HealthCare Roundtable e-News – September 11, 2019

Leaked Pelosi Drug Pricing Plan Includes Form of Medicare Direct Negotiating and Trump’s International Pricing Index

A six-page proposal from the office of House Speaker Nancy Pelosi (D-Calif.) began floating on Monday in an effort to unite democrats on key drug pricing legislation. After increasing pressure from progressives has mounted, the plan includes details for allowing the Health and Human Services Secretary to negotiate the prices of 250 drugs per year. Drug companies who refuse to negotiate with the secretary would be hit with fines of up to 75% of the sales of the drug from the previous year.

“We continue to engage Members across the caucus as the committees of jurisdiction work to develop the boldest, toughest possible bill to lower prescription drug prices for all Americans,” Pelosi spokesperson Henry Connelly said. (InsideHealthPolicy).

Sources say most progressives are pleased with the plan, particularly with its removal of policy around using an outside arbiter to help set the price of drugs. Rep. Pramila Jayapal (D-Wash.), among others, have praised the removal of arbitration in the plan, citing that the policy would have been “too cumbersome”.

In an effort to appease both progressives and moderates, the plan also includes the Trump administration’s proposal on an international pricing index, which had been previously included in legislation that is currently stalled in the Senate. In support of the measure, Rep. Hakeem Jeffries (D-N.Y.) stated, “There’s no reason in the world why everyday Americans pay more for lifesaving prescription drugs than any other country in the world.”

States Pass Record Number of Laws in 2019 Tackling Drug Costs and Accessibility

So far in 2019, 33 states have enacted laws to address drug access and affordability. 51 initiatives — topping last year’s record of 45 in 28 states — have been enacted so far this year and, according to the National Academy for State Health Policy, more are expected before the year ends.

“Both Democrat and Republican leaders have shown a willingness to pursue strong measures that help consumers but also protect state taxpayer dollars,” said Hemi Tewarson, director of the National Governors Association’s health programs.

Among the key areas of legislation have been measures allowing importation of prescription drugs, monitoring price increases and pricing transparency. Experts have noted, though, that while states’ activities in addressing drug plans is substantial, only federal legislation can make a large enough impact on the current marketplace.

According to sources, federal lawmakers are keeping an eye on legislation passed by the states to help gauge compromise options. Several committees in the Senate and House have spent months drafting bills to support a drug pricing package, to which insights from the state level could be applicable.

State Insurance Commissioners Send Letter to Senate Health Committee Urging Air Ambulance Reforms

A group of 32 state insurance commissioners are pushing back against air ambulance providers who say the Senate health committee’s fix for air ambulance surprise medical bills would lead to the closure of rural air ambulance bases.

“The tactics that are being employed by the bad actors within the air ambulance industry are nothing but a delay strategy to allow them to continue to use balance billing as a business model,” the 32 insurance commissioners wrote in a Sept. 4 letter to Senate health committee Chairman Lamar Alexander (R-Tenn.) and ranking Democrat Patty Murray (D-Wash.). (InsideHealthPolicy).

Sen. Lisa Murkowski (R-Ark.) has been vocal about addressing rural and urban needs in air ambulance-related surprise billing, though no specifics on an amendment have been offered. Despite the claims from ambulance providers and several GOP lawmakers, the health committee did not make changes to its air ambulance policy during the August recess, according to committee sources and Inside Health Policy.

PCORI Claims Institute’s Research Could Help Evaluate Prices in Pelosi Drug Plan

The Patient-Centered Outcomes Research Institute (PCORI) recently claimed that its research could help an arbiter in a drug price negotiation process evaluate whether drugs are worth their price tag, a component that had previously been discussed as part of House Speaker Nancy Pelosi’s (D-Calif.) drug pricing plan but has been opposed by Progressives. (InsideHealthPolicy).

The Institute’s Executive Director Joe Selby told reporters on Monday (Sept. 9) that the Institute tries to “document the differences in outcomes that matter to patients so that someone can calculate a value from the perspective among others of patients.” The group says its analysts could plug PCORI data into different cost-effectiveness models and reach different conclusions, confirming that PCORI would only disclose the primary data that underpins cost-effectiveness evaluations and no other medical or personal information. (InsideHealthPolicy).

A leaked version of Pelosi’s drug plan circulated around Capitol Hill late Monday with no inclusion of an arbiter in its current state. PCORI has spoken with Pelosi’s office about its work, though Selby said he had not talked with her office specifically about her upcoming government price negotiation plan. Sources say that Pelosi’s plan could be amended with the inclusion of an arbiter if negotiations fail. (InsideHealthPolicy).