HealthCare Roundtable e-News – December 9, 2020

President-Elect Biden Formally Introduces Members of the Administration’s Health Team

On Monday, President-elect Joe Biden announced several of his nominations to the new administration’s Health team, among the key picks being California Attorney General Xavier Becerra to lead HHS and Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital, to lead the Centers for Disease Control and Prevention. Biden also plans to nominate Vivek Murthy as surgeon general, who previously served in the position under the Obama administration from 2014-2017.

The president-elect also named members of the team who will not require confirmation in the Senate, including Marcella Nunez-Smith, Chair of the COVID-19 Equity Task Force, Jeff Zients as Biden’s “COVID-19 czar,” and Natalie Quillan as deputy coordinator of the COVID-19 Response. (InsideHealthPolicy)

In a statement, Biden said, “this team of world-class medical experts and public servants will be ready on day one to mobilize every resource of the federal government to expand testing and masking, oversee the safe, equitable, and free distribution of treatments and vaccines, re-open schools and businesses safely, lower prescription drug and other health costs and expand affordable health care to all Americans, and rally the country and restore the belief that there is nothing beyond America’s capacity if we do it together.” Biden also formally announced last week that Dr. Anthony Fauci, the nation’s top infectious disease expert, will serve as chief medical advisor and maintain his current role as Director of the National Institute of Allergy and Infectious Diseases. According to sources, the team is keen to take on a different approach to handling the coronavirus pandemic. Biden has already called for 100 days of mask-wearing at the start of his presidency.

Pharma Groups Sue Trump Administration Ahead of Most-Favored-Nation Rule Demonstration

On Friday (Dec. 4), a joint lawsuit was filed against the Trump administration by Pharmaceutical Research and Manufacturers of America (PhRMA), the Association of Community Cancer Centers, Global Colon Cancer Association, and National Infusion Center Association over demonstrations of Most-Favored-Nation (MFN) rule, which are scheduled to begin in the new year. The MFN model is the Trump administration’s attempt to implement policy lowering drug costs by implementing Medicare pay cuts to doctors nationwide. Biotechnology Innovation Organization had also been preparing to file a separate suit in a federal court in the state of California.

The MFN pilot program will test paying Part B drugs at comparable amounts to the lowest adjusted price paid by any country in the Organisation for Economic Co-operation and Development (OECD). In a statement, PhRMA said the interim rule “exceeds the statutory authority provided to the Centers for Medicare and Medicaid Services, raises serious constitutional questions and improperly fails to follow required rulemaking procedures.” (InsideHealthPolicy)

Consulting firm Avalere Health published the results of their study last week, concluding that a majority of beneficiaries in Medicare FFS would not see a reduction in their out of pocket costs from the MFN model. The study found that less than 1% of Medicare beneficiaries would see reduced costs, largely because 94% of FFS Part B beneficiaries already have supplemental coverage.

CMS Finalizes Physician Fee Rule, Does Not Include Drug Pricing Proposal

Last week, CMS finalized the Physician Fee Schedule rule that includes updates on Medicare payment policy changes after January 1, 2021. The final rule does not include a provision that would assign certain section 505(b)(2) drug products to existing multiple-source drug codes when a product meets the definition of a multiple-source drug, which had previously been proposed by the agency.

CMS had claimed the proposal was consistent with the concept of paying similar amounts for similar services and with efforts to curb drug prices; however, the Pharmaceutical Research and Manufacturers of America (PhRMA) opposed the proposal by the agency, commenting that its inclusion would have been “inconsistent with the statute” and would give CMS free rein to make ad hoc decisions about whether to classify 505(b)(2) drugs as multiple source drugs. (InsideHealthPolicy)

“In response to comments asking for more detail about our proposed approach and requests to delay finalizing a decision, CMS is not finalizing the proposal or the corresponding regulation text for CY 2021, the agency stated in a release.

Health Groups Call on Congress to Act on COVID-19 Relief Priorities During Lame-Duck Session

Last week, health care industry groups wrote to congress calling for action on coronavirus relief and strengthening Medicare while COVID-19 cases surge. Blue Cross Blue Shield Association (BCBSA) and America’s Health Insurance Plans (AHIP) are both urging Congress to act now before it’s too late.

The groups are calling for an increase in federal matching funds (FMAP) to 12% until a state’s unemployment rate dips below 5%, a solution that’s consistent with the one backed by the National Governors Association. Similarly, the Association of Community Affiliated Plans (ACAP) is calling for these changes and requesting that Congress pause sales of short-term limited duration plans and reverse the rule that lets those plans operate for up to three years. (InsideHealthPolicy)

ACAP is also recommending Congress adjust the definition of “uninsured” to mean anyone not enrolled in comprehensive coverage to make sure that consumers can get covered under Medicaid’s COVID-19 treatment category, as well as a special enrollment period for consumers who have entered the exchange grace period due to non-payment and are slated to have their coverage terminated once open enrollment ends.