DCMedical News: Tuesday, July 24, 2018
DCMedical News
Washington, D.C.
Tuesday, July 24, 2018
DCMedical News is published every day either the House or the Senate is in session.
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THE BIG STORY TODAY IN HEALTH CARE
Drug Prices, Continued: HHS reports “What the Media is Missing on Drug Pricing,” here. Milliman reports to America’s Health Insurance Plans (here) that drug manufacturers can give more (see PHARMA, below). CBO reports to Congress (here) that action taken in the Bipartisan Budget Act (compelling manufacturers to fill more of the ‘Donut Hole’) will also produce savings in net Medicare spending on Part D (but avoids calculating what those savings will be).
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Health Manpower Legislation Passes the House: Passing the House Monday were these four bills:
H.R. 3728, (here) the Educating Medical Professionals and Optimizing Workforce Efficiency Readiness (EMPOWER) Act, authored by #SubHealth Chairman Michael C. Burgess, M.D. (R-TX) and Reps. Jan Schakowsky (D-IL) and Larry Bucshon (R-IN), passed the House by voice vote. H.R. 3728 will amend Title VII of the PHSA to reauthorize the health professions workforce programs that support loan repayment and provider training experiences in primary care, dentistry, rural or underserved areas, and in community-based settings. These programs include the Centers of Excellence, the Health Professions Training for Diversity Program, Primary Care Training and Enhancement grants, Training in General Pediatric and Public Health Dentistry grants, Area Health Education Centers, the National Center for Healthcare Workforce Analysis, and Public Health Workforce grants. H.R. 3728 will also restructure the geriatric health professional grant program to reflect changes that the Health Resources and Services Administration (HRSA) has pursued to enhance outcomes for geriatric patients. H.R. 3728 was the subject of a September 2017 legislative hearing.
H.R. 5385, (here) the Dr. Benjy Frances Brooks Children’s Hospital GME Support Reauthorization Act of 2018, authored by #SubHealth Ranking Member Gene Green (D-TX) and #SubHealth Chairman Burgess, passed the House by voice vote. H.R. 5385 will reauthorize the Children’s Hospital Graduate Medical Education (CHGME) program for five years. H.R. 5385 was the subject of a May 2018 legislative hearing.
H.R. 1676, (here) the Palliative Care and Hospice Education and Training Act, authored by Reps. Eliot Engel (D-NY), Tom Reed (R-NY), and Buddy Carter (R-GA), passed the House by voice vote. H.R. 1676 will direct HHS to award grants to improve the training of health professionals in palliative care. It will also increase education and awareness about the benefits and services of palliative care, and also enhances research on palliative care through leveraging existing authorities and funds at the National Institutes of Health (NIH). The text of H.R. 1676 was the subject of a September 2016 (previous Congress) legislative hearing.
H.R. 959, (here) the Title VIII Nursing Workforce Reauthorization Act of 2017, authored by Rep. David Joyce (R-OH), passed the House by voice vote. H.R. 959 will amend Title VIII of the Public Health Service Act (PHSA) to reauthorize nursing workforce development programs, which support the recruitment, retention, and advanced education of skilled nursing professionals. The bill also extends advanced education nursing grants to support clinical nurse specialists and clinical nurse leaders, defines nurse-managed health clinics, adds clinical nurse specialists to the National Advisory Council on Nurse Education, and reauthorizes loan repayments, scholarships, and grants for education, practice, quality and retention. H.R. 959 was the subject of a September 2017 legislative hearing.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare Advantage and Seriously Ill Patients: Duke Margolis Center scholars report (here) that “Medicare Advantage’s financing structure and increased flexibility following recent statutory and regulatory changes make it a fertile environment for testing new payment and care delivery innovations for patients with serious and advanced illness.” NYT coverage here, FierceHealthcare coverage here.
The Kaiser Family Foundation has updated its health insurance premium tracking tool, report here, site here: https://www.kff.org/private-insurance/issue-brief/tracking-2019-premium-changes-on-aca-exchanges/. The report says: “This analysis looks at preliminary lowest-cost bronze, second lowest-cost silver, and lowest-cost gold premiums in the 50 states and the District of Columbia. (Our analyses from 2018, 2017, 2016, 2015, and 2014 examined changes in premiums and participation in these states and major cities since the exchange markets opened nearly four years ago.) The second lowest-cost silver plan serves as the benchmark for premium tax credits (which subsidize premiums for low and modest income exchange enrollees) and is the only plan that offers reduced cost sharing for lower-income enrollees. About 63% of marketplace enrollees are in silver plans this year, and 29% are enrolled in bronze plans.”
KFF Also Tracks §1332 Waivers: The Kaiser Family Foundation Tracking for Section 1332 (of PPACA) waivers has also been updated, here. “Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents.”
KFF on Enrollment Problems: One in three marketplace enrollees reported having trouble signing up for 2018 PPACA marketplace coverage, KFF “Chart of the Week” (here).
PHARMA
PhRMA Filling the Donut Hole: CBO sent a letter (here) concerning the impact of Section 53116 of the Bipartisan Budget Act. “That section requires manufacturers of brand-name prescription drugs to increase from 50 percent to 70 percent the discount provided to certain Medicare Part D beneficiaries when those enrollees’ spending on brand-name prescriptions falls within a range called the coverage gap (sometimes referred to as the donut hole). When Part D was implemented, such beneficiaries who were not enrolled in the low-income subsidy (LIS) program were responsible for 100 percent of the cost of their prescriptions in that range of spending during a given year. (The law was changed in 2010 to require manufacturers of brand-name prescription drugs to provide a 50 percent discount to non-LIS beneficiaries.) When that legislation was being considered, CBO estimated that section 53116 would reduce net Medicare spending for Part D by $7.7 billion over the 2018–2027 period. CBO subsequently learned of data that indicated a greater savings from enacting section 53116.”
PhRMA Rebates to Health Plans: Milliman (here) reports for AHIP, as follows: “Manufacturer rebates are offered for a limited subset of drugs (81% of all Part D drugs analyzed do not offer rebates and 64% of brand drugs analyzed do not offer rebates), but that limited subset of drugs accounts for a significant portion of Part D spending (over half of all Part D spending and approximately three-quarters of brand spending). Because manufacturer rebates are generally not offered for generic drugs, which comprise the majority of Part D utilization, utilization is concentrated in drugs without rebates. For CY2016, 89% of scripts had no rebates. In 2016, manufacturer rebates totaled approximately 22% of total Part D brand drug gross spending. The average rebate for brand drugs with rebates was 30% of gross drug cost.” And much more, here.
EVENTS & MEETINGS
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.
10:00 a.m. – 11:30 a.m., Bipartisan Policy Center, “The Future of Healthcare: Where Does the Bipartisan Path Lead?” National Press Club, 529 14th St NW, 13th Floor, Washington, DC, 20045, Burke, Capretta, Daschle, Jennings, Roy.
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.
Aug. 22
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), CAR-T cell therapies, collection of patient reported outcomes in cancer clinical studies.
Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice (6-15-2018) 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: 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