HealthCare Roundtable e-News – June 27, 2019

Roundtable Releases 2019 Specialty Drug Survey

2nd Annual Congressional Forum

On Tuesday, the Public Sector HealthCare Roundtable released its Annual Specialty Drug Survey in conjunction with our 2nd Annual Congressional Forum.

We were very grateful to have Matt Eyles, President & Chief Executive Officer of America’s Health Insurance Plans (AHIP), as our Keynote Speaker for this year’s forum. AHIP, like the Roundtable, is committed to expanding access to affordable health care coverage to all Americans, through a competitive marketplace that fosters choice, quality, and innovation. His focus on the high cost of prescription drugs was welcomed by our members and guests. 

In addition to the formal agenda, Roundtable members met with staff for House Speaker Nancy Pelosi, Senate Majority Leader Mitch McConnell, and John O’Brien, Senior Advisor to the Secretary of Health and Human Services for Drug Pricing Policy. Roundtable members also held a number of meetings with individual members of their Congressional Delegations. 

NOTICE: Due to the Fourth of July Holiday, the next Roundtable e-News will be produced during the week of July 8th. 

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Bipartisan Senate HELP Package Targets Surprise Medical Bills, Includes Pay Cap for Air Ambulance Costs

Yesterday, the Senate HELP committee passed legislation that includes bans on surprise medical bills and includes pay caps on out of network air ambulance bills. Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) sought stakeholder input earlier this year and put forward draft legislation this month. The health package seeks to lower costs in a number of areas, and particularly the commercial market. The Roundtable weighed-in with a letter to the Committee earlier this year offering similar policy recommendations.

With respect to addressing air ambulance billing, the package states that patients would pay only the amount they would incur if the air ambulance flight was in-network based on the median contracted rate in that area. The bill also notes that if health plans do not have enough data to determine the appropriate amount a patient would pay, they could refer to external data sources. 

The bill, which has not yet been scheduled for a floor vote, has received support from House Energy and Commerce Committee Chair Rep. Frank Pallone (D-N.J.) and ranking member Rep Greg Walden (R-Ore.).

Executive Order Seeks Transparency on Hospital Prices, HSA Flexibility

On Monday (Jun 24), President Trump signed an executive order creating more transparency for hospital prices and other health services, as well as out-of-pocket costs. The EO directs agencies to draw up rules requiring hospitals and insurers to make public more information on the prices agreed to in contract negotiations, while also enforcing that hospitals and insurers would have to give estimates on out-of-pocket costs to patients prior to receiving non-emergency medical care.

Commenting on the decision, Federation of American Hospitals President and CEO Chip Kahn said, “We appreciate the administration’s executive order where it will meet consumer transparency needs. If implementing regulations take the wrong course, however, it may undercut the way insurers pay for hospital services resulting in higher spending.”  

The executive order also directs the Treasury Secretary to expand pre-deductible coverage of services and drugs for chronically ill individuals in HSA-qualified HDHPs.

House Ways & Means Committee Marks-up Five Health Care Bills

The House Ways & Means committee met June 26 to mark-up several health care bills ranging from telehealth policies to funding for the Patient-Centered Outcomes Research Trust Fund. 

Committee Chair Richard Neal (D-Mass.) offered a bipartisan bill alongside Ranking Member Rep. Kevin Brady (R-T.X.) known as the Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of 2019, which aims to extend payment protections and funding for the National Quality Forum and State Health Insurance Programs, including rural providers. 

Also discussed was legislation aimed at eliminating beneficiary cost-sharing requirements for chronic care management services, which was a result of a code created by CMS to pay for CCM services in the Medicare Physician Fee Schedule. The American Medical Group Association (AMGA) supported the bill and, in a statement, noted that the policy will “help fulfill the code’s potential and remove an unintended barrier to its use.” (InsideHealthPolicy).

Senate Finance and Health Committees Look to Finalize Drug-Pricing Package

The Trump Administration is applying pressure to the Senate Finance Committee to finalize its proposed drug pricing bill, according to White House sources and those involved in group negotiations. Members of the committee have been swept up in bipartisan talks on a potential deal to limit drug price increases in Medicare. 

There have been some notable disagreements on a few of the bills policies, including the administration’s plan to rely on foreign drug price controls and eliminate rebates in Medicare Part D. HHS Secretary Alex Azar spoke publicly in support of the proposal this week, while Senate Finance Committee Chair Chuck Grassley (R-Iowa) has spoken out against international pricing references. (InsideHealthPolicy). 

“You’ve got to have meaningful steps to rein in high drug prices, and the chairman and I are talking about [the drug pricing package] every day, sometimes several times a day, and the focus is on getting it right,” Sen. Ron Wyden (D-Ore.) explained last week. 

It’s expected that if the Finance Committee can come to an agreement on the deal, the bill will likely be combined with the Senate Health Committee’s package when it goes to the full Senate for a vote. Senate Health Committee Chair Lamar Alexander (R-Tenn.) indicated that the combined package could potentially get a vote on the Senate floor before the end of July.