HealthCare Roundtable e-News – June 11, 2019

Grassley Looks to Put Forward Bipartisan Drug Price Package This Month

According to Senate Finance Committee Chair Charles Grassley (R-Iowa), the committee is expected to unveil legislation this month in an effort address skyrocketing drug costs. The package will likely include reforms to Medicare Parts B and D, as well as Medicaid, according to a recent report from Politico. 

Grassley and ranking member Sen. Ron Wyden (D-Ore.) have been negotiating proposals for the package and have a history of working together on pharmaceutical legislation and specifically out-of-pocket caps on Medicare Part D. Details of this package have not been finalized and neither member has commented on the specifics of which policies it will include. Some have speculated that the bill will likely not authorize direct Medicare negotiations with drug manufacturers, a priority for Democrats. 

Sources have shared that White House HHS officials have been informed of the policies being considered throughout the process. Grassley has asserted that if a drug pricing package can’t come to fruition this month, then the committee likely not see another attempt until 2020. (Politico).

Drug Makers Look to Negotiate Catastrophic Costs, Donut Hole Discounts with Senate Finance Committee

Senate Finance Committee on the seniors’ Medicare Part D drug costs. According to several sources, the drug manufacturers will agree to cover the “catastrophic” costs in exchange for caps on seniors’ costs and the removal of the 70% discounts they currently pay for drugs that beneficiaries take while in the donut hole. (InsideHealthPolicy). 

Lawmakers have continuously looked for ways to close the donut hole, the gap beneficiaries fall into after they accumulate more than a few thousand dollars in drug expenses and are at risk of having to pay the full cost of their medications. Some experts have argued that a cap on seniors’ health costs in the hole, as proposed by the drug manufacturers, would make beneficiaries more likely to blame the insurance companies for the resulting rising health costs and premiums. (InsideHealthPolicy). 

Several proposals are part of the discussion, including a template from the American Action Forum, on administering changes to the retail drug program. Senate Finance Committee Chair Chuck Grassley (R-Iowa) has stated that committee members have been considering modifying policies on catastrophic costs in Part D, while Senate Finance ranking member Ron Wyden (D-Ore.) has argued that drug makers ought to be held accountable for what their products cost both seniors and taxpayers. (InsideHealthPolicy).

OMB Reviewing HHS’ Anti-Kickback Safe Harbor Proposal and Penalty Rules

The White House Office of Budget and Management is in the process of considering an HHS proposal to revise anti-kickback statute safe harbors and civil monetary penalty rules for beneficiary inducements, as reported last week by the office. The rule is expected to include adjustments to the physician referral policy known as the Stark law as a part of HHS’ Regulatory Sprint to Coordinated Care. The Roundtable has vocally opposed the proposal. 

HHS’ Office of the Inspector General’s regulatory post stated that the rule “proposes to amend the safe harbors to the anti-kickback statute and the civil monetary penalty (CMP) rules under the authority of the [OIG] to better support coordinated care.” (InsideHealthPolicy). 

The OMB review will likely complete its review of the anti-kickback rule next month.

Ways & Means to Hold Hearing on Medicare for All, Single-Payer Proposals This Week

The House Ways & Means Committee is expected to hold a hearing this Wednesday (June 12) on coverage expansion options, including Medicare for All. Notably, W&M is the first committee to hold hearings on progressive health policy, and the hearing itself will also be the third time in the past month that a House committee has examined single-payer policy opportunities. 

The committee will also consider options for expanding government-run healthcare, although there are no material policies expected to be reviewed at this time. Rep. Pramila Jayapal (D-Wash.), a co-sponsor of the House Medicare for All bill, told reporters she hopes to secure “as many Medicare for All-related witnesses as possible.” (InsideHealthPolicy) 

Asked about the hearing, Ranking Member Kevin Brady (R-Texas) said, “I’m pleased. We asked that Chairman Neal hold a hearing on Medicare for All because it is so devastating for the good health care plans that people get at work, as well as ending CHIP and Medicare advantage that 20 million seniors rely on.”