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April 3, 2023

This Week in Health Policy for April 3

This Week (April 3-7)

Congress will be on recess next week and the following week. During this time, WCEY will not publish This Week in Health Policy. We will resume publishing on April 17.

Last Week (March 27-31)

Health Care Highlights

CMS issues Medicare Advantage and Part D rates for 2024. Late Friday (March 31), the Centers for Medicare and Medicaid Services (CMS) published its final 2024 rate announcement for Medicare Advantage (MA) and Part D plans. CMS said MA plans in 2024 can expect to a 3.32% payment bump compared with 2023, this is up from the 1.03% increase CMS initially projected in the rate notice. CMS finalized proposed changes to the Part C risk adjustment model, including switching to the ICD-10 code classification system and updating fee-for-service data years underlying the model to 2018 for diagnosis and 2019 for expenditures. CMS said those changes will be phased in over three years. The agency also finalized technical adjustment to the per capita cost calculations related to indirect and direct medical education costs, which also will be phased in over three years. Click here for the fact sheet. 

Medicare Trust Fund gets a new insolvency date. On Friday (March 31), the Medicare Board of Trustees published a report that projected the Hospital Insurance Trust Fund will become insolvent in 2031, three years later than projected in last year’s report. The report attributes the extended deadline in part to the Inflation Reduction Act’s drug pricing provisions. The report said factors related to the COVID-19 pandemic are expected to be eliminated by 2024. Click here for the report. Click here for the fact sheet.

CMS removes seven drugs from inflation penalties. On Thursday (March 30), CMS removed seven drugs from the list of drugs that will be subject to penalties for having prices that rose faster than inflation. STAT News reported, “Medicare officials said that the cutback on the list happened because the agency made some recalculations after considering public feedback.”

Judge orders HHS to stop enforcing ACA preventive coverage provisions. On Thursday (March 30), a Texas judge ordered the Department of Health and Human Services (HHS) to stop enforcing a provision in the Affordable Care Act requiring health insurers to cover certain preventive services at no out-of-pocket cost to enrollees. The judge also ruled that a requirement to cover the HIV prevention drug PrEP violated employers’ religious rights. The ruling, which could have long-term implications on insured patients’ coverage for preventive services, is expected to be appealed.

FDA approves Narcan for over-the-counter sales. On Wednesday (March 29), the Food and Drug Administration (FDA) approved the opioid overdose treatment Narcan nasal spray for over-the-counter, nonprescription use. FDA suggested consumers could expect to see Narcan available on store shelves by the summer. 

Senate votes to immediately end COVID-19 National Emergency declaration. On Wednesday (March 29), the Senate voted to pass a House-approved measure (H J Res 7) to immediately terminate the COVID-19 national emergency declaration. Currently, both the national emergency and the public health emergency declarations are set to end May 11. While the White House has issued statements against abruptly ending the national emergency and public health emergency, President Biden is expected to sign the resolution, which means the national emergency would end prior to the May 11 date. The change could have implications for certain coverage-related waivers like election and notice deadlines for COBRA eligibility and Medicare Advantage plans.

CMS publishes FAQs on COVID-19 coverage post-PHE. On Wednesday (March 29), CMS released FAQs prepared by the Departments of Labor, HHS, and the Treasury on COVID-19 coverage after the public health emergency ends. The FAQs address COVID-19 diagnostic testing, vaccines and preventive services, as well as the timeframes to complete certain employee benefit elections or other coverage-related actions, such as steps to take after losing Medicaid or Children’s Health Insurance Program coverage as part of the redeterminations process set to begin April 1.

Hearings, Markups, and Other Committee Action

House Energy and Commerce Subcommittee on Health hearing on "Lowering Unaffordable Costs: Examining Transparency And Competition In Health Care."  On Tuesday (March 28), the Subcommittee held a hearing entitled, “Lowering Unaffordable Costs: Examining Transparency and Competition in Health Care.” During the hearing, discussion largely centered on ways to increase transparency and competition in the U.S. health care market to address high health care costs. Specifically, lawmakers and witnesses discussed ways to improve compliance with the hospital price transparency rule and the usability of available data; policies, such as site-neutral payments, to address discrepancies in costs of services by location; and the need to increase transparency among pharmacy benefit managers (PBMs) and understand their role in high drug prices. 

  • More information available here.

House Ways and Means Subcommittee, Appropriations Subcommittee, and Energy and Commerce Committee Hearings on HHS FY 2024 Budget Request.
This week, three House committees held separate hearings to discuss President Biden’s fiscal year (FY) 2024 budget proposal for HHS. The hearings follow those held in the Senate last week and mark the beginning of a months-long appropriations process to fund HHS before the end of the fiscal year. Each committee heard testimony from HHS Secretary Xavier Becerra who defended the president’s budget request and highlighted what he characterized as department successes. Republicans at all three hearings raised concerns about the size of President Biden’s $6.8 trillion budget proposal and the impact on the federal deficit and inflation, with several members and chairmen questioning the budget’s impact on the Medicare Trust Fund, calling the proposals a “budget gimmick.” Democrats, meanwhile, criticized a recent House Freedom Caucus proposal to cap FY 2024 spending at FY 2022 levels, and asked Becerra to share how such a policy would impact HHS research programs and consumers.

House Oversight and Accountability Subcommittee on Health Care and Financial Services hearing on “FDA Oversight Part I: The Infant Formula Shortage." On Tuesday (March 28), the Subcommittee held a hearing on this past summer’s infant formula shortage and the federal government’s response. During the hearing, lawmakers heard testimony from former Deputy Commissioner at FDA’s Office of Food Policy & Response Frank Yiannas and President and Executive Director of the Center for Science in the Public Interest Peter Lurie.

  • More information available here.

Senate Finance Subcommittee on Health Care hearing on “An Oral Health Crisis: Identifying and Addressing Health Disparities.”
On Wednesday (March 29), the Subcommittee held a hearing to examine the oral health crisis. During the hearing, lawmakers heard testimony from dentists, academics, and advocates who shared ways to identify and address health disparities in oral care. Discussion topics during the hearing included obstacles to teledentistry and dental coverage for pregnant women.

  • More information available here.

Senate Finance Committee hearing on “Pharmacy Benefit Managers and the Prescription Drug Supply Chain: Impact on Patients and Taxpayers.”
On Thursday (March 30), the Senate Finance Committee held a hearing on pharmacy benefit managers and their role in the prescription drug supply chain, which was notable for its display of bipartisanship with Committee leaders and members expressing aligned interests in examining the PBM market and promoting policies to increase transparency and address perverse market incentives to lower costs for patients. During the hearing, Committee members heard testimony from a panel of five witnesses, including academics, a startup PBM, and a lawyer who represents pharmacies, all of whom, except one witness, spoke in favor of greater transparency among PBMs. The Senate Finance Committee is one of several congressional committees looking at the role PBMs play in drug prices.

  • More information available here.

Reports, Studies, and Journals

JAMA Psychiatry: Increased use of telehealth services and medications for opioid use disorder during the COVID-19 pandemic associated with reduced risk for fatal overdose. The study, conducted by researchers at CDC, CMS, and NIH, found Medicare patients with opioid use disorder who received telehealth care during the pandemic saw the risk of a fatal overdose decline by 33%.

Congressional Budget Office: S. 113, Prescription Pricing for the People Act of 2023. In the report, CBO estimates the cost of implementing S. 113, which would require the Federal Trade Commission to study anticompetitive practices within the pharmaceutical supply chain, particularly looking at the role of PBMs. CBO estimated the bill would cost $3 million over two years to fund the 12 employees needed to conduct the research.

Centers for Disease Control and Prevention: Risk Assessment of Mpox Resurgence and Vaccination Considerations. In the report, CDC researchers said most U.S. jurisdictions have a "greater than 35%" risk of mpox, formerly known as monkeypox, resurging over the coming months.


Contact Information
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Washington Council Ernst & Young
   •  Heather Bell (