HealthCare Roundtable e-News – February 27, 2023

 

Top News

CBO Releases Presentation on Economic Impact of IRA Drug Pricing Provisions

On Friday, February 17th, the Congressional Budget Office (CBO) released a presentation estimating the budgetary impact of three key prescription drug provisions in the Inflation Reduction Act. In total, CBO estimates that these provisions will reduce the federal budget deficit by $237 billion from 2022 to 2031. According to the presentation, provisions allowing the Secretary of Health and Human Services (HHS) to negotiate prices for certain drugs covered under Medicare Part B and Part D will reduce the budget deficit by $35 billion in 2031. CBO estimates net prices for selected drugs will decrease by 50% on average. However, since these drugs are projected to account for less than one-fifth of total spending net of discounts and rebates in 2031, the overall reduction in net prices in Medicare will be smaller. CBO estimates the average drug prices in 2031 will be 9% lower in Part B and 8% lower in Part D. Inflation rebates on manufacturers will reduce the deficit by $8 billion in 2031, but the Part D redesign will increase the deficit by $2 billion in 2031.

 

Top Republicans Send Letter to HHS & CMS Asking for Updates on $3 Billion in IRA Funding

Last Thursday, House and Senate Republicans from health-related committees sent a letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicaid & Medicare Services (CMS) Administrator Chiquita Brooks-LaSure requesting regular updates on the use of $3 billion in funding for implementation of the drug pricing measures in the Inflation Reduction Act. Senate Finance Committee Ranking Member Mike Crapo (R-ID), House Ways and Means Committee Chair Jason Smith (R-MI), and House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) signed the letter. According to the letter, the $3 billion in funds lack adequate safeguards and oversight. The Republicans asked for updates on how HHS and CMS will prevent the funds from generating waste, fraud, or abuse.

Administrative Action

Recently, the Health and Human Services Office of the National Coordinator for Health Information Technology (HHS ONC) released a new toolkit for communities interested in implementing health IT systems to incorporate social determinants of health (SDOH) data. HHS created this toolkit to help communities who are exploring options to leverage SDOH information exchanges to coordinate and address health equity challenges. The toolkit provides an overview of the current information exchange landscape, implementation considerations, and examples of challenges and opportunities from existing exchanges. 

Congressional Action

Last Thursday, the Senate Health, Education, Labor, and Pensions Committee convened to discuss the current shortage and lack of diversity of healthcare workers, particularly nurses and behavioral health workers. These work force trends have concerning implications for the aging American population and the access to health care in rural areas, as healthcare groups struggle to attract and retain talent outside of urban and suburban cores. Healthsperien’s comprehensive notes from the recent hearing can be found here

Medicare

  • CMS updated its provider-specific guidance related to the COVID-19 Public Health Emergency (PHE). On January 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic. To support the transition, CMS provides resources and fact sheets about PHE waivers and flexibilities for providers, including information about which waivers and flexibilities have already ended, become permanent, or will end at the end of the PHE. The provider-specific fact sheets include information on hospice, home health agencies, long-term care facilities, laboratories, Medicare Shared Savings Program, ambulances, and teaching hospitals.

  • CMS released a statement maintaining their current restrictive national coverage determination (NCD) for the new monoclonal antibody treatments for Alzheimer’s disease. The treatments, which were granted accelerated approval by the Federal Food and Drug Administration (FDA), are currently only covered under Medicare if the beneficiary is enrolled in a clinical trial. This statement was issued in response to a request by the Alzheimer’s Association to expand coverage and access to these treatments, based on additional data published late last year. While CMS recognized that additional evidence is being generated, they do not believe the evidence sufficiently demonstrates that the treatments are reasonable and necessary. However, they note that they will expand coverage if and when the FDA grants the drug traditional approval.

Marketplace

On Wednesday, Amazon announced that it will buy One Medical, a membership-based primary care platform. The acquisition signals Amazon’s continued expansion into the healthcare space, as the deal adds to Amazon’s primary care operations in nearly thirty markets. The company believes this acquisition supports its healthcare strategy to transform how primary care is delivered by making it easier for individuals to access medical care. Even though the Federal Trade Commission will not block the deal, it has indicated that it will continue its investigation of the merger.

Research

  • Late last week, Epic Research released a new study on cancer screenings before and during the COVID-19 pandemic. The review of over 375,000 cancer diagnoses from January 1, 2018, through December 31, 2022, shows no significant increase in the rate of cancer or advanced cancer diagnoses from 2020-2022 compared to pre-pandemic. The study also makes clear that there was a drop in the detection of cancer cases early in the pandemic due to reduced screenings. However, as screening rates returned to normal, so did cancer detection rates.

  • On Wednesday, the Milbank Memorial Fund and the Physicians Foundation released the first national primary care scorecard which found that there is a chronic lack of support for the implementation of high-quality care in the United States across all measures – financing, workforce, access, training, and research. These two nonprofits developed the scorecard in response to the 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care which proposed the development of a scorecard for primary care in the U.S. The scorecard finds: 1) Financing: The U.S. systemically underinvests in primary care. 2) Workforce: Gaps in access to care are growing while the primary care physician workforce is shrinking. 3) Access: The percentage of adults without a usual source of care is increasing. 4) Training: Too few physicians are being trained in community settings. 5) Research: There are few federal funding opportunities for primary care research.

Inflation Reduction Act – Impact on Retiree Healthcare Plans

Alisa Bennett, President of Cavanaugh Macdonald Consulting and a member of the Roundtable’s Corporate Advisory Committee, discussed the impact of the Inflation Reduction Act (IRA) on public sector retiree health plans at the Winter Meeting of the National Association of State Retirement Administrators (NASRA). Her remarks highlighted a White Paper which takes a closer look at how provisions of the IRA will impact public plans.

The Roundtable is happy to share the Cavanaugh Macdonald Inflation Reduction Act White Paper for the information of our members and friends.

Mark Your Calendar for Upcoming Roundtable Events

Webinar – March 28, 2023 – 2:00 PM (EST) – The Cost of the Pharmaceutical Industries’ Anticompetitive Practices and its Impact on Public Sector Purchasers

To protect profits and delay competition, pharmaceutical companies often abuse patent thickets, the accumulation of an overlapping set of patents, and other anti-competitive practices which leads to higher costs for Roundtable members and the public sector purchasers they serve. A recent Matrix Global Advisors (MAG) report highlights the cost of these practices, finding that abuse of patent thickets results in certain drugs costing patients and the healthcare system an estimated $1.8 billion to $7.6 billion per year. Join us for a discussion with the Public Sector HealthCare Roundtable senior policy team and the report’s authors on the cost of anti-competitive practices by the pharmaceutical industry and policymakers’ efforts to enact legislative and regulatory reform.

 

Webinar – May 9, 2023 – 2:00 PM (EST) – Drivers of Health Care Costs: Hospital Consolidation and Lack of Price Transparency

With healthcare costs growing at an unsustainable rate, employers, taxpayers, and patients have to pay more for the same quality of care. Hospitals are one of the top drivers of rising healthcare costs due to the lack of market competition. Join us to hear from the Public Sector HealthCare Roundtable senior policy team and our group of experts on the impact of hospital consolidation, anti-competitive practices, and the lack of price transparency on patients and market-based solutions to increase hospital competition and reduce healthcare costs.

 

19th Annual Conference – November 1-3, 2023