May 30, 2023
This Week in Health Policy for May 29
This Week (May 29 - June 2)
The House and Senate will be in recess for Memorial Day with the Senate scheduled to return for the remainder of the week. Debt limit negotiations may bring House members back for votes.
Senate Health, Education, Labor & Pensions Committee will hold a hearing on “Solving the Child Care Crisis: Meeting the Needs of Working Families and Child Care Workers.”
Last Week (May 22 - 26)
Health Care Highlights
Health care on the table in debt limit talks. Debt limit negotiations between House Republican leaders and the White House are expected to continue over the holiday weekend in the hopes of reaching a deal before the early June X date that would result in the US defaulting on its debt. While the White House did not comment on the discussions, House Republican leaders expressed cautious optimism that a deal could be reached in the coming days. House Republican leaders are pushing for the debt limit to include spending cuts, including returning unobligated COVID-19 relief funds, as well as policy measures such as Medicaid work requirements, while the White House and Democrats have pushed for a clean debt limit increase.
CMS issues Medicaid Drug Rebate Program proposed rule. On Tuesday (May 23), the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking for the Medicaid Drug Rebate Program that aims to increase transparency into Medicaid prescription drug prices. The proposed rule would require manufacturers of up to 10 high-priced Medicaid-covered outpatient drugs to share drug pricing information through an annual Medicaid Drug Price Verification Survey. In addition, CMS proposed changes to curb pharmacy benefit managers’ (PBMs) use of spread pricing by requiring Medicaid-managed care plans contracts with PBMs include requirements for PBMs to report the cost of covered outpatient drugs and dispensing or administration fees for the drugs separately from administrative costs or fees. The proposed rule also aims to address the misclassification of drugs, which can impact the rebates state Medicaid programs receive. Click here for the press release. Click here for a fact sheet on the misclassification of drugs provisions and click here for a fact sheet on the drug price verification survey and PBM transparency provisions. Click here for the proposed rule.
CMMI releases new model data. On Thursday (May 25), the Centers for Medicare and Medicaid Innovation (CMMI) released new public-use files with data from the 2021 performance year of the Global and Professional Direct Contracting (GPDC) Model, which was renamed and relaunched as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. CMMI said it also will post 2023 participant data for the ACO REACH model, as well as data on the 2015--2016 performance years for the Pioneer Accountable Care Organization (ACO) Model. Click here to access the new public files.
Surgeon General issues advisory on teens’ social media use. On Tuesday (May 23), Surgeon General Vivek Murthy issued an advisory on youth mental health and social media usage. The advisory calls on policymakers, technology platforms and parents to create safe limits for teens’ social media use.
House passes bills to combat fentanyl epidemic. On Monday (May 22), the House passed the Preventing the Financing of Illegal Synthetic Drugs Act (HR 1076), which requires the Government Accountability Office to conduct a study on illicit financing related to synthetic drug trafficking, including fentanyl and methamphetamines. Later in the week on Thursday (May 25), the House voted 289-133 to pass the HALT Fentanyl Act, which would permanently classify fentanyl-related substances in the Schedule 1 category and expand mandatory minimum prison sentences.
PHE waiver updates. Late Friday (May 19), CMS said it would continue to allow physical therapists, occupational therapists, speech language pathologists, diabetes self-management training and medical nutrition therapy providers at rehabilitation agencies and comprehensive outpatient rehabilitation facilities to bill Medicare Part B for telehealth services, though CMS did not specify an end date for the flexibility.
Hearings, Markups, and Other Committee Action
House Energy and Commerce Committee markup of 19 bills related to health care, broadband, and energy. On Wednesday (May 24), the Committee advanced 18 bills, including six health care measures, and delayed consideration of H.R. 3285, the Fairness for Patient Medications Act, which would establish patient protections regarding highly rebated drugs. The health care bills advanced included the Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023, a legislative package that includes proposals to reauthorize several programs set to expire at the end of the fiscal year, codify and build on CMS’ price transparency rules, enact site-neutral payments for certain drugs administered in hospital outpatient departments, increase transparency into PBMs and bar spread pricing for payment arrangements with Medicaid plans, avert $16 billion in Medicaid Disproportionate Share Hospital cuts for fiscal years 2024 and 2025, and more. The committee also passed bills to add new reporting requirements for 340B Drug Discount Program entities and allow for value-based purchasing arrangements in Medicaid for rare disease treatments, as well as bills to overhaul the Organ Procurement and Transplantation Network and require HHS to report on the impact of certain Medicare regulations on provider and payer consolidation.
House Oversight and Accountability Committee hearing on “The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part I: Self-Interest or Health Care?” On Tuesday (May 23), the Committee discussed the ways PBM-negotiated rebates impact drug list prices, anticompetitive practices that are forcing independent and community pharmacies to close, and policies that disrupt the provider-patient relationship. The provider and pharmacist witnesses spoke about how PBMs negatively impact their businesses and interactions with patients. Meanwhile, the PBM witness detailed ways PBMs could operate transparently and not increase drug prices or costs and the consumer witness focused on the role pharmaceutical manufacturers play in setting high list prices. But each witness agreed more transparency is needed within the PBM market to identify meaningful ways to lower costs for patients.
House Appropriations Subcommittee on Agriculture, Rural Development, Food and Drug Administration postponed a markup of the FY 2024 appropriations bill for FDA. The Subcommittee postponed a Wednesday (May 24) markup of FY appropriations for the FDA and other agencies as debt limit negotiations continue between the White House and House Speaker Kevin McCarthy’s (R-CA) office.
House Committee on Veterans’ Affairs hearing on “COVID-19 Supplemental Funding: Did It Protect and Improve Veteran Care?” On Tuesday (May 23), the Committee held a hearing to discuss the impact roughly $36.7 billion in supplemental COVID-relief funding on veterans’ health. During the hearing, witnesses representing the VA and state veterans’ homes spoke about how the funds were used to support staffing and bolster resources, however, VA Inspector General Michael Missal said they found the VAs outdated financial management systems posed “significant challenges” to understanding exactly how Covid funds were spent.
Reports, Studies, and Journals
CMS Office of Minority Health: Disparities in Health Care in Medicare Advantage Associated with Dual Eligibility or Eligibility for a Low-Income Subsidy and Disability. The report, conducted in collaboration with the RAND Corporation, found Medicare Advantage enrollees who were dually eligible for Medicare and Medicaid or eligible for the low-income subsidy were more likely to have below-average scores for clinical care quality.
Health Affairs: Health Insurance For People Younger Than Age 65: Expiration Of Temporary Policies Projected To Reshuffle Coverage, 2023–33. The Congressional Budget Office (CBO) projected 6.2 million people will become uninsured as part of the Medicaid redeterminations process. In total, CBO projected an additional 9.4 million people will transition from Medicaid to other forms of coverage, with 1.6 million enrolling in individual coverage and 7.8 million enrolling in employer-based coverage.
Centers for Disease Control and Prevention: HIV Declines Among Young People and Drives Overall Decrease in New HIV Infections. The latest Centers for Disease Control and Prevention data show estimated annual new HIV infections were 12% lower in 2021 compared to 2017, driven by a 34% decrease in new infections among 13- to 24-year-olds. However, the report found disparities remain in HIV prevention methods, such as PrEP, with few Black or Hispanic/Latino people who are eligible for PrEP prescribed the medication in 2021.