HealthCare Roundtable e-News – August 4, 2021

Advocacy Updates

White Paper: Fix EGWP Issue in Part D Redesign Efforts

The Roundtable is pleased to share a white paper authored by Evernorth with consultation and support from several key Roundtable members describing the potential unintended consequences of not differentiating between individual Medicare Part D plans and EGWPs in drug pricing reforms. The Roundtable continues to lead bipartisan efforts on the Hill to address this critical issue. The white paper can be found here.

Roundtable Signs Letter to Extend CMMI EMTM Model

Last week, the Roundtable joined over two dozen stakeholder organizations including consumer groups, health plans, pharmacy associations, and many others requesting an extension of the CMMI Medicare Part D Enhanced Medication Therapy Management model, which tests comprehensive MTM services for Medicare beneficiaries with medically complex conditions. The letter can be found here.

Bipartisan Infrastructure Bill Compromise Unveiled in Senate, Delay of Rebate Rule a Likely Pay-For

Senators and staff worked throughout the weekend to finalize the $1.2 trillion infrastructure bill. Senate Republicans agreed to the deal after a meeting on Wednesday, with a bipartisan group finalizing the details of the package late Sunday night. Senate Majority Leader Chuck Schumer (D-N.Y.) stated that he predicts the bill will pass in a matter of days, suggesting the Senate will be able to “quickly process relevant amendments” given how much work has been put into drafting the bill.

There is still some debate over policies that will be able to help offset the costs of the massive infrastructure package. In recent months, House Speaker Nancy Pelosi (D-Calif.) has considered savings from the Elijah Cummings Lower Drug Costs Now legislation to help pay for the bill. Senators have also proposed redirecting $250 billion in unused COVID-19 relief funds, including $50 billion intended for federal unemployment relief, and delaying a passed Trump-era Medicare rebate rule that would save $50 billion by avoiding eliminating Part D rebates.

Democrats and Republicans alike have also expressed support for banning spread pricing in the commercial market as a potential offset for bill’s costs, which the Congressional Budget Office scored as just under $1 billion in 2019. (InsideHealthPolicy)

Sen. Kyrsten Sinema (D-Ariz.) acknowledged that the process for drafting the bill was “difficult” and “long,” but added that it was “what our forefathers intended.” Sinema also shared that the process “of finding bipartisan compromise and working together to achieve the objectives that the American people are depending upon us to do is the very heart and very core of why each of us serve in this government.”

Poll Shows Eight in Ten Likely Voters In Favor of Medicare Dental Benefits

According to a recent poll, a majority of voters are now in favor of the inclusion of Medicare dental benefits. The survey, which was commissioned by CareQuest Institute, OPEN and Families USA, also found that more than half of the 1,000 likely voters hold their lawmakers responsible for the fact that those benefits aren’t already part of the program.

Dental and consumer advocates are praising the results of the survey, particularly now that lawmakers are debating whether to add dental coverage and other new benefits to Medicare as part of an upcoming $3.5 trillion Democrat-led budget reconciliation package.

Ifetayo Johnson, Executive Director of the Oral Health Progress and Equity Network (OPEN), stated that it’s no surprise eight in ten voters want to see these benefits included where “millions of older adults and people with disabilities in this country pay into Medicare their whole working lives and yet it completely leaves out the mouth.” (InsideHealthPolicy)

The survey also found that a majority of older Americans would consider skipping dental visits because the cost of care is too high. Advocates claim that emergency visits for preventable oral health conditions cost an estimated $2 billion per year and are pushing Congress to follow through on what their constituents have expressed to be necessary coverage as part of the upcoming bill. (InsideHealthPolicy)

NIH Suggests Proposed Biomedical Research Agency Partner with Industry, Federal Agencies to Bring Products to Market

Officials are suggesting that the Biden administration’s proposed biomedical research agency, the Advanced Research Projects Agency for Health (ARPA-H), could work with industry and federal agencies in order to bring the administration’s funded projects to the general public. Tara Schwetz, Associate Deputy Director of the National Institutes of Health, explained in a stakeholder meeting how federal agencies and industries would benefit from the partnership.

The proposed research agency would be structured similarly to the Defense Department’s Defense Advanced Research Projects Agency (DARPA), which invests in high-risk, innovative research that also helps developers find customers for their technologies. ARPA-H would look to bring together project managers who would have the flexibility to identify research opportunities and consider how to bring together research partners who might not normally write an NIH grant to move research forward quickly. (InsideHealthPolicy)

“In terms of our customer base right and how those outputs that would be developed could transition potentially to the market and the broader public, we could envision that through multiple different channels. And some could be through partnering with industry and providing some incentives for them to do so if there isn’t much incentive that already exists,” Schwetz told stakeholders.

NIH Director Francis Collins also shared with stakeholders that there are a few hurdles ARPA-H will need to overcome, including being approved and funded through various congressional committees. Collins also noted that the upcoming fiscal year officially starts on Oct. 1, but that the federal government typically does not get funded by then. (InsideHealthPolicy)

Save The Date: 2021 Annual Conference
Monday, November 1 – Wednesday, November 3, 2021
The Alexandrian Hotel, Old Town Alexandria, VA
Registration will open in early August!