HealthCare Roundtable e-News – March 26, 2019

House Leadership in Talks with White House on Compromise Drug Pricing Bill

Senior staff from the White House and for House Speaker Nancy Pelosi (D-Calif.) are reportedly in talks to review and discuss upcoming drug pricing legislation, a topic that has received much bipartisan support in recent months. While Pelosi and fellow Democrats will look to push Medicare Part D price negotiation, the Trump administration and other Republicans are looking to codify proposals from the President’s “Blueprint” and proposed regulations such as reference pricing tied to International Pricing Index in Medicare Part B. (InsideHealthPolicy) 

Both the White House and Pelosi have expressed a mutual interest in addressing skyrocketing drug prices and “are having ongoing conversations to see where we can work together,” the White House official said. While staff from both the White House and Pelosi have confirmed the talks, neither group has confirmed any details of the conversations or proposed solutions. (InsideHealthPolicy). 

Lawmakers on both sides have opposed the administration’s proposals on Part D, including the elimination of rebates, while sources say some Democrats are wary of the cost of negotiating with the administration on any policies that negotiate lower drug prices. The split comes from the concern that a deal wouldn’t go far enough to create reasonable change, while also handing the President a platform could bolster his reelection in 2020. (InsideHealthPolicy)

Drug Companies Express Concern Over Proposal to Disclose Prices in TV Ads

The White House is currently reviewing a final rule to require drug companies to disclose product prices in all television advertisements, which the Trump administration claims “will provide manufacturers with an incentive to reduce their list prices by exposing overly costly drugs to public scrutiny.” (InsideHealthPolicy). 

Some drug companies have expressed concern that disclosing drug prices in ads could be misleading to customers, claiming that the prices listed in ads wouldn’t reflect that actual amount a customer would pay, nor would it reflect the actual amount the drug company receives. In a letter to CMS administrator Seema Verma, a senior vice president for government relations at Pfizer, Robert W. Jones, explained that “requiring list price disclosures could result in increased consumer confusion and may potentially deter patients from seeking care.” 

While the rule has received some support from lawmakers, several drug companies have acknowledged the need for patients requiring more information and will propose an alternative to the rule, saying they will voluntarily include information in all ads that will direct viewers to websites with information on list prices and out-of-pocket fees.

CMS Prepares for Second Year of Bundled Pay Demo as Trial Period Comes to an End

After a drop in 250 Medicare providers from its Bundled Payments for Care Improvement Advanced demonstration, CMS announced it will consider other options for maintaining the program’s “robust participation,” including opening another application period in the coming months. The program is the Trump administration’s first attempt to produce an alternative pay model for providers and had initial participation of close to 1,300. (InsideHealthPolicy). 

BPCI Advanced is the latest model built off the original BPCI, which had expired last Fall, and supports providers with 32 bundled clinical episodes. Upon its release, CMS had announced an option for providers to pass on the model after a six-month trial, which came to an end in March. (InsideHealthPolicy) 

CMS reports that 1,100 providers are set to participate in the second year of the program, with 715 acute care hospitals and 580 physician group practices among the group that has decided to continue. While an enrollment period for the model’s third year opens in April, the agency has noted that it does not expect to enroll more providers for the fourth- or fifth-year demo. (InsideHealthPolicy).

In Letter to Drug Companies, CVS Requests Hold on Raising Net Prices Before 2020 Plan Bids

During a session at the national health policy conference last Wednesday (Mar. 13), House Energy & Commerce Committee Chair Frank Pallone (D-N.J.) shared that his committee’s focus in 2019 will not be on supporting Democrat-led healthcare initiatives, including the high-profile Medicare for All bill, but instead will be on blocking the Trump administration’s healthcare agenda, specifically on repeals of the Affordable Care Act. Pallone also announced his committee will launch an investigation into the administration’s backing of “junk” insurance plans.

In a recent letter to drug makers, CVS highlighted the need to accurately set Medicare Part D bids for the 2020 calendar year and requested that drug companies hold off in raising net prices. Evercore ISI, an investor research firm, has implied that the letter from CVS was likely sent as the company prepares for its public hearing in April for the Senate Finance Committee, which has requested the presence of pharmacy benefit manager executives to speak on their role in rising drug prices. 

Last January, HHS proposed a cut to rebates that aren’t shared with beneficiaries and is planning to finish that regulation before plan bids are due in June, according to HHS official John O’Brien. 

In the event that CMS bans rebates prior to the June 3rd due date for plan bids, CVS is asking drug makers not to raise the rebated price of their products, and required the drug companies’ assurances “that, regardless of the issuance of any Final Rule, you will, at a minimum, honor the financial value of your Current Offer and continue to provide to the Part D Plans the same or lower net effective drug price for calendar year 2020.” (InsideHealthPolicy).