HealthCare Roundtable e-News – September 12, 2022


Register Now for Roundtable Events

Wednesday: Webinar on IRA Legislation

The Public Sector HealthCare Roundtable will host a Webinar on the recently enacted Inflation Reduction Act (IRA) on Wednesday, September 22nd at 4:00 PM (EDT). The presentation will include an overview of the health care provisions of the IRA by Roundtable staff as well as a panel of Roundtable corporate members who will highlight how they expect the IRA to impact their areas of expertise and services.

Click here to register for the IRA Webinar.


Registration for our 2022 Annual Conference

After two years of virtual meetings, the Roundtable’s highly-regarded annual conference returns to an in-person event in Old Town Alexandria, Virginia on November 9-11, 2022.

The 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.  

The Agenda

We have released our preliminary agenda and look forward to sharing additional details as we continue to confirm timely speakers for each conference segment.

A Virtual Option

Since we know many of our members have appreciated the opportunity to share our conference with plan leaders and staff, we will offer a virtual option to any member that registers at least one attendee for the in-person conference. Details will be provided to registered health plan members.

Lodging Information

The Alexandrian Old Town Alexandria

$229 Room Rate

Book by October 7, 2022

Top News

Drug Makers Will Not Cover Costs of Part D Drugs With Price Negotiations

According to health experts, the drug pricing provisions of the Inflation Reduction Act do not require (subscription required) drug companies to cover the cost of drugs with Medicare-negotiated prices in the Medicare Part D redesign. The changes make plans pay a greater share of drug prices through much of the coverage phases. Once redesigned, plans will pay 65% of costs after the $505 deductible until beneficiaries hit the new $2,000 out-of-pocket cap, after which plans will pay 60% of costs. CMS must determine the discounted price for eligible drugs, establish reimbursement procedures for pharmacies, and design procedures for dispute resolution.


U.S. District Court Rules PrEP Coverage Violates Religious Freedom

The U.S. District Court in the Northern District of Texas issued a ruling to strike down key parts of the preventive services provision under the Affordable Care Act (ACA). Judge O’ Connor ruled that mandating coverage without cost-sharing of drugs that prevent HIV infection (PrEP) violates the religious freedom of those required to cover the drugs under the Religious Freedom Restoration Act. He also ruled that the US Preventive Services Task Force (USPSTF) violates the Appointments Clause, in that they are unconstitutionally appointed, and thus cannot wield regulatory power to require the coverage of PrEP by insurers. Finally, the Court ruled that the Health Resources and Service Administration (HRSA) and Advisory Committee on Immunization Practices (ACIP) do not violate the Appointments Clause and are empowered to require insurers to cover contraception, the HPV vaccine, and screenings and behavioral counseling for STDs and drug use.

Administrative Action

  • CMS released a Request for Information (RFI) seeking public input on accessing health care and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency. The Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs RFI is part of the Biden-Harris Administration’s ongoing work to advance health equity and reduce health disparities. Comments are due by November 4 and can be submitted here.

  • An FDA advisory panel voted 7-2 to recommend approval of an experimental drug to treat Amyotrophic Lateral Sclerosis (ALS) by pharmaceutical company Amylyx. While the FDA is not required to follow the panel’s recommendation, the move may suggest a potential approval later this month. The move was significant as the panel previously voted against approving the drug in March due to concerns of the evidence of the drug’s effectiveness. In its approval, Amylyx publicly committed to voluntarily withdrawing the drug if the current ongoing trial fails to show benefit.


The Department of Homeland Security (DHS) announced that it will not consider most non-cash benefits, such as Medicaid, CHIP, and SNAP, as indicators that an individual is likely to become a public charge for immigration-related determinations. Under the Immigration and Nationality Act, non-citizens may not be allowed admission to the U.S. or approved for permanent residence if DHS determines they are likely to become a public charge, primarily dependent on the government for subsistence. This change reverses a 2019 public charge rule, which took into account use of certain non-cash public benefits including Medicaid when determining an individual’s immigration status. The rule will be effective December 23, 2022 and is anticipated to increase Medicaid and CHIP participation.


CVS Health announced that they have entered into an agreement to acquire Signify Health for $8 billion, a health analytics platform and provider network. Signify Health combines in-home social and medical needs assessments with advanced analytics to help improve patient experience and assist primary care providers transitioning to value-based payment models. The purchase is subject to approval by Signify’s shareholders, though the companies report they expect the deal to close in early 2023.


The Commonwealth Fund published an issue brief analyzing the impact of five policies for expanding coverage and affordability after the extension of the American Rescue Plan Act (ARPA) premium subsidies from the Inflation Reduction Act (IRA). The five policies include filling the Medicaid gap in non-expansion states, reducing the employer affordability threshold, adding a $10 billion reinsurance fund, increasing the federal Medicaid matching rate in expansion states, and enhancing and funding marketplace cost-sharing subsidies. Researchers estimated the five policies would cumulatively cover 3.7 million more people in 2023. In total, the reforms would increase federal spending over 10 years by $606 billion and increase the federal deficit by $575 billion.