Health Policy Report (2/10)

The Week in Review

The impeachment trial of President Donald Trump came to a close last week after Senators reached a final verdict on two articles of impeachment. Following two days of closing arguments and Senate speeches, the upper chamber voted to acquit the president on charges of abuse of power and obstruction of Congress. President Trump was cleared on a near party-line vote, with Sen. Mitt Romney (R-UT) joining all Senate Democrats in voting to convict on the abuse of power charge.

While the Senate finished up its impeachment trial, House Democrats officially rebuked the Trump administration’s recently announced Medicaid block grant proposal. The lower chamber passed a Congressional Review Act (CRA) resolution that would overturn recent guidance from the Centers for Medicare and Medicaid Services (CMS) to allow states to accept capped Medicaid funding in exchange for more flexibility in spending the money. The resolution is not likely to be taken up by the Senate; however, Democratic Senators could introduce a similar resolution as a means of messaging against the block grant guidance.

Also on the House floor last week, lawmakers cleared a bill out of the Education and Labor Committee that would amend the National Labor Relations Act and related labor laws to extend protections for union workers. The legislation — which includes provisions that prohibit employers from interfering in union elections and facilitate initial collective bargaining agreements for new unions — is not expected to be taken up in the GOP-controlled Senate after the Trump administration argued that it would stymie job growth and undermine the president’s deregulatory agenda in a veto threat earlier last week.

The Week Ahead

Congress will return to action today as lawmakers begin to formulate a post-impeachment agenda. On the House floor this week, lawmakers will consider a package of bills out of the Natural Resources Committee aimed at designating certain public lands as wilderness for the purposes of protection and restoration. The lower chamber will also consider a joint resolution that would eliminate the deadline for the ratification of the Equal Rights Amendment. Meanwhile, Senators will resume consideration of pending presidential nominations, starting with the nomination of Andrew Brasher to be Circuit Judge for the Eleventh Circuit Court. 

Trump Spotlights Drug Pricing, Medicare for All in SOTU

Last Tuesday, President Trump delivered his third State of the Union Address to a joint session of Congress. The speech, themed “the Great American Comeback,” served as an opening argument for his re-election the day after a crowded field of Democratic presidential hopefuls held their first contest at the Iowa Caucuses. President Trump focused on his accomplishments in his first term, highlighting low unemployment rates, rising wages, and the passage of the United States-Mexico-Canada Agreement. The President avoided the topic of impeachment — even as the Senate had yet to acquit him — instead focusing on his accomplishments and messaging leading into his fourth year in office.

With respect to health care issues, President Trump specifically addressed prescription drug pricing, surprise billing and price transparency, and affordable coverage options which was a reference to new regulations allowing for Association Health Plans and short-term, limited duration insurance plans. Among the President’s core points on healthcare, he emphasized that Democratic proposals for health care reform, such as Medicare for All, would “wipe out the private health insurance plans of 180 million Americans.” On the topic of drug pricing, the President highlighted his willingness to “tak[e] on the big pharmaceutical companies” and pointed to a record number of approvals for generic drugs at the Food and Drug Administration (FDA). President Trump directly called on Congress to pass bipartisan legislation “that achieves the goal of dramatically lowering prescription drug prices,” specifically noting that he hasdbeen speaking with Sen. Chuck Grassley (R-IA) on drug pricing reform.

While no details were provided in last week’s speech, the administration is expected to soon roll out a new insulin policy through a CMS demonstration that would reportedly allow insurers to offer Part D plans that provide additional financial support to beneficiaries during the coverage gap — possibly a $50 monthly cap. Premiums would reportedly remain the same under the plan, and co-pays would be uniform across the coverage phases. Also during his speech, the President briefly touched on the opioid epidemic, suggesting that drug overdose deaths have declined for the first time in nearly 30 years. He reiterated a commitment that the administration “will not quit until we have beaten the opioid epidemic once and for all.” The President went on to touch list a series of new initiatives to improve care for Americans with kidney disease, Alzheimer’s, and mental health challenges. He also suggested that new funding for the National Institute of Health (NIH) will allow research to pursue new cures for childhood cancer and eradicate AIDS in America by the end of the decade. Finally, President Trump touted recent legislation to provide paid family leave for parents in the federal workforce and called on Congress to pass the Advancing Support for Working Families Act to extend paid family leave to all parents. 

W&M Releases Bipartisan Surprise Billing Legislation

The leaders of the House Committee on Ways & Means released bipartisan legislation to end “surprise bills” last Friday. The legislation would limit consumers’ responsibility to paying their in-network cost sharing for emergency medical services and for out-of-network providers practicing at an in-network facility. Payment disputes between providers and payers would be settled through direct negotiations and, if unsuccessful, arbitration. Health plans would also be required to provide an Advance Explanation of Benefits to consumers at least three days in advance of a scheduled medical appointment. The legislation encourages health plans and providers to conduct their own negotiations regarding reimbursement, and the Secretary of Health and Human Services (HHS) would establish an independent dispute resolution process for payment disputes that are otherwise unresolvable. The Ways & Means bill is expected to save $10 billion over ten years.

Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) issued a joint statement Friday morning announcing the legislation, stating: “Our bipartisan approach differs from other proposals in that we require – for the first time – that patients receive a true and honest bill in advance of scheduled procedures and we create a more balanced negotiation process to encourage all parties to resolve their reimbursement differences before using the streamlined and fair dispute resolution process.” Majority Leader Steny Hoyer (D-MD) has expressed support for moving on surprise billing, saying that leadership would like action “sooner rather than later.” Ways & Means has yet to schedule a hearing or markup for the legislation, although a markup is likely on Wednesday, February 12.

The House Education & Labor Committee, which has a bill of its own, has scheduled a markup of its legislation for Tuesday, February 11. It is unclear when the legislation might come to the House floor, however, nor what the process would be for reconciling the proposals.

CMS Announces Policies, Rate Methodologies for MA and Part D in 2021

On Wednesday, the Centers for Medicare and Medicare Services (CMS) released a pair of regulatory documents delineating the structure and conditions for plans offered under Medicare Parts C and D in the next one to two years. Part II of the Advance Notice for Calendar Year (CY) 2021 proposes updates to the methodologies used to pay Medicare Advantage (MA) plans and Part D sponsors. CMS also proposed a rule with a range of policy changes to MA and Part D plans for CYs 2021 and 2022. Taken together, the documents further CMS’ emphasis on addressing the opioid epidemic, kidney care, drug pricing, price transparency, and more. As MA plans for beneficiaries with end-stage renal disease (ESRD) will become available in 2021, both the Advance Notice and the proposed rule address implementing policies around those plans.

CMS released Part I of the Advance Notice last month. That narrow document addressed MA’s risk adjustment model, which was required to have a longer comment period than the topics addressed in Part II. CMS releases the advance notice and another document, called a call letter, on an annual basis to alert MA and Part D plan sponsors making methodological changes to payments, updating policy and benefit parameters, and instructing sponsors how to enter bids. This year, CMS is opting to not release a call letter, instead publishing a proposed rule to make policy changes within the rulemaking process. Instructions for plan sponsors will be issued separately.

CMS framed the documents as an advancement on beneficiary out-of-pocket costs, lowering program costs, and furthering President Trump’s executive order on improving kidney care. Health and Human Services Secretary Alex Azar said that the rule would improve Medicare for rural seniors and individuals with kidney disease. He also highlighted specialty drug costs, perhaps in reference to a proposal to add a new specialty drug tier in Part D plans. CMS anticipates little impact from the specialty tier proposal, however. “In addition to giving those with kidney disease more choices, today’s proposals shed desperately needed light on previously obscured out of pocket costs for prescription drugs. At the same time, it strengthens plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal,” added CMS Administrator Seema Verma.

ONDCP Releases Annual National Drug Control Strategy

The White House Office of National Drug Control Policy (ONDCP) released its annual report on the National Drug Control Strategy last Monday, outlining the administration’s priorities for addressing the challenge of drug trafficking and use. This year’s report maintained a focus on reducing the number of Americans dying from drug overdoses through a “whole-of-government approach.” ONDCP Director Jim Carroll said in a press release that despite “significant progress in preventing substance misuse before it starts, getting more people into treatment and long-term recovery, and curbing the flow of deadly drugs into our communities, now is not the time to rest on this success.” The administration also released an accompanying performance reporting system and data supplement, as well as the first-ever National Treatment Plan for Substance Use Disorder.

The administration acknowledged that although the opioid crisis has mobilized awareness and resources to reduce opioid overdose fatalities, the broader landscape of substance use disorders cannot be ignored. They pointed to the increase in poly-substance use associated with individuals’ economic decisions around drug use (such as switching to historically cheap street drugs) and called for prevention efforts to encompass all drug use. Three lines of effort will be the main focus of the National Strategy: preventing drug use before it starts, providing treatment leading to long-term recovery for those suffering from substance use disorder, and reducing the availability of drugs in the United States. The report also updates nine goals — including quantifiable and measurable objectives for each — to be achieved by 2022. The goals address drug-induced mortality — the administration’s top priority; educating the public about the dangers of drug use; expanding access to evidence-based treatment; decreasing the over-prescribing of opioid medications; and reducing the availability of illicit drugs in the United States through reduced production, increased seizure trends, and increased prices and reduced purity.

The administration also released the first-ever national Treatment Plan for Substance Use Disorder, as mandated by the SUPPORT for Patients and Communities Act. The National Strategy prioritizes increasing access to evidence-based addiction treatment — including Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD) — and supporting those in recovery with peer support services, access to housing, training, educational, and employment. The Treatment Plan identifies key elements of the “treatment gap” between those needing treatment and those receiving it and establishes a plan to close it. Three pillars guide the Treatment Plan and its 22 areas of focus: 1) expand early intervention, treatment, and recovery support services infrastructure; 2) improve delivery systems, provider efforts, and services for people with SUD, including special populations; and 3) improve the quality of treatment.