HealthCare Roundtable e-News – November 7, 2018

What Voters Can Expect from A Democratic-Led House on Drug Pricing Reform

Lawmakers on both sides are considering what the effects of a House flip in favor of Democrats could mean for drug pricing initiatives, pending the results of upcoming midterm elections. Drug pricing has remained a top issue for many voters, and this election in particular will set the tone for potentially more aggressive drug pricing reform strategy and subcommittee agendas.

A Democrat-led House would initially focus on campaign finance changes, according to House minority leader Nancy Pelosi, and reinstating provisions of the Voting Rights Act, with drug price discussions following shortly. Democrats have been preparing a $1 trillion infrastructure package to slow the increases in prescription drug costs, but noted that proposals would be run through the regular committee process in an effort to try to build a consensus with Republicans first.

A document detailing Democratic drug pricing priorities pegs top policy issues as allowing Medicare Part D to negotiate drug prices, imposing requirements for drug manufacturers to report and justify significant price increases to HHS, and creating a Senate-confirmed “price-gouging” enforcer position and agency to investigate drug manufacturers and identify “unconscionable price increases.” (InsideHealthPolicy)

A flip to a Democratic house would also lead to key leadership changes that would impact drug pricing issues; Rep. Lloyd Doggett (D-TX), who has been a critic of rising drug costs is considered to be a favorite to chair the Ways & Means health subcommittee. Chair of the Energy & Commerce Committee would also be up for grabs, and the House Committee on Oversight and Government Reform will likely apply more pressure on drug manufacturers.

State Lawmakers in Maryland and Minnesota Look to Reintroduce Rate-Setting Commissions for Rx Drugs

Lawmakers in both Maryland and Minnesota will look to reintroduce bills that would create rate-setting commissions for prescription drugs, after both states’ bills had unsuccessful runs during the last session. The new bills, based on the model legislation by the National Academy for State Health Policy (NASHP), would establish a Drug Cost Review Commission and an advisory board to closely evaluate drug prices.

“Consumers continue to be outraged by the price of necessary prescription drugs, and the federal government has not acted to stem the cost of drugs,” NASHP Executive Director Trish Riley said. “States can be great laboratories for innovation and this is a great opportunity for Maryland to be a national leader and develop new approaches that can be adopted by other states and ultimately by the federal government.”

Drug manufacturers and PhRMA opposed the bill during Maryland’s last session, and Delegate Josephine Peña-Melnyk, a democrat, expects the group to oppose the next iteration of the bill as well, noting that she is open to making some changes to the bill, but that the rate-setting authority will not be “watered down.”(InsideHealthPolicy).

Lawmakers Noticeably Quiet on International Pricing Plan

Late last month, the Trump administration announced a plan to reduce the price of some prescription drugs by comparing what Medicare pays to what other industrialized countries pay. The plan supports the administration’s efforts to make drug costs more competitive, but has lobbyists accusing members of the GOP of being too slow to criticize the President’s actions ahead of midterms.

The President’s plan would be steered by CMS and would cover half of the US population, which the administration estimates could reduce Medicare Part B spending by $17 billion over the next five years. The Pharmaceutical Research and Manufacturers of America (PhRMA), however, claims the plan would “jeopardize access to medicines for seniors and patients with disabilities living with devastating conditions such as cancer, rheumatoid arthritis and other autoimmune diseases.”

Although some critics have suggested that Republicans don’t know whether the administration is serious about the plan and they don’t want to get in the way of a good campaign issue, Ian Spatz, a senior adviser at Manatt Health, suggested that Republican lawmakers don’t need to fight the proposal because it’s merely a “prerule,” not an actual proposed rule that requires public comment. (InsideHealthPolicy).

CMS Finalizes 2020 Payment and Policy Changes for Home Health Agencies and Infusion Therapy Suppliers

Last Wednesday, CMS agreed to fund a 2.2 percent pay increase for home health agencies during the 2019-2020 calendar year. The model, known as the Patient-Driven Groupings Model (PDGM), also included case-mix methodology refinements, a change in the home health unit of payment from 60 days to 30 days (as part of the Bipartisan Budget Act of 2018), and will eliminate the use of the number of therapy visits provided to determine payment, relying more heavily on clinical characteristics and patient diagnosis, functional level, comorbidities, and admission source to determine a payment category.

A few key stakeholders of the rule raised concerns with the model’s behavioral element, with Bill Dombi, president of the National Association for Home Care and Hospice, suggesting that his organization will request changes from the House. Keith Myers, chair of the Partnership for Quality Home Healthcare, said that the group would continue to work with Congress to refine the payment system and ensure that the approach will deliver high-quality care for older Americans. (InsideHealthPolicy).

“While we had hoped CMS would consider modifications outlined by the home health provider sector when finalizing this rule, this announcement reinforces the need for the industry to continue our advocacy to get the new home health payment system right,” Myers said.

It’s expected that the rule will be published in the Federal Register on Nov.13, and will become effective Jan. 1, 2019.

‘Get America Covered’ Urges Americans to Make Informed Healthcare Decisions During Open Enrollment Period

As open enrollment period in most states begins this month, Get America Covered is urging Americans to be informed of their options throughout the coverage selection process. The group, which was started by former Obama administration officials and is run solely on donations, is encouraging shoppers on the Affordable Care Act’s health insurance exchanges to buy coverage that is both comprehensive and affordable (InsideHealthPolicy).

Most recently, the ACA has been a subject of controversy as the GOP has tried and failed to target a repeal. While CMS has slashed funding to $10 million for all 39 participating states, the ACA has remained in full effect with the same benefits and responsibilities. Josh Peck, co-founder of Get America covered, spoke about the public’s need for accurate information that educates and advises Americans on the right coverage plans for their needs.

“Get America Covered is returning for a second year because the administration is once again not doing their job,” says group co-founder Josh Peck. “People need the facts. So that’s what we’re going to do, make sure that people have the basic information they need to sign up for coverage.” (InsideHealthPolicy).

For individuals living in the 39 states that use, the open enrollment period ends on Dec. 15. For more information on the ACA and the Nov. 1- Dec. 15 enrollment period, click here.