DCMedical News: Tuesday, September 4, 2018
DCMedical News
Washington, D.C.
Tuesday, September 4, 2018
DCMedical News is published every day either the House or the Senate is in regularly scheduled session.
THE BIG STORY TODAY IN HEALTH CARE:
Supreme Court nomination hearings begin for Judge Brett Kavanaugh (for a summary of health-field cases involving Judge Kavanaugh see DCMN of 7-11, here; see White House profile here). Oral argument begins Wednesday on the “Obamacare litigation” (Texas v. US, complaint here); the case was filed by Republican state attorneys general and governors from 20 states and contends that PPACA should be found unconstitutional following Congress’ elimination of the tax penalty for failing to have insurance. The House and Senate are back in regular session.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Doc Pay Rule: One hundred and seventy medical groups (letter here, report here) sent a letter opposed to the proposed physician payment rule for 2019 (proposed rule here), and another one hundred and twenty-six patient and provider (generally specialist) groups said (letter here) the E/M (evaluation and management) cuts (consolidating five categories into one) will financially compromise the most medically complex Medicare patients. The “administrative simplification” part of the proposed rule has garnered praise, in general. Comment period on the proposed rule ends September 10.
National Advisory Council on Nurse Education and Practice: “HRSA is requesting nominations [Federal Register notice here] for voting members of the NACNEP representing leading authorities in the various fields of nursing, higher and secondary education, and associate degree schools of nursing; representatives of advanced education nursing groups (such as nurse practitioners, nurse midwives, and nurse anesthetists); hospitals and other institutions and organizations which provide nursing services; practicing professional nurses; the general public; and full-time students enrolled in schools of nursing.”
Advisory Committee on Training in Primary Care Medicine and Dentistry: also, “HRSA is requesting [Federal Register notice here] nominations for voting members of the ACTPCMD representing allopathic medicine, osteopathic medicine, family medicine, general internal medicine, general pediatrics, physician assistant, general dentistry, pediatric dentistry, public health dentistry, dental hygiene, advanced practice nurse programs, and other health professionals engaged in primary care or oral health interprofessional training. Among these nominations, students, residents, or fellows representing allopathic medicine, osteopathic medicine, physician assistant, or dentistry are encouraged to apply.”
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Health insurance coverage: Twenty-eight million Americans (8.8%) did not have health insurance during the first three months of 2018, compared to 9.1% in 2017, 20 million fewer than in 2010, per a CDC report released in August (here). Other findings: “In the first 3 months of 2018, among adults aged 18–64, 12.5% were uninsured at the time of interview, 19.2% had public coverage, and 70.0% had private health insurance coverage. In the first 3 months of 2018, among children aged 0–17 years, 4.6% were uninsured, 41.9% had public coverage, and 54.6% had private health insurance coverage. Among adults aged 18–64, 70.0% (138.6 million) were covered by private health insurance plans at the time of interview in the first 3 months of 2018. This includes 4.2% (8.3 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges. The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan increased, from 43.7% in 2017 to 47.0% in the first 3 months of 2018.”
Medicaid: Nebraska joined Idaho and Utah with Medicaid expansion proposals on the November ballot.
Final regulations for short term, limited duration health insurance plans (STLDI) were published (here): The plans are less expensive than coverage which would include “essential health benefits” such as maternity and mental health. The plans can now last up to 12 months and can be renewed for up to 36 months. However, there is no guarantee of renewability. STLDI plans are the second initiative of the Administration to promote lower priced health insurance. In June, the Labor Department issued a final rule (here) that will make it easier for small companies to buy association health plans and will also allow them to be sold to people who are self-employed. The pair of new rules carries out an executive order President Trump signed last October (here).
State single payer initiatives figure in some elections this fall. In New York, a RAND report (here) on the “New York Health Act,” has galvanized opposition from business and insurance interests. RAND says that new taxes for health care would need to be $139 billion in 2022 and $210 billion in 2031 to fully finance the plan. Texas and Florida may also consider such proposals.
PHARMA, DEVICES
CMS to Allow “Indication-Based-Formulary Design”: An August 29 memo from CMS (new release here, “fact sheet” here, memo here) gives new flexibility to Part D plans to restrict use of prescribed drugs. The “indication-based-formulary design” would work (beginning in calendar 2020) as follows: “Under this type of formulary design, plans negotiate formulary coverage based on specific indications, and only certain indications are considered to be on-formulary for a given drug. As discussed in the blueprint, providing Part D plans with the flexibility to employ the latest formulary tools would enable them to better negotiate for prescription drugs, especially high-cost drugs. The ability to exclude drugs from their formulary for specific indications will provide additional negotiating leverage with manufacturers, which can ultimately reduce beneficiary and program costs.”
This authority would be an addition to another new Part D tool, “step therapy”: “As outlined in the July 25, 2018, Health Plan Management System (HPMS) memorandum, Part D sponsors may utilize step therapy-like requirements within their PA [Prior Authorization] to promote cost-effective drug therapy by requiring the use of one formulary drug for a certain indication prior to authorizing coverage of a second drug for that indication.”
The “Blueprint”: The Administration has released a report (here) on the impact of the first 100 Days of the Drug Pricing Blueprint, claiming that two companies reduced prices, four canceled planned price increases, thirteen committed to price freezes for the remainder of 2018. Also reported: “In July, FDA approved more generic drugs than in any single month in its history. In the past 100 days, FDA also approved the first generic drug under a pathway designed to expedite the development and review of generic drugs for products that lack competition, approved the first generic version of the EpiPen, and approved a new biosimilar competitor for an expensive drug that fights infection in cancer patients (just the 10th biosimilar ever approved).”
READING
“Recent Trends in Life Expectancy Across High Income Countries,” BMJ (here). “Life expectancy in the United States is lower than in other high income countries and the position of the USA in international rankings of life expectancy has been deteriorating over time. Life expectancy declined for two consecutive years in the USA between 2014 and 2016 and in England and Wales during 2014-15. Widespread or sustained declines in life expectancy are an important indicator of conditions influencing health and wellbeing within countries. Most high income countries included in this analysis experienced declines in life expectancy during 2014-15 likely related to a particularly severe influenza season. Declines in life expectancy in the USA differ from those in other countries in that they are more concentrated at younger ages (0-65 years) and largely driven by increases in drug overdose mortality related to its ongoing opioid epidemic. Many of these countries rebounded and experienced gains in life expectancy during 2015-16 substantial enough to offset the previous year’s declines, but the UK and the USA did not and continue to face adverse conditions.”
EVENTS & MEETINGS
September 5
10:00 a.m., the Health Subcommittee of the House Energy and Commerce Committee, chaired by Rep. Michael C. Burgess, M.D. (R-TX), room 2123 of the Rayburn House Office Building. The hearing is entitled, “Opportunities to Improve Health Care,” including prohibition of gag clauses, enhancement of fraud prevention, care coordination under Medicaid for children with complex conditions, extension of “Money Follows the Person” legislation for five years, details here.
September 10
9:00 a.m., continuing September 11, Advisory Committee on Training in Primary Care Medicine and Dentistry (ACTPCMD). Information about ACTPCMD and the agenda for this meeting can
be found on the ACTPCMD website at: https://www.hrsa.gov/advisory-committees/primarycaredentist/index.html. Details 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
September publication dates: 4, 5, 6, 12, 13, 14, 17, 18, 20, 21, 24, 25, 26, 27, 28.
October publications dates: 1, 2, 3, 4, 5, 9, 10, 11, 12, 15, 16, 17, 18, 19, 22, 23, 24, 25, 26
November publication dates: 13, 14, 15, 16, 26, 27, 28, 29, 30
December publication dates: 3, 4, 5, 6, 7, 10, 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com