HealthCare Roundtable e-News – October 10, 2023

Top News

Biden-Harris Administration Advances Medicare Drug Price Negotiations to Lower Prescription Drug Costs

The Biden-Harris Administration announced that all 10 drug companies whose drugs were selected for price negotiation with Medicare for the first cycle of the program have decided to participate in those negotiations. The 10 selected drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Embrel, Imbruvica, Stelara, and Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill. These drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, or about 20%, of total Part D gross covered prescription drug costs between June 1, 2022 and May 31, 2023. Medicare enrollees taking the 10 drugs paid a total of $3.4 billion in out-of-pocket costs in 2022. The negotiation process will consider the selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on people who rely on Medicare, among other considerations, such as costs associated with research and development as well as costs associated with production and distribution.

 

FTC Staff Endorse Amendments to Mental Health Parity Act Regulations

The Federal Trade Commission’s Bureau of Consumer Protection has submitted a comment supporting proposed amendments to regulations implementing the Mental Health Parity and Addiction Equity Act, addressing concerns about the impact of substance abuse disorders on individuals and the potential exploitation of consumers seeking treatment. The comment highlights the FTC’s use of enforcement tools to combat SUD treatment scams under the 2018 Opioid Addiction Recovery Fraud Prevention Act, resulting in penalties against deceptive companies. It emphasizes that consumers facing financial obstacles are vulnerable to scams that hinder their access to treatment, and that insurance coverage alone does not protect them from scammers. The comment concludes that the proposed amendments strike a balance between maintaining previous enforcement systems and improving SUD treatment insurance coverage. The Commission approved the comment with a 3-0 vote.

 

Biden Administration Announces Enforcement of Transparency Rule Requirements for Prescription Drugs

The Departments of Labor, Treasury, and Health and Human Services (the Departments) released new FAQs noting that they will now begin enforcing non-grandfathered group and individual health insurers to disclose their negotiated rates and historical net prices for prescription drugs in three separate machine-readable files. A previous November 2020 Final Rule required insurers to release negotiated rates for in-network providers, out-of-network allowed amounts, and billed charges, but enforcement of the prescription drug provisions was ultimately deferred due to concerns of overlap with transparency provisions in the Consolidated Appropriations Act of 2021. In the new FAQs, the Departments note that they have now determined that there is no meaningful conflict of reporting requirements, and that exercise of enforcement discretion is no longer warranted. The Departments note that they will start enforcing the rules on a case-by-case basis.

Administrative Action

  • The Departments of Health and Human Services, Labor, and the Treasury (the Departments) are seeking public input on how best to ensure coverage and access to over-the-counter (OTC) preventive services, including the benefits of requiring most health insurance plans to cover these services at no cost and without a prescription by a health care provider. This new Request for Information (RFI) is asking for feedback on access to a range of OTC items, including contraceptives, tobacco smoking cessation products, folic acid during pregnancy, and breastfeeding supplies. Currently, under the Affordable Care Act, most plans must cover certain preventive items and services at no cost, but some of these items are available OTC without a prescription and aren’t required to be covered for free unless prescribed by a healthcare provider. The purpose of the RFI is to understand the potential challenges and benefits for different stakeholders, including consumers, plans, issuers, pharmacies, and healthcare providers, in providing cost-free coverage for recommended OTC preventive products without requiring a prescription.
  • The United States Preventive Services Task Force (USPSTF) recently recommended that routine blood-pressure screenings for hypertensive disorders be implemented at prenatal visits throughout pregnancy. The recommendation is consistent with USPSTF’s 2017 statement that encouraged preeclampsia screening, but now expands that to include screening for all hypertensive disorders. The expansion of screening includes chronic or preexisting hypertension, gestational hypertension, preeclampsia, and eclampsia. The inclusion of screening for hypertensive disorders stems from the high rates of maternal morbidity and mortality caused by such disorders. Additionally, the recommendation aims to create a more equitable healthcare environment for minority groups that are disproportionately affected by maternal and infant morbidity.

Congressional Action

Hours before October 1st, Congress managed to prevent a government shutdown. A last-minute agreement passed the House and Senate before being signed by President Biden late Saturday night. H.R. 5860, the 45-day stopgap funding bill, provides fiscal year appropriations to federal agencies until November 17. The bill includes billions in disaster relief funds but does not include new aid for Ukraine or funds for border security. Specifically, the continuing resolution grants $16 billion to FEMA’s Disaster Relief Fund and extends funding for the National Flood Insurance Program until November 17, 2023; funding for community health centers and teaching centers that operate GME programs is extended through November 17, 2023; and authorization of the Federal Aviation Administration is extended through December 31, 2023. Additionally, the Animal Drug User Fee program is reauthorized through fiscal year 2028. The bill passed 335 to 91 in the House and 88 to 9 in the Senate. This news comes after unsuccessful attempts to pass a conservative stopgap funding bill earlier in the week. While this bill prevents shutdown for the time being, Congress’ work is far from over. In the upcoming weeks, Congress will be focused on passing government funding bills to avoid a shutdown in November.

Research

The Health Care Transformation Task Force (HCTTF) published their vision for transforming value-based care to make it more patient-and family-centered. Driving this work, the group acknowledges that 80 to 90 percent of health is rooted in socioeconomic and environmental factors, including societal inequities. The HCTTF also believes that consumers should be front and center in all stages of value-based care design and decision-making to ensure high-quality care and equity are prioritized. The cornerstone of their vision includes addressing health inequities, coordinating team-based care for improved outcomes, increasing affordability for patients and many more. Lastly, the HCTTF calls for continued support of clinicians through an extension of the Medicare Access and CHIP Reauthorization Act (MACRA) 3.5 percent incentive payment for Advanced Alternative Payment Models (AAPMs), which is set to expire at the end of Performance Year 2023—which has been essential to continued investment in transforming care delivery from traditional Fee-for-Service to newer AAPMS.


Registration Open for 2023 Annual Conference

The Public Sector HealthCare Roundtable 2023 Annual Conference Moves to Washington, DC

The conference features a new location, a revised format, and a great agenda!

Wednesday, Nov. 1 to Friday, Nov. 3, 2023

The Roundtable’s highly-regarded annual conference provides members and guests a unique opportunity to hear presentations by high level government officials and key experts – from Congress and the Administration, academics, benefit consultants, plan administrators, advocates and industry leaders in an intimate dialogue-oriented setting.

After years of successful conferences in Old Town Alexandria, we have outgrown our space at the Alexandrian Hotel. This year we will hold our conference at the historic Mayflower Hotel in Washington, DC. The new location will undoubtedly improve the overall experience for all of our attendees.

In recent years, many of our attendees have urged us to schedule more free time in the conference agenda for networking. Since we understand the importance of this networking time, we have revised this year’s agenda to incorporate longer breaks and more time before evening receptions.

This year, the conference will begin at Noon on Wednesday, November 1st and will conclude at Noon on Friday, November 3rd. By adding time on Wednesday, we have been able to add critical content, lengthen our breaks, and add free time prior to any evening activities.

Although we certainly believe the best way to experience our conference is in-person, this year’s conference will once again feature a virtual option. Any health plan that registers at least one individual to join us in Washington, will be eligible to register online attendees.

Register Today