HealthCare Roundtable e-News – September 6, 2022


Special Announcements

Roundtable to Host 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.


Roundtable Releases 2022 Specialty Drug Survey!

Today, the Public Sector HealthCare Roundtable released its annual report of specialty drug costs, titled “Assessing the Unsustainable Cost of Specialty Medications: A Survey of Public Sector Health Plans.” Now in its fourth year, the survey assessed the rising price of specialty medications for public sector plan sponsors, strategies our members deploy to control costs, and federal policy recommendations following the passage of the Inflation Reduction Act. Click here for the full report.


Roundtable Responds to CMS Medicare Advantage Request for Information

On Wednesday, August 31st, the Roundtable provided a response to a recent Request for Information (RFI) regarding ways to strengthen Medicare Advantage (MA). The response highlighted the important role of MA in providing affordable and innovative benefits to public sector retirees via Employer Group Waiver Plans, in particular. The response can be found here.

Please do not hesitate to reach out to Roundtable Senior Policy Advisor, Andrew MacPherson, with questions or comments:

Top News

States Could Expand Drug Price Controls to Some Commercial Plans

According to the National Academy for State Health Policy, states could expand (subscription required) certain drug price control measures to commercial plans. Through state action, provisions of the Inflation Reduction Act of 2022 such as Medicare price negotiation, inflationary rebates, and out of pocket cost caps may apply to state-regulated markets, including exchange plans and insurance for state employees. As of August 23, states have introduced or enacted 135 bills to regulate pharmacy benefit managers (PBMs), 34 bills to increase price transparency, and 54 bills to cap out-of-pocket costs for medicines. Experts have outlined three ways for states to complement the Inflation Reduction Act:

  1. Referencing Medicare negotiated drug prices to set upper-payment limits
  2. Applying inflation rebates to drugs sold to state-regulated insurance
  3. Capping out-of-pocket costs for insulin and other medicines

However, state action would have a limited impact because many employers are self-insured, which is federally regulated under the Employee Retirement Income Security Act.


House Republicans Send Letter to HHS Secretary Seeking Information on IRA Implementation

House Energy & Commerce Ranking Member Cathy McMorris Rodgers (R-WA) and Ways & Means Ranking Member Kevin Brady (R-TX) sent a letter to Health and Human Services (HHS) Secretary Xavier Becerra seeking information regarding HHS’ implementation of drug pricing provisions in the Inflation Reduction Act of 2022. House Republicans pose 18 questions and ask for a commitment to transparency around implementation of the law and express concern about its impact on medical innovation, inflation, drug prices, and access to therapies. They ask that HHS provide written answers to their questions by September 12 and a briefing to the Committees on Energy & Commerce and Ways & Means by September 19.

Administrative Action

  • The Department of Health and Human Services (HHS) announced that it will provide $11 million to the company Grand River Aseptic Manufacturing to put the Jynneos monkeypox vaccine into vials and prepare it for distribution. The funding is part of the Biden administration’s efforts to boost the vaccine supply for monkeypox. More than 17,000 people have contracted monkeypox in the U.S. The administration has so far made 1.1 million vials of the vaccine available to order by states and territories and says it is “soon approaching” a point at which all 1.6 million individuals it considers to be at high risk for the disease can receive the recommended two doses. As of August 23, more than 207,000 people in the U.S. have been vaccinated against the current monkeypox outbreak.

  • The Health Resources and Services Administration (HRSA) announced that they are awarding over $20 million in funding to states, communities, and providers to reduce disparities in maternal and birth outcomes. HRSA’s grants will be used to support state- lead maternal health task forces, building coordinated network of care for pregnant individuals in rural communities, training and compensation for doulas, and support community services that influence infant health outcomes such as house stability, workforce development, and education. The awards are a component of the implementation of the White House Blueprint for Addressing the Maternal Health Crisis. HRSA also notes they will continue to analyze maternal and child healthcare workforce needs, to support safe pregnancies and childbirth and improve outcomes for parents and infants nationally.

  • On International Overdose Awareness Day, the U.S. Department of Health and Human Services (HHS) through the Substance Abuse and Mental Health Services Administration announced the awarding of $79.1 million in overdose prevention grants to address the opioid and overdose epidemic. The grant funding is a part of the Administration’s drug control safety and prevention strategy and includes resources to 1) support first- responders, 2) implement targeted strategies for substance use disorder harm reduction, and 3) train the healthcare workforce in treating opioid use disorders. Last year more than 107,000 Americans died from drug overdoses, an increase of more than 15 percent from 2020, underscoring the critical importance of a coordinated, comprehensive strategy to prevent overdose and to sustain recovery.

Congressional Action

Last week, Chair Ron Wyden sent letters requesting 15 state insurance commissioners and state health insurance assistance programs provide information on Medicare Advantage and Part D plans’ marketing practices. Recently, CMS and the National Association of Insurance Commissioners both reported receiving more complaints about false and misleading advertising from these plans. In his letter, Chair Wyden askes states to report any complaints or misleading marketing data, examples, or trends among the plans, third-party marketing organizations, or other related organizations by September 16th


  • CMS announced the Medicare Shared Savings Program (MSSP) saved Medicare $1.66 billion in 2021 compared to spending targets. CMS noted this is the fifth consecutive year the program has generated overall savings and high-quality performance results. Nearly all ACOs reported and met the quality standard required to share in savings under the program. Approximately 58% of participating ACOs earned payments for their performance in 2021, many of which tended to be low revenue (i.e., those made up of physicians, included a small hospital, or served rural areas). As of January 2022, MSSP includes approximately 525,000 participating clinicians who provide care to 11 million people with Medicare. CMS has set a goal that 100 percent of people with Traditional Medicare will be part of an accountable care relationship by 2030.

  • JAMA Psychiatry published a new study reporting that the expansion of telehealth services during the COVID-19 pandemic was associated with longer treatment courses and better health outcomes for individuals with opioid use disorder. Data was collected and analyzed from two groups of Medicare beneficiaries, who initiated opioid use disorder-related care either prior to or during the COVID-19 pandemic. Those in the COVID-19 group were more likely to receive telehealth-related services and medications for opioid use disorder, which was further associated with lower overdose risk. The study has generated support for the implementation of permanent opioid use disorder- related telehealth, though it also found disparities in access among Black and Southern populations, underscoring the need to reduce the digital divide.


  • The Kaiser Family Foundation (KFF) published a review of the accessibility of information for people with limited English proficiency (LEP) and people with disabilities provided by states through their Medicaid websites and online application landing pages as of June 16, 2022. These websites are a key source of information for Medicaid beneficiaries, especially as the COVID-19 Public Health Emergency (PHE) ends and states begin to resume regularly scheduled redeterminations and renewals that may cause individuals to lose coverage.

  • CMS released a proposed rule (fact sheet) simplifying applications, verifications, enrollment, and renewals for health care coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The rule proposes a series of changes to Medicaid and CHIP to ease administrative burden for states and reduce barriers to enrollment and retention of coverage for eligible individuals. Proposals in the rule include streamlining application and enrollment, improving retention rates at and between regular renewals, removing barriers to specific CHIP enrollment, and enhancing integrity of Medicaid and CHIP.


ValuePenguin’s recent analysis of U.S. Bureau of Labor Statistics data found that over half of all primary care providers in the U.S. are nurse practitioners and physician assistants. The number of primary care physicians has shrunk 0.21% since 2016, and an estimated 1 in 3 physicians reported they expected to leave primary care within five years, worsening current primary care provider shortages. However, over the same period, the number of nurse practitioners and physician assistants grew by 56% and 27%, respectively, and they are among the top ten fastest-growing professions. As the population of primary care physicians continues to decline, nurse practitioners and physician assistants are anticipated to take on an even larger role in providing primary care services.

Roundtable Reminders

SAVE THE DATE – November 9-11, 2022
Annual Conference Returns to Alexandria, VA

After two years of virtual meetings, the Roundtable is planning an in-person Annual Conference for this November. We will return to The Alexandrian Hotel in Old Town Alexandria, Virginia for our annual policy conference from Wednesday, November 9 to Friday, November 11, 2022.

Details will be released later this year. For now, save the dates!