HealthCare Roundtable e-News – October 20, 2021

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Preliminary Agenda

Senate Finance Committee to Hear From Health Experts on Barriers to Coverage Coinciding with Reconciliation Package

The Senate Finance Committee is expected to hear from a panel of health coverage experts today (Wednesday, Oct. 20) while Democrats weigh possible program extensions to be included in the upcoming reconciliation package. The panel will share their insight on the landscape surrounding federal health care programs that help Americans purchase health insurance coverage, though the testimonies will not be directly tied to reconciliation policies.

Among the experts asked to testify is witness Frederick Isasi, executive director of Families USA, who will share an overview of the last 15 years to give a benchmark of where the country is in terms of ensuring Americans can get affordable, quality coverage. Isasi is also expected to offer suggestions and key action items for improving coverage and access, potentially offering input on the reconciliation package and how lawmakers might address existing barriers. (InsideHealthPolicy)

Among the top considerations for Democrats building out the reconciliation package is the permanent extension of the expanded Affordable Care Act tax credits enacted under the American Rescue Plan (ARP). Republicans have raised their concerns about tax credits and several ranking house members with jurisdiction over health care have requested the Congressional Budget Office generate scores for the health provisions included in the emerging reconciliation bill and have also specifically asked for estimates and other data on the ARP provisions. (InsideHealthPolicy)

Biden Administration Zeroes in on Former FDA Head Califf as Potential Pick for Commissioner

President Joe Biden is expected to nominate former FDA Chief Robert Califf to become the agency’s chief once more, after having led the agency from 2016-2017 under the Obama administration. Califf’s potential nomination comes at a time when more at the agency is at an all-time low following the challenges faced over the course of the COVID-19 pandemic.

Prior to joining the FDA, Califf was a professor of medicine and vice chancellor for clinical and translational research at Duke University. Califf is currently the head of clinical policy and strategy for Verily and Google Health and has called for the FDA to be an independent agency in the past, pushing for increased use of digital health technologies and changes to the clinical trial enterprise. Califf could face potential push back from Senate Budget Committee Chair Bernie Sanders (I-VT) and Joe Manchin (D-W. Va.), both of whom opposed Califf’s nomination for FDA Chief back in 2016. Manchin and Sen. Edward Markey (D-Mass.) cited Califf’s past ties to industry as one reason why they did not think he would be effective in changing the culture at FDA. (InsideHealthPolicy)

A White House official told CNN last Thursday that there has not been a decision made for the FDA commissioner but that the administration “remain[s] grateful to the strong acting leadership at the FDA,” in the interim period. Carl Tobias, a former FDA consultant and current Williams Chair at Richmond University Law, says that while acting FDA Chief Janet Woodcock has been an effective acting commissioner, Biden administration and the agency need a permanent leader.

Audit Shows States Relaxed Prescription Drug Rules to Help Beneficiaries During Pandemic

Last week, the HHS Office of the Inspector General (OIG) released an audit showing data on the actions states across the country took to help Medicaid beneficiaries afford and access prescription drugs during the pandemic. Early on in the pandemic, CMS had issued waivers and modifications to assist providers and beneficiaries; however, the report notes that such waivers did not specifically address prescription drugs.

The audit surveyed 23 states and the District of Columbia, assessing how each has assisted patients over the course of the pandemic in easing access to prescriptions. Several states said they altered or paused the enforcement of prior authorization requirements while others said they relaxed their requirements on early refill limits that keep patients from replenishing a prescription before the existing supply is completed. (InsideHealthPolicy)

Prior to the pandemic, many states required beneficiaries to use at least 70% of controlled and non-controlled drugs before they could be refilled. Some states lowered their early refill limits for all controlled and noncontrolled drugs to 50% while others allowed pharmacists to approve early refill requests from beneficiaries using the Submission Clarification Code (SCC) 13, a pharmacy billing standard that was adopted after Hurricane Katrina and can be used during state emergencies or natural disasters. (InsideHealthPolicy)

High Ratings for 2022 MA Plans A One-Time Anomaly, Experts Say

Health experts are anticipating the star ratings for Medicare Advantage (MA) plans have likely reached their high-water mark, despite CMS’ released ratings showing that 68% of MA plans that offer prescription drug coverage earned four or five stars for 2022. According to the experts, the high ratings many MA plans have seen in 2021 will likely drop next year as COVID-19 emergency policies dissipate and new policies are set in place by the Biden administration.

In addition to having a high rating, plans that earn 4 to 5 stars also qualify for quality bonus payments, which have come under question from the Medicare Payment Advisory Commission in past years. CMS Administrator Chiquita Brooks-LaSure said in a statement the star ratings are “important tools in the toolbox for beneficiaries to use as they consider Medicare coverage options,” however, one beneficiary advocate said that star ratings begin to lose their significance when most plans are above average.

“This strange year of unusually high ratings is likely a one-time anomaly, since the end of the public health emergency, combined with the many imminent technical changes, will change the performance calculus in the 2023 ratings,” said Melissa Smith of HealthMine wrote in a blog post. (InsideHealthPolicy)

Pelosi Says She Expects Medicare Negotiation, Expanded Benefits to Be Scaled Back in Reconciliation Package

Last week, House Speaker Nancy Pelosi (D-Calif.) acknowledged that opposition from Senate Democrats will likely lead to the paring down of Medicare drug price negotiation in the reconciliation package. The party continues to be divided on measures surrounding drug pricing and Medicare coverage, threatening the advancement of package priorities if Moderate Democrats do not get on board.

For the first time, Pelosi acknowledged at an event hosted by the San Francisco radio station KQED that while she and many of her colleagues have been fighting to push through the House-passed Elijah E. Cummings Lower Drug Costs Now Act, known as H.R.3, many of her more moderate party members have expressed that the policies are too aggressive to gain their full support.

Debate also continues around how lawmakers will include dental, vision and hearing benefits in the upcoming package. Moderate Democrats including Sen. Joe Manchin (D-W.Va.) have been proponents of allowing the expansion of Medicare benefits to cover dental, vision and hearing care only for the poorest Americans as a means to pare the projected cost of the package. Progressive Democrats, however, and groups including AARP have argued that this approach would, instead, fundamentally alter the social insurance program and alienate wealthy senior citizens.