HealthCare Roundtable e-News – March 14, 2022


Roundtable News

In a letter addressed today to House Speaker Nancy Pelosi and Senate Majority Leader Charles Schumer, Roundtable president, Gary Harbin, urges Congress to pass the drug pricing package proposed by the Senate Finance Committee.

“Our members have a fiduciary duty to the public sector consumers that we serve to offer high-quality benefits at a cost that is affordable,” Harbin wrote. “The rapidly increasing cost of prescription drugs in the U.S. threatens our ability to accomplish this goal,” he added.

The full text of the letter can be found here.

Top News

Congress Passes Legislation to Fund the Government for FY 2022

Late Thursday, March 10th, the United States Senate passed the FY 2022 Consolidated Appropriations Act, funding the federal government and sending the bill to President Biden’s desk to avoid a government shutdown. H.R. 2471 provides $1.5 trillion in discretionary resources across the 12 fiscal year 2022 appropriations bills. In total, the regular 12 appropriations bills include $730 billion in non-defense funding, a $46 billion increase over fiscal year 2021. This 6.7 percent increase in non-defense funding is the largest in four years. The bills provide $782 billion in defense funding as well. In addition to the 12 fiscal year 2022 appropriations bills, the funding legislation contains a supplemental funding bill providing $13.6 billion to support Ukraine. The legislation originally included about $15 billion in further COVID-19 funding for the federal government to deploy, however, Speaker Pelosi chose to exclude this from the larger omnibus. To review Healthsperien’s summary of the legislation, click here


Milliman Publishes a Study Analyzing CMS’ Proposal to Move DIR to the Point of Sale

Milliman released results of a study requested by the Pharmaceutical Care Management Association (PCMA) examining the impact of CMS’ proposal moving pharmacy direct and indirect remuneration (DIR) to the point of sale, rather than post-point of sale, to key stakeholders in the Medicare Part D individual market. According to the study, on average across beneficiaries, the proposed policy could reduce cost-sharing and increase premiums. Milliman estimates the cost-sharing reduction would outweigh the premium increase for beneficiaries in the aggregate. For individual beneficiaries, net impacts will vary by income, health status, plan choice, pharmacy choice, drug use, benefit design, and other factors. The comment period is currently closed on the Medicare Part C and D rule. CMS is due to release a final Medicare Part C and D rule in the coming months. 

Administrative Action

The Department of Health and Human Services (HHS) announced that through its subsidiaries – the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of Minority Health (OMH) – nearly $35 million in new funding grants would go towards strengthening and expanding mental health services, like suicide prevention programs, for America’s youth. This initiative will accompany the American Rescue Plan’s allotted $9.2 million, to address the Biden-Harris administration’s tackling of the nation’s mental health crisis. HHS Secretary Xavier Becerra has begun a National Tour to Strengthen Mental Health to engage with local leaders and Americans about the mental health challenges within their communities.

The Biden-Harris Administration is launching a nationwide Test to Treat Initiative this week so Americans can rapidly access needed COIVD-19 treatments. Through this program, people who test positive for COVID-19 will be able to visit hundreds of local pharmacy-based clinics and federally-qualified community health centers (FHQCs), and residents of long-term care facilities will in one-stop, be assessed by a qualified health care provider who can prescribe antiviral pills on the spot. Additionally, HHS has invested in and purchased a broad variety of COVID-19 treatments and therapies. The Test to Treat Initiative will also include new actions to educate the public about the availability of new treatments and the importance of starting them soon after the onset of symptoms; and provide information to health care providers about these new treatments. 

Regulatory Action

The Centers for Medicare and Medicaid Innovation (CMMI) announced they are accepting applications for the recently announced Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model for Performance Year (PY) 2023. CMMI noted that ACO REACH is a redesign of the Global and Professional Direct Contracting (GPDC) Model in response to stakeholder feedback, participant experience, and the Biden-Harris Administration’s priorities, including a commitment to advancing health equity. Interested stakeholders are required to submit their application via web portal by April 22, 2022 at 11:59 PM EDT. Details on the model, as well as eligibility requirements can be found in the Request for Applications (RFA). Healthsperien recently released a comprehensive summary of the ACO REACH RFA which can be accessed here.

Congressional Action

Bipartisan Legislation is Introduced to Extend the Hospital at Home Demonstration
Congressmen Brad Wenstrup (R-OH) and Earl Blumenauer (D-OR) and Senators Tim Scott (R-SC) and Tom Carper (D-DE) introduced the Hospital Inpatient Services Modernization Act to establish a two-year extension of the Acute Hospital Care at Home COVID-19 waiver implemented during the pandemic and require the Department of Health and Human Services (HHS) to conduct a thorough review of the program. In November 2020, CMS announced the Acute Hospital Care at Home Waiver, which permitted acute-level care to be delivered to patients in the home. CMS had statutory authority to create this waiver under Section 1135 of the Social Security Act, but the waiver is tied to the COVID-19 Public Health Emergency which is predicted to end soon.
Legislation Introduced to Reform FDA’s Accelerated Approval Program
Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) introduced the Accelerated Approval Integrity Act, which would “improve the Food and Drug Administration’s (FDA) ability to ensure that drugs that receive accelerated approval are providing proven clinical benefits.” The Accelerated Approval Integrity Act will provide FDA with additional authority to ensure products that receive accelerated approval are providing a clinical benefit to patients in a timely manner.
Senator Schumer Outlines Senate Democrats Spending Priorities
In a letter to his colleagues, Senate Majority Leader Chuck Schumer outlined spending priorities for Senate Democrats. Specifically, the letter mentions a proposal of $1 billion to bolster the Federal Trade Commission’s (FTC) competition bureau and consumer protections to address companies practicing price gouging, lowering the cost of prescription drugs, health care, and the costs of raising a family, lowering the cost of insulin, curbing rising meat prices, and reforming unfair ocean shipping practices, strengthening domestic supply chains and bringing manufacturing jobs back to America, reforming the US Postal Service, lowering the cost of energy, as well as an omnibus package that includes assistance to Ukraine and additional funds to prepare the country in the event of another COVID variant.


A bipartisan group of 41 lawmakers, led by Representatives Suzan DelBene (WA-01), Markwayne Mullin (OK-02), Ami Bera, M.D. (CA-07), Mike Kelly (PA-16), Peter Welch (VT-At-Large), Darin LaHood (IL-18), and Brad Wenstrup (OH-02), sent a letter (IHP subscription required) to HHS Secretary Xavier Becerra requesting that the department make reasonable alterations to the Medicare Shared Savings Program (MSSP) and implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) to increase provider participation in successful alternative payment models. To achieve the goal set forth by CMS in 2021 to ensure every Medicare beneficiary is in a value-based program by 2030, the letter outlines six specific actions for HHS to take.