POLICY BRIEFINGS


Baldwin to Force Vote on Short-Term Plans


Sen. Tammy Baldwin (D-Wis.) has introduced Senate Joint Resolution 63 that would force a vote on overturning the Administration’s expansion of short-term limited-duration health insurance plans. The bill requires 30 signatories to force a Senate vote, and only a simple majority in either chamber to pass. The resolution of disapproval was cosponsored by 29 other Democrats. The bill would reverse a recent regulation that increased access to health insurance plans that are not required to comply with the Affordable Care Act’s (ACA) popular consumer protections. Baldwin has not yet secured the support of any of her Republican colleagues.


Lawmakers Urge HRSA Oversight of 340B


Bipartisan leadership of the House Energy and Commerce Committee and Senate HELP Committee sent a letter to the Health Resources and Services Administration (HRSA) regarding the agency’s oversight of the 340B Drug Pricing Program. The lawmakers acknowledge that HRSA has requested that Congress consider legislative action to provide the agency with broader rulemaking authority over the program, but also point out that HRSA has not used its existing authority to implement regulations to better administer 340B. The letter outlines HRSA’s authority to (1) establish and implement a binding Administrative Dispute Resolution (ADR) process for the resolution of certain disputes relating to compliance with 340B Program requirements, (2) provide for the imposition of civil monetary penalties (CMPs) against manufacturers that knowingly and intentionally overcharge a covered entity for a 340B drug, and (3) issue precisely defined standards of methodology for calculation of 340B ceiling prices. Additional regulations from HRSA “could help clarify and update program requirements in pursuit of strengthening access to necessary care and proper administration of the program,” the lawmakers write.


E&C Requests Information on PBMs, Hospital Consolidation


Republican leadership of the House Energy and Commerce Committee have contacted several pharmacy benefit managers (PBMs) in an attempt to better understand their role in the drug supply chain. The lawmakers seek information about drug negotiations, PBM work in the Medicare and Medicaid programs, and specialty drugs. “We request your assistance in order to better understand the relationship of a drug’s list price with the price negotiated and the different incentives that are offered to encourage reductions in list price,” the letter states. They also request details on what percentage of rebates or discounts are passed along to PBM clients, and whether PBMs inform their clients if manufacturers offer to lower list prices for particular clients. The letters were signed by Chairman Greg Walden (R-Ore.), Health Subcommittee Chairman Michael Burgess (R-Texas), and Oversight and Investigations Subcommittee Chairman Gregg Harper (R-Miss.). They request a response from CVS, EnvisionRXOptions, Express Scripts Holding Company, Humana Inc., Prime Therapeutics, Procare Pharmacy Benefit Manager, Inc., and UnitedHealth Group by September 30.

Reps. Walden, Burgess, and Harper also sent a letter to the Medicare Payment Advisory Commission (MedPAC) last week, requesting that the commission conduct research into hospital consolidation and the financial impact it has on the Medicare program and its beneficiaries. The lawmakers acknowledge the efficiencies and economies of scale that can be accomplished through consolidation, while also highlighting the data which indicates that hospital consolidation can increase spending for both the Medicare program and patients. According to the letter, the lawmakers wish “to determine the impact consolidation has on patients, and if patients end up paying higher prices due to consolidation for no identifiable benefit to the beneficiary.” The lawmakers pose a series of questions for MedPAC and request a response with 30 days.


Lawmakers to Comment on CMS E&M Proposed Rule


A bipartisan group of House lawmakers are circulating a letter urging the Centers for Medicare and Medicaid Services (CMS) to abandon a proposal that would revise physician payment rates for certain office visits in 2019. CMS proposes to pay the same rate for doctor visits regardless of complexity. The letter argues that the July proposed rule to consolidate billing codes for evaluation and management (E&M) services would reduce access to care for the sickest patients and “devalues the expertise, clinical decision-making, and time of physicians who treat patients with complex conditions.” Reps. Marsha Blackburn (R-Tenn.), Brad Wenstrup (R-Ohio), Earl Blumenauer (D-Ore.), and Doris Matsui (D-Calif.) request sign-on from their colleagues by September 5. Comments on the CMS proposal are due September 10.



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