HealthCare Roundtable e-News – April 4, 2022


Roundtable News

Save-the-Date – Wednesday, April 13th at 3:00 PM (EDT)
“Biosimilars in the U.S.: Benefits, Public Policies and Opportunities – A Roundtable Webinar”
Please plan to join us on April 13th for a webinar: “Biosimilars in the U.S.: Benefits, Public Policies and Opportunities,” on how the marketplace has benefited from the use of biosimilars to lower healthcare costs and improve patient access to life-changing therapeutics. This webinar will offer perspectives from the Biosimilars Council and Sandoz on the evolving biosimilar federal and state policy landscape and how key stakeholder groups will be affected. We will also offer policy considerations that can help our organizations to achieve these savings and increased access for your members.
Click here to register for this meeting.
After registering, you will receive a confirmation email containing information about joining the meeting.
FTC Requests Comments on PBMs – Roundtable Requests Member Feedback
The staff of the Federal Trade Commission (FTC) is inviting public comments about the practices of Pharmacy Benefit Managers (PBMs) and their impact on patients, physicians, employers, independent and chain pharmacies, and other businesses across the pharmaceutical distribution system. They are encouraging the public to comment on any issues or concerns they believe are relevant or appropriate for their consideration.
Since Roundtable members generally contract with PBMs to support the administration of their pharmacy benefits, we are considering submitting comments in response to the FTC’s solicitation. If you would like to submit comments for inclusion in the Roundtable’s response, please send them to Tom Lussier, Roundtable Administrator, no later than Monday, April 18th.
If you prefer to respond directly to the FTC, please note that the solicitation closes on April 25th.
To read the full Solicitation for Public Comment, click here.

Top News

Biden Administration Releases Proposed FY 2023 Budget for the Federal Government

President Biden released his proposed FY 2023 budget for the federal government. Although the proposed budget is aspirational and not binding, it allows the public to forecast what the President’s priorities for the upcoming year are. This is the first step in the process for deciding the FY 2023 budget. President Biden is proposing a $5.8 billion fiscal year budget that includes items that were part of his “build back better” agenda, including reducing energy costs and combatting climate change, cutting prescription drug costs, funding mental health care, funding free community college, continuing the enhanced child tax credit and high-quality preschool. As it relates to the Department of Health and Human Services (HHS), the President is requesting $127.3 billion in discretionary funding, a $26.9 billion or 26.8-percent increase from the 2021 enacted level.


CMS Releases 2021-2030 Projections of National Health Expenditures

The CMS Office of the Actuary released the 2021-2030 National Health Expenditures (NHE) report which presents health spending and enrollment projections for the coming decade. The report notably shows that despite the increased demand for patient care in 2021, the growth in national health spending is estimated to have slowed to 4.2%, from 9.7% in 2020, as supplemental funding for public health activity and other federal programs, specifically those associated with the COVID-19 pandemic, declined significantly. The report finds that annual growth in national health spending is expected to average 5.1% over 2021-2030, and to reach nearly $6.8 trillion by 2030.


U.S. House of Representatives Pass Insulin Cost Cap Bill

On Thursday, March 31st, the House passed the Affordable Insulin Now Act (H.R. 6833) in a 232-193 vote. The Senate, led by Senators Jean Shaheen (D-NH) and Susan Collins (R-ME), is negotiating an alternative insulin bill that is expected to include measures aimed at reducing drug list prices and capping costs for the insured, but that bill’s prospects are uncertain. They plan to combine these provisions with a bill by Sen. Raphael Warnock (D-GA), which is a companion to the bill that the House passed. Critics of the House bill, including some House Republicans, contended the bill will cause premiums to rise. America’s Health Insurance Plans (AHIP) also released a statement opposing the bill.
The Congressional Budget Office (CBO) also released an estimate on HR 6833, and found that the higher premiums from the bill would increase government spending by $6.6 billion over 10 years and decrease revenues by $4.8 billion.
Senate Finance Committee Releases Bipartisan Report on Mental Health Care in America
The Senate Finance Committee released a bipartisan report on the shortfalls that prevent American families from accessing mental health care. This bipartisan report largely reflects work done by the Committee over the course of the 117th Congress, which includes conducting public fact-finding efforts through hearings as well as a request for information in which there were over 500 submissions from organizations and individuals. Chapters within the report outline key challenges across five areas: status of the workforce; children, adolescents, and young adults; access to care, integration, and coordination; mental health and SUD parity; and telehealth. Notably, Committee members are in the process of drafting comprehensive legislation to address mental health in the U.S.

Administrative Action

HHS awarded $256.6 million in grant funding to support 76 grantees in delivering Title X family planning services nationwide. These grants are intended to restore access to Title X services and fill service gaps caused by more than a quarter of Title X providers withdrawing from the program over the past two and a half years due to the previous Administration’s Title X rule. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services. The program supports a diverse network of clinics including state and local health departments, federally qualified health centers, hospital-based sites, and other private nonprofit and community-based health centers. To view the full list of the awardees, please click here.
The Government Accountability Office (GAO) released a report titled Mental Health Care: Access Challenges for Covered Consumers and Relevant Federal Efforts. The report highlights the challenges consumers with coverage experience with accessing mental health services and the planned federal efforts to address these challenges. The Agency interviewed federal officials and representatives from 29 stakeholder organizations representing consumers, health plans, providers, insurance regulators, and mental health and Medicaid agencies. GAO found that people may have difficulty finding in-network mental health providers that accept new patients. 

Regulatory Action

CMS released the Fiscal Year (FY) 2023 Hospice Payment Rate Update proposed rule that provides routine updates to hospice reimbursement rates and the aggregate cap amount. The rule also discusses the inclusion of the new Hospice Outcomes and Patient Evaluation (HOPE) tool in the Hospice Quality Reporting Program (HQRP), proposes the establishment of a permanent mitigation policy to minimize the impact of annual reimbursement changes due to the hospice wage index, and expands on the quality measures that will be in effect in FY23. The rule also contains a Request for Information (RFI) on health equity that builds on the RFI included in last years’ final rule.
CMS will accept comments on the proposed rule until May 31, 2022.

Congressional Action

The House Committee on Appropriations Subcommittee on Labor, Health & Human Services, Education & Related Agencies held a hearing on the President’s Fiscal Year (FY) 2023 Budget for the Department of Health and Human Services (HHS). The Honorable Xavier Becerra, HHS Secretary, the witness for this hearing reflected on the Department’s achievements over the past year related to COVID-19 vaccinations and boosters, a record number or health insurance enrollees, and key investments to address disparities and improve equity. He noted that the President’s Budget, made up of $127.3 billion in discretionary and $1.7 trillion in mandatory budget authority, will allow for the continuation of these efforts, including reinvestments in public health, research, and development and investments in overdose prevention, mental health, maternal health, cancer, and HIV/AIDS. Healthsperien’s full notes can be found here


Late last week, the Peterson-KFF Health System Tracker released analysis on out-of-pocket spending on insulin among those with private insurance. The report reviewed claims data from private health plans to assess how many insulin users might save with a $35 monthly cap on out-of-pocket costs in the individual, small group, and large group markets as well as how many enrollees paid more than $420 annually out-of-pocket for an insulin product (which is an average of $35 a month). They found that among enrollees in the individual and small group markets taking insulin, over 1 in 4 paid more than an average of $35 per month out-of-pocket for insulin in 2018. Low-income ACA Marketplace enrollees receiving significant cost-sharing assistance were less likely to have out-of-pocket insulin costs averaging over $35 per month. 


The Supreme Court denied hearing a case challenging HHS’ decision to delegate authority to the Actuarial Standards Board to set the definition of “actuarial soundness” in Medicaid and consequently state payment of a tax levied on private insurers. Texas and four other states argued that HHS had allowed a private entity to deprive a state of participating in Medicaid in this scenario, which violated the “non-delegation doctrine,” or the federal government’s limited authority to delegate powers to private actors. The Federal District Court originally held that HHS violated the doctrine, but in July 2020 the Fifth Circuit reversed the decision. The plaintiffs then appealed the case to the Supreme Court. In his statement, Justice Alito concurred in the denial of hearing the case, in part due to complex nature of the case. However, Justice Alito, along with Justices Thomas and Gorsuch, signaled his openness to review future cases around determinations by the Actuarial Soundness Board.
CMS announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. First authorized in 2005, MFP has provided states with $4.06 billion to support people who choose to transition out of institutions and back into their homes and communities. A New Notice of Funding Opportunity will make awards of up to $5 million available to the more than 20 states/territories that currently do not participate in MFP. The funds will support initial planning and implementation of MFP in these states. State Medicaid agencies not currently participating in MFP may apply through May 31, 2022.