means to get legislation passed to further bolster Republican candidate support in upcoming re-election races. A Senate Finance GOP member confirmed that the bill text is being written and will be available this month. (InsideHealthPolicy).

Meanwhile, a dark-money group has been funding paid ad campaigns to back insurers who oppose the Finance bill despite its backing by the Trump administration. Issue-based groups, including the American Future Fund, have been running television and radio ads opposing the committee’s drug pricing bill and praising those who have opposed it.

Lawmakers, Physicians and Provider Groups Clash on Surprise Medical Billing

Lawmakers’ efforts to push surprise medical billing legislation are being threatened by a dark-money group seeking to derail support through an effective ad blitz, according to sources. The group has reportedly been spending the majority of its ad dollars in states with “vulnerable senators” calling on them to reject “rate settling” as part of a surprise billing fix. (InsideHealthPolicy).

Both the House Energy & Commerce Committee and Senate have recently approved surprise medical billing legislation, however, the respective bills have some variances. The House bill includes a combination of a benchmark rate and arbitration, while the Senate version currently relies solely on a set benchmark rate. Providers and physician groups who oppose the bills are pushing back with an onslaught of paid ad campaigns, while stakeholder groups supporting a benchmark payment have been meeting with lawmakers, launching digital ads, and fostering grassroots letter writing campaigns in an effort to sway public opinion.

“We want to see legislation,” said Chip Kahn, CEO of the Federation of American Hospitals, which represents for-profit hospitals. “It’s a problem we can’t solve ourselves-I wish we could-and we need legislation to ensure patients don’t suffer from sticker shock, that their copayments are reasonable and within the bounds of their coverage.”

The Public Sector Roundtable is a member of the Coalition Against Surprise Medical Billing, a multi-stakeholder organization including employers, health plans, consumer groups, labor unions and others who support fair, local, market-based approach to protect patients and families from surprise medical billing. 

Annual Study Shows Americans View Pharma as the Most Poorly Regarded Industry

The American analytics and advisory company Gallup released the results of its annual industry ranking survey this week, which polls Americans’ views on U.S. business industry sectors. According to this year’s survey, the pharmaceutical industry is currently viewed the most negatively. Of the respondents, 58% said they viewed the drug industry negatively and 27% said they viewed it positively, giving the sector an overall net-positive score of -31.

“The industry’s rating likely will not recover until its role in the opioid epidemic is addressed, and the political pressure on the industry for high prices and massive profits subsides,” said Gallup analyst Justin McCarthy. (InsideHealthPolicy).

According to Gallup, the poll was conducted by surveying adults over the phone between August 1st and 14th, prior to the announcement of the Johnson & Johnson lawsuit resulting in the company owing $572 million for its role in Oklahoma’s opioid epidemic. The overall survey had a 3% margin of error.

California State Senate Committee Passes Pay-For-Delay Bill

Last week, California lawmakers passed a first-of-its-kind bill in a key senate committee to eliminate pay-for-delay activity amongst drug manufacturers in the state. According to the Senate Appropriations Committee, pay-for-delay agreements, which enable brand-name drug manufacturers to pay other drugmakers to refrain from producing a generic version after the drug’s patent expires, are not illegal at face value, but they can be used in ways that violate antitrust law. (InsideHealthPolicy).

“Every pharmaceutical company has a right to get a return on their investment on the products that they produce that in many cases save lives,” California Attorney General Xavier Becerra said. “But you should not be allowed to exploit the desperation and the need of an American in order to make money off of these drugs.” (InsideHealthPolicy).

The bill, which is similar to a federal bill proposed by Sen. Chuck Grassley (R-Iowa), was passed by the state senate committee on a 5-1 vote and follows promised legislative changes announced by Becerra earlier last month. Becerra had previously announced that drug makers would pay the state $70 million to settle four claims that the companies engaged in illegal deals between brand and generic drug makers to delay generic competition.

The Public Sector HealthCare Roundtable strongly supports federal legislation to end pay-for-delay arrangements between brand and generic drug makers.

Government Updates Copay-Coupon Rules Favorable To Insurers

Last week, lawmakers announced that they will be putting up new barriers to drug copay coupons. According to a document jointly released by the Department of Health and Human Services (HHS) and the Departments of Labor and Treasury, the new policy will let insurers exclude coupons from out-of-pocket calculations regardless of whether generic alternatives are available.

The new restrictions, come in part, as a response to a Notice of Benefit and Payment Parameters for 2020, released by HHS this past April. The notice said that plans can exclude brand-drug copay coupons from consumers’ out-of-pocket calculations when generics are available for the brand drugs to which coupons would apply. The governments concern with this notice, is that copay-coupon policy will conflict with rules for high-deductible health plans that allow people to set up health savings accounts.

“The Departments note that such a requirement could create a conflict with certain rules for high deductible health plans (HDHPs) that are intended to allow eligible individuals to establish a health savings account (HSA),” the departments state.

Federal lawmakers have further stated, that the new generic-equivalent restriction, will not be enforced until next year when HHS formally changes the copay-coupon rules in the 2021 Notice of Benefit and Payment Parameters.