HealthCare Roundtable e-News – February 20, 2024


Save the Date

2024 Congressional Forum | Thursday, June 6, 2024 | Washington, DC

The Roundtable is pleased to announce a Congressional Forum to be held on Capitol Hill in Washington, DC on Thursday, June 6, 2024. This year’s Forum will begin with an informal reception on Wednesday evening. Thursday will include a full morning of speakers and lunch; the afternoon will provide attendees an opportunity to meet with Members of Congress, congressional staff, and targeted Biden Administration officials.

Program details, together with a registration process, will be announced in late March. In the meantime, mark your calendars for the opportunity to attend the Roundtable’s 2024 Congressional Forum.

Top News

CMS Releases Medicare Prescription Payment Plan Draft Part Two Guidance

The Centers for Medicare and Medicaid Services (CMS) recently released (fact sheet) draft part two guidance for the Medicare Prescription Payment Plan. The new draft guidance focuses on Medicare Part D enrollee education, outreach, and communications regarding the Medicare Prescription Payment Plan. The draft guidance was released in anticipation of certain provisions of the Inflation Reduction Act being implemented, like the prescription drug law that goes into effect in 2025. The law requires all Medicare Part D plans to offer enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments, instead of a lump sum at the pharmacy. Contrary to the draft part one guidance, which focused on Part D plan sponsor operational requirements, the draft part two guidance centers on education and outreach for the program. CMS outlined four categories of information the draft part two guidance, which include:

  • Outreach and education requirements for Part D plan sponsors, including requirements for member ID card mailings, updates to current Part D materials, and website contents.
  • Requirements for Part D plan sponsor communications with prospective and current program participants, particularly around election of the payment plan as well as voluntary removal, non-payment, and termination.
  • Information about how CMS will perform outreach and education activities, including developing an educational product on the program, modifying already existing Part D enrollee resources to include information on the program, and engaging interested parties through national outreach and education efforts.
  • Additional operational requirements for Part D plan sponsors, including guidance for non-retail pharmacies, Part D bidding for Contract Year 2025, and Medical Loss Ratio (MLR) instructions.

CMS seeks comments from interested parties on the draft part two guidance, with comments due on March 16, 2024.


FTC and HHS Investigate Generic Drug Shortages with RFI on GPOs and Wholesalers

The Federal Trade Commission (FTC) and the U.S. Department of Health and Human Services (HHS) have jointly issued a Request for Information (RFI) to investigate the potential contributions of group purchasing organizations (GPOs) and drug wholesalers to generic drug shortages. Seeking public comment on market concentration and contracting practices, the RFI aims to comprehend the influence of these entities on pharmaceutical pricing and availability. FTC Chair Lina M. Khan emphasized the urgency of addressing chronic drug shortages and scrutinizing opaque drug middlemen, while Secretary Xavier Becerra highlighted the Biden-Harris Administration’s commitment to mitigating health care monopolies. GPOs, acting as intermediaries, negotiate deals for generic drugs between health care providers and manufacturers, while drug wholesalers purchase drugs from manufacturers and supply them to health care providers. The RFI is part of ongoing efforts by the FTC and HHS to enhance competition in pharmaceutical markets and ensure access to affordable care. The inquiry focuses on various topics, including compliance with legal obligations, the impact of the Federal Anti-Kickback Statute on market concentration, and the effect of GPO compensation models on suppliers.


Millions of Medicare Beneficiaries to Benefit from New Out-of-Pocket Drug Spending Cap

The Kaiser Family Foundation (KFF) recently published an article explaining that in 2025, Medicare beneficiaries will pay no more than $2,000 out-of-pocket for prescription drugs covered under Part D. The spending cap originates from a provision in the Inflation Reduction Act of 2022 which implemented several changes to the Medicare Part D program aimed at lowering out-of-pocket costs for beneficiaries. The new $2,000 spending cap, coupled with the elimination of the 5% coinsurance in the coverage phase of the Part D benefit, amounts to a cap of $3,300 for out-of-pocket brand name drugs. If the provision were implemented in 2021, 1.5 million Medicare beneficiaries enrolled in Part D plans would have seen savings. Accounting for the past decade of Part D enrollees’ spending, a total of 5 million people had out-of-pocket costs of $2,000 or more in at least one year between the years of 2012 and 2021. Thousands of people will begin feeling the benefits of the spending cap in 2025 – with over 100,000 enrollees in California, Florida, and Texas, facing out-of-pocket costs of $2,000 or more in 2021.


Senate HELP Hearing on Price of Prescription Drugs

Last week, the Senate Committee on Health, Education, Labor & Pensions (HELP) held a hearing to discuss the role of large pharmaceutical companies in the cost of prescription drugs in America and abroad. The Committee convened two panels, one with CEOs from Johnson & Johnson, Merck, and Bristol Myers-Squibb and a second which featured leaders of research institutions. The Committee and panelists discussed the role of intermediary parties, like pharmacy benefit managers (PMBs), the price differential across countries for prescription drugs, what goes into the price of a drug, and how the price of prescription drugs can be reduced from a corporate perspective. Healthsperien’s comprehensive coverage of the hearing can be found here.

Administrative Action

The U.S. Department of Health and Human Services (HHS) released the 2023 update to its Equity Action Plan related to their implementation of President Biden’s Executive Order on “Further Advancing Racial Equity and Support for Underserved Communities Through The Federal Government.” In alignment with the Biden-Harris Administration’s whole-of-government equity agenda, this Equity Action Plan supports HHS in advancing health equity and well-being for all. The plan includes the following five priority areas: prevent neglect and improve care to help children thrive in their families and communities, promote accessible and welcoming health care for all, improve maternal health outcomes for rural, racial, and ethnic minority communities, prioritize the behavioral health of underserved populations, and increase clinical research and trial diversity to support innovation. Since the release of the HHS’ first Equity Action Plan in 2022, HHS has proposed rules on language access and rules that prohibit discrimination based on disability. Additionally, HHS approved the provision of 12 months of continuous postpartum coverage through the Centers for Medicare and Medicaid (CMS) in 42 states, DC, and the Virgin Islands.


The Peterson-KFF Health System Tracker recently published a brief that analyzed data from the Survey of Income and Program Participation (SIPP) to get a better understanding of how many people have medical debt and how much they owe. The brief explains that nearly 20 million people in the United States owe medical debt, collectively around $220 billion of debt in total. The analysis further found that that people who are in worse health and those living with a disability are more likely to have medical debt, with 13% of people with a disability having medical debt compared to only 6% of people without a disability having debt. The brief also shows that middle aged adults and Black Americans are more likely to have medical debt. It found that 11% of people aged 35-49 had medical debt, compared to just 6% of those aged 65-79. Similarly, 13% of Black Americans reported having medical debt compared to 3% of Asian Americans and 8% of white people. The brief found that, overall, people struggling with poor health or financial insecurity are more likely to have medical debt.

Mark your calendar:

Roundtable’s Congressional Forum

June 6, 2024

Washington, DC

Roundtable’s 20th Annual Conference

November 6-8, 2024

The Mayflower Hotel, Washington, DC

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