HealthCare Roundtable e-News – May 22, 2019

Wyden Introduces Legislation to Boost Health Care Cost Transparency

Senator Ron Wyden (D-Ore.), Ranking Member of the Senate Finance Committee, introduced a new piece of legislation aimed at boosting transparency around health services costs. The bill, titled Health Care Price Check Act of 2019 would require Medicare and health insurance companies to give beneficiaries information on the cost and quality of health services, including out-of-pocket fees, and other products through an online tool and toll-free phone number. 

“Consumers need access to information on the quality of providers. There is often a misconception that higher cost care is also higher quality. Providing quality information alongside cost can enable consumers to choose higher-value care and prepare financially for non-emergency situations,” Wyden’s office said. (InsideHealthPolicy). 

The bill emphasizes the different types of health care costs most Americans receive and calls on insurers to provide information on costs of services and products, as well as provider quality and information on whether a provider is out of a patient’s network. As a result of the bill, consumers would have access to this information regardless of whether they have a private plan or Medicare. Click here to learn more about Wyden’s proposal.

Energy & Commerce Subcommittee to Consider Seven Drug Pricing Transparency Bills at May Hearing

The House Energy & Commerce health subcommittee is expected to review several pieces of drug pricing legislation at their “Improving Drug Price Transparency and Lowering Prices for Americans” hearing later this month. The bills being considered include the Stopping the Pharmaceutical Industry from Keeping drugs Expensive, also known as SPIKE, Act, the Fair Accountability and Innovative Research (FAIR) Drug Pricing Act,Public Disclosure of Drug Discounts ActDrug Price Transparency ActPrescription Pricing for the People ActCreating Lower Cost Alternatives for Your Prescription Drugs Act, and the Sunshine for Samples Act of 2019. 

The House Ways & Means committee had previously passed a bill that combined policies from the SPIKE and FAIR Acts. Senate Finance Committee Chair Chuck Grassley (R-Iowa) had opposed the SPIKE Act, and Health Subcommittee Chair Rep. Lloyd Doggett (D-Texas) had criticized the merged bill for being “too watered down.” (InsideHealthPolicy). 

Both the Finance Committee and Health, Education, Labor and Pensions Committee are currently working on their own packages for lowering health services costs and prescription prices. Both committees are expected to propose new legislation later this summer.

Senate Committee Leaders to Consider Drug Pricing Legislation and Surprise Billing in Health Costs Package

Several drug pricing bills and legislation to address so-called “surprise billing” are to be considered by Senate committee leaders in an upcoming health care cost-reduction package, according to lawmakers. Though the exact bills to be included has not yet been decided, Democrats and Republicans have claimed the bills in the package will be kept as bipartisan as possible. Concerns over language in the Hyde amendment had stalled the inclusion of the Alexander-Murray legislation in the package. (InsideHealthPolicy). 

“Things that Chairman Alexander is doing and things we’re doing would need to be joined in order to get it up on the floor of the Senate, because the possibilities of getting two separate bills up with all the work we have is going to be very difficult. We have a better chance of getting health care reform up if they’re together,” said Senate Finance Committee Chairman Chuck Grassley (R-Iowa). (InsideHealthPolicy). 

The Finance committee has set June 19th as the tentative date for marking up drug pricing legislation, according to committee staffers. Details on the drug-pricing policies the committee is currently pursuing have yet to be revealed. (InsideHealthPolicy).

CMS Abandons Proposal to Make Changes to Protected Drug Classes

The Trump administration has backed off a proposal that would allow Medicare Part D plans to deny coverage protections for six drug classes. The rule, proposed in November of 2018, had called for letting Part D plans exclude drugs in protected classes when manufacturers raise prices at unreasonable rates, or when companies make new formulations of drugs already on the market. (InsideHealthPolicy). 

“Medicare beneficiaries with the most complex, chronic conditions are breathing a sigh of relief. This rule cements Medicare’s protected classes policy as an essential patient safeguard in Medicare’s prescription drug program,” said Chuck Ingoglia, the executive director of the Partnership for Part D Access. 

Lawmakers in both parties shared concerns that any changes to the protected classes would hurt seniors. According to an agency fact sheet, “CMS will continue to carefully review these comments as we continue to consider policies that would lower prescription drug costs, address challenges that independent pharmacies face, and improve the quality of pharmacy care.” (InsideHealthPolicy). 

In addition to abandoning the protected class change, CMS chose not to alter step therapy or prior authorization in Part D as originally proposed.

House Committee Democrats Press Trump Administration for Documents Explaining ACA Move

Chairs of several House committees are calling on the Trump administration to hand over documents explaining why the administration had recently shifted its position on the Affordable Care Act since the GOP launched its legal challenge against the bill. In a series of letters, Energy & Commerce Chair Frank Pallone (D-N.J.), Education & Labor Chair Bobby Scott (D-Va.), Ways & Means Chair Richard Neal (D-Mass.), Judiciary Chair Jerrold Nadler (D-N.Y.) and Oversight & Reform Chair Elijah Cummings (D-Md.) noted that a subpoena may be issued if the administration’s offices do not provide documents and a transcribed interview of Acting Office of Management and Budget Director Russ Vought by May 24. 

“Given the grave consequences that would result if the Trump Administration’s legal position were to prevail, it is Congress’ responsibility as an independent and co-equal branch of government to understand how this decision was made,” said Reps. Pallone, Scott, Neal, Nadler, and Cummings. “If the President and his Administration truly stand by their decision to seek to eliminate health insurance coverage for millions of Americans, it is unclear why the White House would cover up its role in this unprecedented and disastrous reversal.” (InsideHealthPolicy). 

The requests for documentation surrounding the pivot comes two weeks after the Trump administration surprised lawmakers and chose not to defend Obamacare in the Texas v. Azar court case. The case, heralded by 20 GOP-led states, contends that the entire piece of legislation is invalid because Congress zeroed out its individual mandate penalty.