HealthCare Roundtable e-News – September 15, 2020


2020 Virtual Annual Conference Tell Us What You Think!

We are actively working to develop an agenda that will continue our tradition of delivering a highly-regarded program that 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.

Since we know there are limits to how long you will remain engaged in an online presentation, we are currently planning late morning (for our members and friends on the West Coast) and afternoon segments on Monday, November 9th through Thursday, November 12th.

Since we’d like to include your ideas in this planning process, we have prepared a very brief questionnaire that we’d like you to complete and return to us.

The questionnaire can be found here

The Preliminary Schedule/Agenda can be found here.

Please send your responses to: Tom@healthcareroundtable.us


Matrix Global Advisors Releases Follow-on Report Examining Drug Company Anticompetitive Tactics

Yesterday, Matrix Global Advisors (MGA) released a report authored by Alex Brill — a keynote speaker at the 2019 Annual Roundtable Conference — and commissioned by the Coalition for Affordable Prescription Drugs (CAPD) that dives into one of the anticompetitive tactics that drug companies use to delay the timely entry of generic competition into the market: product hopping. The report also quantifies the impact this practice has on drug costs for patients and the health care system. 

The report found that just five instances of product hopping – for the brand drugs Prilosec, TriCor, Suboxone, Doryx, and Namenda – cost patients and the U.S. health care system $4.7 billion annually. 

The report can be found here.

The press release link from Matrix Global Advisors can be found here.

Trump Signs ‘Most Favored Nation’ Executive Order Aimed at Lowering Drug Prices

The White House unveiled on Sunday the latest executive order signed by President Trump, known as the “Most Favored Nation” order. The measure calls for Medicare to test paying the same price for the same expensive prescription drugs that other developed countries do, which is often less than in the United States. It also looks to include certain Part D drugs sold at pharmacies, in addition to some Part B medications administered at doctors’ offices hospitals.

Trump celebrated the announcement of the order on Twitter, commenting that his “Most Favored Nation order will ensure that our Country gets the same low price Big Pharma gives to other countries.”

“The days of global freeriding at America’s expense are over … and prices are coming down FAST! Also just ended all rebates to middlemen, further reducing prices,” he tweeted.

The order itself has been mostly kept under wraps since it was announced back in July. While it has been opposed by many in the pharmaceutical industry, Trump claims he worked to come up with a solution by holding meetings with industry stakeholders prior to unveiling it on Sunday. Many claimed these meetings never happened, and the Trump administration had missed its initial deadline to reach a conclusion by the end of August.

Industry group PhRMA criticized the order, claiming it would “give foreign governments a say in how America provides access to treatments and cures for seniors and people struggling with devastating diseases.” When asked about a counter proposal from the industry, deputy press secretary Judd Deere offered that the negotiations “did not produce an acceptable alternative, so the President is moving forward.”

Medicaid Directors Anticipate Budget Cuts, Increased Competition for Funds Post-Pandemic

The National Association of Medicaid Directors is bracing for an impending recession as a result of the COVID-19 pandemic, leaving many directors to anticipate cuts and increasing competition for funds. The group is urging Congress to increase federal Medicaid matching funds and send more COVID-19 relief to states, but uncertainty about the government’s portion of payments and moving target dates set by Congress is leaving many directors with few options.

Arizona Medicaid director Tom Betlach has analyzed the current economic climate and the 2008 recession, saying that there are five options for Medicaid directors to balance their budgets during an economic downturn: cutting so-called optional benefits like prescription drugs or dental; reducing provider rates; reconsidering who is eligible; slimming down administrative services; and imposing provider assessments to increase revenue. (InsideHealthPolicy)

Betlach warns that many of these options have risks and potentially a long-term impact on Medicaid beneficiaries’ health. Several of the options may also decrease the number of federal matching dollars a state could receive. Betlach notes that similarly to previous recessions, “Congress has taken action to provide states some additional support, but at the same time, they’ve attached requirements to obtaining that additional support.” (InsideHealthPolicy)

According to NAMD Executive Director Matt Salo, increasing states’ Medicaid match has proven to be the most effective and efficient way to stabilize economies in previous recessions. Particularly when it comes to education systems, schools will be in need of funding for staff, protective equipment, training and more, and will likely be competing with Medicaid for the funds they need if the match is not increased. (InsideHealthPolicy)

Senate Republicans’ Coronavirus Relief Package Fails to Win Over Democrats

Senate Republicans fell short last week in passing their $300 billion coronavirus relief bill, after only receiving 52 the necessary 60 votes for the bill to pass. Sen. Rand Paul (Ky.) joined Senate Democrats, who considered the bill as a “meager offering,” as the only Republican member to oppose the package. (InsideHealthPolicy)

Democrats claimed they wanted to see more funding for local governments in the Senate bill, well as more funding for COVID-19 testing similar to what was included in the House Democrats’ $3 Trillion bill that was proposed in May of this year. The Senate bill, led by majority leader Mitch McConnell (R-Ky.), had been stripped down from earlier versions but included money for the small-business loan program, funding for schools and the U.S. Postal Service, and liability lawsuit protections for businesses, schools and health care providers.

When asked about the bill’s opposition, Senate Finance Committee Chair Chuck Grassley (R-IA) said that Senate Democrats’ choice “to ignore these needs and to obstruct even in these areas we all agree are needed is just putting politics over people.” (InsideHealthPolicy)

HHS Looks to Roll Out Elements of Rural Health Roadmap in Coming Weeks

The Trump administration announced that it expects to roll out elements of its telehealth capabilities as a part of HHS’ rural health roadmap created by the rural health task force. The roadmap includes recommendations, award grants and calls to expand care. The initiative follows President Trump’s executive order to report on and improve rural health last month.

The plan examines some of the key challenges that rural communities are facing and identifies strategies for transforming rural health that will be rolled out in the coming weeks and months, including building a sustainable health model for rural communities, leveraging technology and innovation to deliver quality and cost-effective care, preventing disease and mortality with rural-specific efforts; and increasing rural access to care by eliminating regulatory burdens. The plan also looks to provide resources for helping rural communities to identify strategies for addressing the five leading causes of death in those areas, including stroke, heart disease, respiratory disease, injury and substance use.

“We cannot just tinker around the edges of a rural healthcare system that has struggled for too long, which is why the Rural Action Plan lays out a bold vision for transforming how healthcare works in rural America,” said HHS Secretary Alex Azar regarding the announcement.

White House Asks Congress to Fund Extenders In the 2021 Fiscal Year

In an effort to keep the government open past September 30, the White House is reportedly looking to have Congress fund Medicare and Medicaid extenders in a continuing resolution, despite the extenders not being expected to expire until November. According to a memo from the Office of Management and Budget, the White House is also looking to consider other policies like a delay in cuts to Medicaid Disproportionate Share Hospital payments. (InsideHealthPolicy)

Congress had initially funded these extenders as part of the CARES Act in the early days of the pandemic and are set to expire in November. Among the extenders affected were the Special Diabetes Programs, teaching health center graduate medical education program, community mental health services demonstration, Money Follows the Person demonstration, State Health Insurance Programs, Area Agencies on Aging, and Aging Disability and Resource Centers. (InsideHealthPolicy)

Lobbyists have been anticipating that a continuing resolution will be needed by the end of the month, as the House and Senate have not passed into law any spending bills for the upcoming fiscal. In an effort to avoid a government shutdown, House Speaker Nancy Pelosi (D-Calif.) and Treasury Secretary Steve Mnuchin have reportedly reached a tentative agreement to continue funding the government past the end of the fiscal year.