HealthCare Roundtable e-News – September 18, 2023

 

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Webinar – September 19, 2023 – 2:00 PM (EST)

Assessing the Congressional Landscape for Drug Cost Containment: Legislative and Policy Considerations in the context of Pharmacy Benefit Manager (PBM) Reforms

The persistent challenges surrounding pharmacy benefit manager reforms (PBM) have garnered significant Congressional attention on a bipartisan basis, and the Roundtable has played an active role in the debate. Before Congress adjourned for the August recess, the Senate Finance Committee (SFC) conducted a bipartisan markup session on the Modernizing and Ensuring PBM Accountability (MEPA) Act, which culminated to its passage out of committee. Without question, the next several months will be a critically important time where Congress will determine potentially major changes to the PBM marketplace.

Join us to hear from the Public Sector HealthCare Roundtable’s senior policy team and policy experts on the hot topic issue of PBMs and how these policies relate to public sector purchasers, an analysis of the evolving legislative landscape, and a lens on crucial considerations as the current year draws to a close and anticipation builds for the year ahead in 2024.

This webinar is being produced in conjunction with Roundtable corporate member Rx Savings Solutions.

Register Here 


Top News

CMS Announces Savings on 34 Prescription Drugs for Medicare Beneficiaries 

The Centers for Medicare and Medicaid Services (CMS) announced a list of 34 prescription drugs that Part B Medicare beneficiaries may save between $1 and $618 on per average dose starting October 1, 2023. The savings were made possible through the Medicare Prescription Drug Inflation Rebate Program, a product of the Inflation Reduction Act, which allows for Medicare to reduce coinsurance for some people with Part B coverage and to discourage drug companies from increasing prices faster than inflation rises. CMS has released information about these 34 Part B drugs in the quarterly Average Sales Price (ASP) public files (fact sheet). The prescription drugs will be maintained at their discounted price from October 1 – December 31, 2023. Additionally, CMS is seeking feedback from the public on any possible discrepancies that could lead to necessary updates to the public files.

 

Commonwealth Fund Study Examines Medicare Marketing Practices and their Impact on Seniors

The Commonwealth Fund released the results of a survey they conducted where information was gathered on the experiences and perspectives of 2,001 adults aged 65 and older regarding plan marketing during Medicare’s annual open enrollment period. This marketing involves private plans heavily advertising their services through various channels such as TV, the internet, billboards, brochures, emails, and phone calls, promoting a wide range of options, including Medicare Advantage, Medigap, and standalone drug plans. This abundance of marketing has led to an increase in complaints due to confusing and misleading sales tactics, prompting the Biden administration to introduce regulations to address these issues. The study found that nearly all individuals aged 65 and older received some form of plan marketing during Medicare’s open enrollment period, one in three respondents reported receiving seven or more phone calls per week related to these plans and one in four expressed a need for more personalized assistance in making their coverage decisions.

Administrative Action

The Administration for Community Living (ACL) released (SummaryFact Sheet) their first set of proposed regulation for adult protective services (APS) programs. APS programs investigate reports of maltreatment, including abuse, neglect, self-neglect, or exploitation of older adults and adults with disabilities in coordination with a variety of medical, social service, legal, law enforcement and other service providers to help individuals recover. However, despite the critical supports provided by APS programs, ACL had not previously established regulatory requirements for these programs, resulting in a patchwork of programs providing varying levels of service quality. Through this proposed rule, ACL seeks to establish minimum standards and improve the quality of APS service delivery overall by. Comments are due by November 11th.

Congressional Action

Senators Bernie Sanders (I-VT) and Roger Marshall (R-KS) announced that they have reached a bipartisan agreement on legislation to address the critical primary care crisis in the United States, including the severe shortages of nurses and primary care doctors. This legislation also aims to increase funding for essential healthcare services such as community health centers, the National Health Service Corps, and Teaching Health Centers. Key aspects of the bill include $5.8 billion annually for three years to support community health centers, mandating nutrition services and $1.5 billion over five years to create 700 new primary care residency slots through the Teaching Health Center Graduate Medical Education program. The bill will be financed by combating healthcare system waste, fraud, and abuse while improving access to affordable generic drugs and holding pharmacy benefit managers accountable. The legislation is set for a markup in the HELP Committee on September 21.

Regulatory Action

  • The U.S. Food and Drug Administration (FDA) approved and authorized updated mRNA COVID-19 vaccines that better target current variants, particularly the Omicron variant XBB.1.5. To better protect against COVID-19-related hospitalizations and deaths, vaccinations are encouraged for those who are eligible. These vaccines are approved for individuals over the age of 12 and are authorized under emergency use for those 6 months to 11 years old. More specifically, individuals aged 5 or older who have not received a COVID-19 vaccination within the last 2 months are eligible for a single dose of the updated vaccine. Individuals 6 months through 4 years old are eligible to receive one or two doses if previously vaccinated and 2 to 3 doses if previously unvaccinated. The FDA confirms that for individuals older than 6 months, the benefits of the vaccines outweigh the potential risks. Additional information regarding clinical recommendations for this updated vaccine will be discussed by the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The FDA predicts that updated COVID-19 vaccines will be offered annually, similar to the influenza vaccines.
  • The U.S. Food and Drug Administration (FDA) voted unanimously against the effectiveness of phenylephrine, the key drug found in popular versions of Sudafed, Dayquil, and other over-the-counter medications. This week’s two-day meeting was prompted by University of Florida researchers who petitioned the FDA to remove most phenylephrine products based on recent studies showing they failed to outperform placebo pills in patients with cold and allergy congestion. The advisers essentially backed the conclusions of an FDA scientific review published ahead of last week’s meeting, which found numerous flaws in the 1960s and 1970s studies that supported phenylephrine’s original approval. If the FDA follows through on the panel’s recommendations, Johnson & Johnson, Bayer, and other drugmakers could be required to pull their oral medications containing phenylephrine from store shelves.

Research

The U.S. Census Bureau announced that 2022 Census data revealed income decline, a rising supplemental poverty rate and increased health insurance coverage. The real median household income fell by 2.3% compared to 2021, decreasing from $76,330 to $74,580 in 2022. This decline is largely due to a 7.8% increase in inflation, the most substantial annual rise in the cost of living since 1981. Despite this financial strain, there was a trend toward more stable employment, with a 3.4% increase in the number of full-time, year-round workers. This shift suggests a move away from part-time or part-year to full-time, year-round work. The official poverty rate remained steady at 11.5% and was not statistically different between 2021 and 2022. However, the Supplemental Poverty Measure (SPM) saw a noteworthy increase, rising by 4.6 percentage points to 12.4%. Health insurance coverage expanded in 2022 with 92.1% of people, or 304 million, having health insurance at some point during the year. Private health insurance coverage continued to be more prevalent than public coverage, at 65.6% and 36.1%, respectively.


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.

Visit the Roundtable’s website for a preliminary Agenda, a Registration Form, and the Mayflower Hotel registration link.

We will be updating the agenda and announcing specific speakers over the course of the next couple of months.