DCMedical News: Tuesday, July 17, 2018
DCMedical News
Washington, D.C.
Tuesday, July 17, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Drug Pricing Giants Face Off Over Price Control Blueprint: In comments submitted (here) in response to the Administration’s proposed drug pricing program, PhRMA (the main drug industry lobby, the Pharmaceutical Research and Manufacturers of America) and PBMs (the pharmacy benefit managers, represented by the Pharmaceutical Care Management Association) squared off on the issue of rebates (which make money for the PBMs and, inferentially, insurance companies) and drug prices (which make money for drug manufacturers).
PhRMA said (in its 130 pages of comments) that it favors eliminating rebates altogether, and instead using a “value-based fee” for the work of PBMs. PhRMA noted that the way prescription drugs are paid for currently encourages higher list prices because pharmacy benefit managers get a share of the rebates they negotiate.
PBMs blamed pharma for setting high prices in the first place. Their group, the Pharmaceutical Care Management Association, whose 170-page statement is here, released “research” showing that Medicare Part D drug premiums would increase dramatically without rebates. The Biotechnology Innovation Organization (BIO, comments here, 42 pages), cautioned against rapid movement which might impede “innovation in that marketplace.” BIO is especially opposed to moving physician-administered drugs covered by Medicare Part B outpatient care into the Part D drug program. BIO said that could increase the costs for nearly 6 million patients, although, as a Part D drug, health plans could negotiate price. The American Cancer Society agreed, echoing the views of practicing oncologists, also the Community Oncology Alliance, here.
The Pew Charitable Trusts, a nonpartisan research and public policy organization, said (here, 29 pages) that PBMs provide some savings for health insurers. “There is no evidence that net prices for drugs would be lower without PBM rebates,” Pew wrote.
Pew also made these points concerning related and current issues of federal drug pricing policy:
Federal Program Incentives – Unlike other government programs, Medicare Part B does not have the correct incentives to reduce drug spending.
Drug Pricing Structures and Incentives – Proposals to reform the Medicare Part B Competitive Acquisition Program and negotiate additional discounts could reduce drug spending, while proposals focusing on price transparency, value-based purchasing, indication-based pricing, long-term financing, and the protected classes may be unlikely to reduce – and could even increase – drug spending.
Price Reporting Requirements and Incentive Structures – Removing the cap on Medicaid rebates could discourage drug price spikes. The growth of innovative drug pricing contract mechanisms suggests that price reporting requirements are not a categorical barrier to innovative drug pricing contract mechanisms, and any changes to these requirements should be narrowly-tailored to specific examples of money-saving arrangements to avoid undermining existing protections for federal healthcare programs.
Cost-Shifting and Cross-Subsidization – Economic theory and empirical analyses do not support the proposition that drug discounts for some purchasers raise prices to other purchasers for 2 brand drugs; any effect on generic drugs does not appear to have materially increased drug spending.
Generic Drug Pricing and Development – Requiring provision of drug samples for generic development as a condition of Medicare and Medicaid participation could increase generic competition. Existing government drug spending is unlikely to be negatively impacting the generic drug market.
Pharmacy Benefit Managers and Rebates – Pharmacy Benefit Managers and drug rebates likely reduce drug spending, and proposed reforms could increase drug spending. Antitrust regulation and enforcement may be important to promote a competitive pharmaceutical marketplace and reduce spending.
340B Drug Pricing Program – 340B discounts are unlikely to be causing drug price increases and may actually discourage price increases. Reducing the size of the 340B program would redistribute existing hospital discounts to drug manufacturers.
Patient Cost-Sharing – Patient cost-sharing is a function of insurance design, not drug prices, and insurers that reduce patient cost-sharing should be empowered to more rigorously manage drug utilization with appropriate clinical safeguards.
Additional comments: from AHA, 23 pages (here), Families USA (here) and from “I Am Essential” (120+ patient and consumer groups, here).
InsideDrugPricing, the new affiliate of InsideHealthPolicy, adds to the debate by reporting that (1) several states are moving to regulate PBMs, (2) the Administration may pursue policies not discussed in the “blue paper,” and (3) the Administration favors eliminating some part (but not all parts) of the current rebate system.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
CMS Administrator Seema Verma wrote a letter (here) to America’s doctors, a discussion of the interrelated problems of physician burnout, documentation and electronic records, and money. She said, “In a recent Medscape survey of over 15,000 physicians, 42 percent reported burnout. Enough is enough . . . Electronic Health Records were supposed to make it easier for you to record notes, and the government spent $30 billion to encourage their uptake . . . (but) turned this tool into a serious distraction from patient care.” To be continued.
EVENTS & MEETINGS
July 17
9:00 a.m. – 5:00 p.m., National Committee on Vital and Health Statistics (NCVHS), Standards (patient medical record information, electronic exchange of such information, health terminology and vocabulary).
Federal Register notice here. Continued on the 18th, 8:30 a.m. – 3:00 p.m.
10:00 a.m., House Ways and Means Oversight Subcommittee hearing “Combating Fraud in Medicare,” 1100 Longworth HOB.
10:15 a.m., House Energy & Commerce Subcommittee on Oversight and Investigation will explore state efforts to improve transparency in health care pricing, 2322 Rayburn HOB.
3:30 p.m., House Ways and Means Subcommittee on Health, Hearing “Modernizing Stark Law to Ensure the Successful Transition from Volume to Value in the Medicare Program,” Eric Hargan, practitioners, 1100 Longworth HOB.
July 20
12:00 p.m. – 1:30 p.m., “State Responses to the Evolving Individual Health Insurance Market,” Commonwealth and Alliance for health Policy, Dirksen SD-106, lunch!
July 25
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), volume requirements for aortic valve replacements and percutaneous coronary interventions.
Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice of meeting here, National Coverage Determination request for comment (6-28-2018) here.
Aug. 20
Meeting of Medicare Advisory Panel on Hospital Outpatient Program (through August 21), APCs, OPPS, the works. Evaluation of Advanced Primary Care (APC) groups; packaging of Outpatient Prospective Payment System (OPPS). Federal Register notice (5-3-2018), here.
FOR REFERENCE
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
Trial subscriptions may end without notice, and all will end July 31.
July publication dates: 18, 19, 20, 23, 24, 25, 26, 27, 30, 31.
August publication dates: prn, Senate may be in session.
September publication dates: 4, 5, 6, 7, 12, 13, 14, 17, 18, 20, 21, 24, 25, 26, 27, 28.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com