Outlook for 2024: Public Sector Health Care Policy, Politics, & Predictions
Congressional Update Webinar – Wednesday, January 10, 2024 at 3:00 PM EST
As 2024 begins, a number of important legislative and regulatory issues will be front in center in Washington as policymakers return for the second session of the 118th Congress. From PBM reforms to pharmaceutical cost containment and potential Medicare Advantage changes, 2024 will present a number of policy opportunities and potential challenges for public sector purchasers.
Please join the Roundtable policy team on Wednesday as they look ahead to 2024 and provide analysis and predictions for the key federal health care policy issues impacting public sector purchasers and the workers they represent.
Roundtable Joins Comment Letter Regarding Surprise Billing
The Public Sector HealthCare Roundtable recently signed on to a non-branded comment letter from organizations representing unions and employers to the tri-departments, Health and Human Services, Labor, and the Treasury, in response to the surprise billing IDR operations proposed rule. While commending the Departments for their efforts, the letter urges improvements to the IDR process, emphasizing the need for open negotiation, better information sharing, eligibility reviews, and reforms in batching claims. The letter also emphasizes the importance of minimizing IDR usage, limiting costs, and encouraging healthcare providers to join group health plan networks, ultimately aiming to achieve the goals of the No Surprises Act in protecting consumers and lowering healthcare costs. Comments for the proposed rule closed on January 2, 2024. Read the full letter here.
Recent Brief Compares How First Ten Drugs up for Medicare Negotiations Compare Internationally
In a recent brief released by the Commonwealth Fund, the first ten drugs that are eligible to be negotiated by Medicare had their prices compared to the cost of the drug in other developed nations. The findings were prefaced by explaining that Americans pay more for brand-name medications than people do in other developed countries. With the implementation of the Inflation Reduction Act (IRA) in 2022, the Centers for Medicare and Medicaid Services (CMS) was empowered to negotiate drug prices on behalf of Medicare for a small group of medications. The first ten drugs, which are used to treat conditions like blood disorders, diabetes, and autoimmune disorders, were selected as they account for substantial portion of Medicare Part D spending, and they met the criteria set by the IRA. Key takeaways from the findings include that list retail prices for the 10 selected drugs are on average three times higher in the United States than in other high-income countries. Additionally, prices after discounts in the U.S. are higher than almost all prices before discounts in relative countries – indicating significant room for reductions in negotiations.
The U.S. Department of Health and Human Services (HHS) and the General Services Administration (GSA) jointly announced new guidance that encourages all federal facilities to have overdose reversal medications included in their safety stations on site. In particular, the Administration is increasing access to the overdose reversal medication called naloxone in a continued attempt to curb the drug overdose crisis. The guidelines also introduce the concept of a “safety station” that would expand the automated external defibrillators (AED) program to allow for anyone within a federal facility to promptly respond to an emergency situation as the station is recommended to include a bystander-empowered opioid reversal agent. The actions taken by President Biden work in tandem to support his National Drug Control Strategy and President Biden’s Unity Agenda. President Biden has committed one of his four pillars of his Unity Agenda to beating the overdose epidemic and has already taken steps toward this goal through HHS and the U.S. Department of Housing and Urban Development when the agencies called on public health departments to partner with housing providers and community development organizations.
The Fifth Circuit court upheld a lower court ruling that the U.S. Department of Health and Human Services (HHS) over-exercised its authority in clarifying that the Emergency Medical Treatment and Labor Act (EMTALA) must include abortion care if the providers deem the operation medically necessary to stabilize a patient in an emergency. Following the landmark case of Dobbs v. Jackson Women’s Health Organization, HHS released guidance that clarified that abortion services are included in the standards of care that hospitals are required to provide under EMTALA – adding that those that refuse to comply risk their contract with Medicare. After HHS released their guidance, the District Court for the Northern District of Texas ruled in August 2022 that their guidance violated the states’ 10th Amendment rights and the Administrative Procedure Act. Judge Engelhardt, who authored the Fifth Circuit court’s opinion, held that the HHS’s guidance does violate the Administrative Procedure Act – pointing to a 2022 ruling that set the precedent that said that EMTALA was not intended to establish guidelines for patient care. Engelhardt said that the guidance has legal consequence and is therefore in violation of the 2022 ruling.