HealthCare Roundtable e-News – January 11, 2022

Build Back Better Plan, ‘Byrd Rule’ Negotiations Paused After Senate Returns from Holiday Break

The Senate has put a hold on negotiations around President Joe Biden’s Build Back Better plan, ruling out any speculation that the Senate Parliamentarian may have to rule on provisions from the package. The news, confirmed by a Senate aide and later by Sen. Joe Manchin (D-W.Va.), leaves the door open on whether drug cost controls would be allowed in the budget reconciliation bill.

Lawmakers had expressed concerns that drug pricing measures from the president’s reconciliation package could potentially violate budget rules that apply to the commercial market, including Medicare inflation rebates that are based in part on price increases in the commercial market and a monthly cap on insulin cost-sharing in private insurance. Past measures around PBM transparency have been at risk of violating the Byrd rule, named after the late-Sen. Robert Byrd (D-W.Va.). Some lobbyists and groups see the hold on negotiations as a sign that the package is in deep trouble.

Prior to the holiday break, Senate Majority Leader Chuck Schumer (D-N.Y.) said the Senate would vote on a revised version of the Build Back Better Act and a potential rule change — if Republicans do not drop the filibuster — early in the new year, with both votes hinging on Manchin. Before Christmas, analysts said it was possible Manchin could support parts of the president’s plan.

CMS Announces Proposed Rule for 2023 MA Plan Changes and SNP Requirements

Last week, CMS unveiled a new rule with additional guidance on changes to Medicare Advantage (MA) and Part D for 2023, including medical loss ratio reporting requirements and changes to special needs plans. Currently, more than 27 million beneficiaries are enrolled in MA plans (including plans that offer Part D prescription drug coverage), and approximately 24 million beneficiaries are enrolled in standalone Part D plans, according to CMS.

The proposed rule aims to lower out of pocket Medicare Part D prescription drug costs and improve consumer protections, reduce disparities, and improve health equity in both programs, as well as revise the MA and Part D regulations related to marketing and communications and the criteria used to review applications for new or expanded MA and Part D plans. Additionally, the rule would revise regulations for D-SNPs, and in some cases other special needs plans, related to enrollee advisory committees, health risk assessments, and ways to improve integration of Medicare and Medicaid.

In accordance with the new rule, CMS says it will reinstitute medical loss ratio reporting requirements that were in place from 2014 through 2017, “to hold plans more accountable for how Medicare revenue is spent.” CMS is also proposing to strengthen oversight of third-party marketing organizations “to detect and prevent the use of deceptive marketing tactics to enroll beneficiaries in MA and Part D plans,” according to a fact sheet, and propose numerous Dual Eligible SNP changes, including that all D-SNPs establish and maintain at least one enrollee advisory committee and the plans consult with such committees on health equity issues. (InsideHealthPolicy)

Learn more about CMS’ proposed rule by viewing the fact sheet, here.

New Report Shows Hikes in Annual Medicaid Launch Prices

Drug price watchdog 46Brooklyn recently unveiled a report highlighting how launch prices for drugs are skyrocketing faster than existing drugs. According to the report, the weighted average price per claim for brand drugs rose 58% in Medicaid from 2019 to 2021, compared to the 5% weighted average price increase for existing drugs.

The 46Brooklyn report, which stems from the institute’s Brand Drug List Price Change Dashboard, relies primarily on Medicaid data because it discloses both drug prices and sales volume. Data from recent years shows the percentage increase in the average price per claim is climbing faster than the percentage increase for price hikes. In 2021, the average price per drug claim was $955, up from $760 in 2020 and $605 in 2019. 46Brooklyn CEO Antonio Ciaccia claims the spike in per-claim prices is mostly due to higher launch prices even though that metric also captures price hikes that brands use to blunt initial generic competition. (InsideHealthPolicy)

Democrat lawmakers recently scaled back legislation enabling HHS to intervene on Medicare inflation rebates by curbing annual price increases on existing drugs and negotiating Medicare prices to keep launch prices in check. A thin majority in the senate has forced Democrats to revise the proposals in the package and compromise to instead give biologics 13 years before they’re subject to Medicare negotiation and protect drugs from negotiation for nine years. (InsideHealthPolicy)