Congress on Track to Approve Major Legislative Package to Address Prescription Drug Prices in the U.S.
Yesterday, the U.S. Senate passed the Inflation Reduction Act of 2022 after more than a year of negotiations that includes a comprehensive set of Roundtable-supported policies to address the skyrocketing cost of prescription drugs in the U.S. The measure will now go to the U.S. House where it will likely pass along party lines. President Biden has indicated he will sign the bill.
For over 15 years, the Public Sector HealthCare Roundtable has advocated on a bipartisan basis for a number of federal policy proposals to address the rising cost of prescription drugs. In recent years, drug pricing has been the Roundtable’s top federal legislative priority. The Senate passage of the Inflation Reduction Act of 2022 marks a major victory for the Roundtable and its members.
- Prescription Drugs
- Allows Medicare to negotiated prices for a limited amount of drugs. Negotiations begin in 2024 and negotiated prices for 10 drugs will hit the market in 2026, increasing to 20 drugs in 2029.
- Reforms the Medicare Part D program and caps out of pocket drug spending in Medicare at $2,000 annually. The Medicare Part D reform section includes language protecting EGWP plans.
- Caps the monthly cost of insulin at $35 for Medicare beneficiaries only. Provisions to extend the protection to the commercial market did not meet reconciliation requirements and failed to garner 60 votes.
- Includes inflationary rebate penalties for drug manufacturers that increase the cost of their drug at a rate higher than inflation for Medicare beneficiaries only. Provisions that apply to those with private insurers were removed because they did not comply with reconciliation rules.
- ACA Subsidies
- Includes a three-year extension on health care subsidies in the Affordable Care Act.
- Tax Reform
- Creates a 15% minimum tax for corporations making $1 billion or more in income.
- Includes a 1% excise tax on stock buybacks that begins in 2023.
- Climate Change
- Invests $300 billion in energy and climate reform.
- Includes $60 billion for renewable energy infrastructure including solar panel and wind turbine manufacturing.
- Includes tax credits for individuals on things like electric vehicles and making homes more energy efficient.
Roundtable staff will continue to advocate with House members and the White House to ensure the bill becomes law. Please do not hesitate to reach out to Andrew MacPherson, Roundtable Senior Policy Advisor, with questions (andrew@healthcareroundtable.
- The Biden Administration declared a public health emergency (PHE) for monkeypox in an effort to speed up vaccine distribution and expand testing. This decision was prompted from concerns about Biden administration officials that the virus is spreading faster than previous outbreaks, and advocacy from LGBTQ groups focused on the monkeypox response. This declaration authorizes the Department of Health and Human Services (HHS) to ship out an additional 800,000 monkeypox vaccines, though more doses will likely not be available for several months.
- President Joe Biden issued an Executive Order on Securing Access to Reproductive and Other Healthcare Services, marking another step by the Administration to protect access to reproductive healthcare services. The Executive Order includes directive to support patients traveling out of state for medical care, ensure health care providers comply with federal non-discrimination law, and promote research and data collection on maternal health outcomes. President Biden signed the Executive Order at the first meeting of the interagency Task Force on Reproductive Healthcare Access.
The Department of Health and Human Services (HHS) released two reports: The National Research Action Plan on Long COVID (the Research Plan) and The Services and Supports for Longer-Term Impacts of COVID-19 Report (Services Report). These reports follow a memorandum by President Joe Biden on addressing the long-term effects of COVID-19. Pursuant to Section 4 of the memorandum, the Research Plan aims to increase collaboration among federal agencies for the purpose of researching the prevention, diagnosis, and treatment of Long COVID. Pursuant to Section 3 of the memorandum, HHS published the Services Report outlining support services currently available to those affected by Long COVID.
- Friday, the Congressional Budget Office (CBO) released the Estimated Budgetary Effects of H.R. 5376, the Inflation Reduction Act of 2022. CBO estimates that the Democrat-introduced tax, climate, and drug-pricing bill would result in a net decrease in the deficit totaling $102 billion over the period of 2022-2031. They further estimate that an increase in the Internal Revenue Service (IRS) budget would generate $204 billion in new revenue by cracking down on tax avoidance. The deficit decrease is partially driven by a repeal of a Trump-era rule banning prescription drug rebates and allowing Medicare to negotiate the cost of high-priced drugs.
- Last month, Sen. Maggie Hassan (D-NH) sent a letter to several members of the Biden Administration, urging them to apply the No Surprises Act (NSA) to any in-network facility where a consumer may be treated by an out-of-network provider. In 2021, the administration issued an interim final rule listing types of facilities that must adhere to the NSA. The statues authorizes the agencies to identify additional facilities, which they asked for comment on in July. Sen. Hassan urged the agencies to provide clarity over the status of facilities whose status has yet to be determined, including birthing centers, clinics, hospice facilities, addiction treatment centers, nursing homes, and urgent care centers.
- The Centers for Medicare and Medicaid Services (CMS) announced the availability of new Home Health programs for children with complex medical conditions, allowing states to have the option to provide care coordination, patient and family support, comprehensive care management, referrals and other services. Health Home initiative have been successfully implemented in the past for Medicare beneficiaries with chronic conditions, and CMS aims to expand this program beginning October 1, 2022.
- The Centers for Medicare & Medicaid Services (CMS) released the FY2023 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospitals Prospective Payment System (LTCH PPS) final rule, which updates the fee-for-service payment policies and rates for Medicare’s prospective payment system for inpatient hospitals and LTCHs (fact sheet). The rule addresses key priorities of the Biden administration, including health equity and maternal health disparities. CMS also published a guidance memo for hospitals with evidence-based practices for obstetric emergencies and submitted a request for information to advance maternal health equity (fact sheet). The full text of the rule can be found here.
The Urban Institute released a report finding that 3.7 million people would gain health care coverage in 2023, or a 29% reduction in national uninsurance, if the remaining 12 states were to expand Medicaid eligibility. To date, more than 20 million people in 38 states have enrolled in Medicaid because of Affordable Care Act (ACA) expansion opportunities and have benefitted from reduced mortality and improved financial security. The report also found that the greatest coverage gains would be realized by Black individuals, young adults, and women, especially women of reproductive age. Federal and state spending on Medicaid in the 12 non-expansion states would be partially offset by federal government savings on uncompensated care. Comprehensive analyses of states which expanded Medicaid demonstrate that the expansion generated savings and increased revenues which outweigh new spending.
The Biden Administration sued the state of Idaho over their restrictive abortion law. The Idaho law, which is set to take effect next month, makes it a felony for doctors to perform abortions in nearly all but extremely narrow circumstances. The Department of Justice alleges that the Idaho law would make it a criminal offense to comply with the federal Emergency Medical Treatment and Labor Act (EMTALA) requirement to provide stabilizing treatment – abortion care – even where a doctor determines that abortion is the medical treatment necessary to prevent a patient from suffering severe health risks or even death. The suit, filed in the U.S. District Court for the District of Idaho, is the first legal action the Biden administration has taken against states that have restricted access to abortion in the aftermath of the Supreme Court ruling to overturn the constitutional right to abortion.
SAVE THE DATE – November 9-11, 2022
Annual Conference Returns to Alexandria, VA
After two years of virtual meetings, the Roundtable is planning an in-person Annual Conference for this November. We will return to The Alexandrian Hotel in Old Town Alexandria, Virginia for our annual policy conference from Wednesday, November 9 to Friday, November 11, 2022.
Details will be released later this year. For now, save the dates!