Health Policy Report (3/21)

Capitol Hill Update

The Senate will convene for legislative business this week eyeing action on a procedural vote that would jumpstart the conference committee process on the bipartisan technology research and innovation package. This procedure will involve taking up the House’s America Creating Opportunities for Manufacturing Pre-Eminence in Technology and Economic Strength (America COMPETES) Act (H.R. 4521), making changes to the underlying text, and subsequently sending the bill back to the lower chamber. House lawmakers would then need to formally “disagree” to the Senate’s changes, which would allow for the opportunity for lawmakers in both chambers to go to conference and develop a compromise version.

Leadership is hopeful that lawmakers can pass the finalized of the United States Innovation and Competition Act (USICA) (S. 1260) and America COMPETES Act prior to Memorial Day. However, the conferees will need to navigate a series of policy differences between the House and Senate bills — particularly on some of the trade and financial services policies contained in America COMPETES — before a clear path forward emerges. Meanwhile, the Senate Commerce Committee will hold a hearing on Wednesday to discuss the importance of additional funding for domestic semiconductor production — a key policy pillar of the House and Senate bills. For more on the policy differences between the two measures, click here to view TRP’s side-by-side analysis.

In the House, Members have adjourned for a weeklong district work period. Lawmakers will return to Capitol Hill on Monday, March 28.

House E&C Holds Hearing on FDA-Related Manufacturing, Clinical Trial Bills, Among Others

On Thursday, the House Energy and Commerce Subcommittee on Health held a hearing (briefing memo) to discuss 22 pieces of legislation related to drug research and manufacturing that are potential candidates for inclusion as riders to the Food and Drug Administration (FDA) user fee reauthorization package slated for passage later this year. Throughout the duration of the hearing, themes emerged surrounding: (1) generic and biosimilars uptake; (2) the need for diversity in clinical trials; (3) rare disease research and development; (4) adjustments to the accelerated approval process; and (5) digital health, among other items.

Members of both parties generally agreed on the proposed policies, though incongruities emerged over whether changes to the accelerated approval process were necessary with Democratic and Republican committee leadership introducing opposing legislation on the subject. Additionally, Rep. Fred Upton (R-MI) asserted that he and Rep. Diana DeGette (D-CO) had received bipartisan feedback on their CURES 2.0 legislation, adding that they plan to review this input and communicate with member offices in the coming week. 

Key Senate Committee Deliberates Drug Pricing Reform

On March 16, the Senate Committee on Finance held ahearing (TRP analysis) to discuss policy options aimed at reducing the cost of prescription drugs in the Medicare program. No legislation was considered during the hearing; rather, Democrats and Republicans discussed policies within the realm of drug pricing that may — or may not — reduce prices. While bipartisan support emerged for certain policies floated by Democrats — namely out-of-pocket caps for certain prescription drugs — members on each side of the aisle largely disagreed on the efficacy of other provisions proposed by their counterparts. Debate among members emerged surrounding the long-term costs of the Democrats’ policies, where Republicans generally felt that the provisions would only marginally reduce drug prices for beneficiaries while stifling innovation and driving inflation. Conversely, Democrats argued that their policies would allow for increased affordability at the pharmacy counter, thus resulting in better health outcomes for beneficiaries.

Notably, Chair Ron Wyden (D-OR) articulated that, in preparation for the hearing, Finance Committee investigators examined pricing data for several of the most commonly prescribed brand name prescription drugs in the Medicare program. Specifically, these investigators reviewed pricing for the top-selling drugs in the U.S. and comparable western countries, subsequently comparing this data from two points in time: 2015 and 2020. Chair Wyden asserted that data from 2015 suggests that — in each case — these prescription drugs had a higher starting price in the U.S. than in other countries. Further, the Chair noted that, while the prices of such prescription drugs saw an increase between the years of 2015 and 2020, the price of these same medications remained steady in international markets.

Medicare, Medicaid Commissions Release March Report to Congress

On Tuesday, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its March 2022 Report to Congress (TRP analysis; report; press release), as did the Medicare Payment Advisory Commission (MedPAC) (TRP analysis; report, press release). MACPAC submitted three chapters in its report. The chapters concern: (1) criteria for the Money Follows the Person (MFP) program; (2) improving vaccine access for adults; and (3) analyzing disproportionate share hospital (DSH) allotments to states. However, the Commission did not make any formal recommendations to Congress in this report. In recent meetings, commissioners appeared to punt MFP and vaccine recommendations to MACPAC’s June 2022 report due to a lack of data available for the March report.

The MedPAC report, by contrast, includes recommendations to Congress regarding payment adequacy in traditional fee-for-service (FFS) Medicare in addition to the Commission’s review of the status of Medicare Advantage (MA) and the prescription drug benefit (Part D). Regarding Part D drug spending, the report reiterated recommendations from the June 2020 report (TRP analysis; press release) that would redesign the Part D benefit by capping out-of-pocket (OOP) spending, reduce Medicare’s role as a payer in the catastrophic phase, and eliminate the coverage gap for non-low-income subsidy (LIS) beneficiaries. MedPAC also conducted a status report on Part D, as well as the Commission’s first report on dual-eligible special needs plans (D-SNP). Finally, MedPAC also updated Congress on their model post-acute care (PAC) value incentive payment (VIP) program.

Senate Reports Favorably on PREVENT Pandemics Act

Last week, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a markup (TRP analysis) for the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics (PREVENT Pandemics) Act (S. 3799). Over the course of the meeting, members offered 27 amendments to the legislation, in which: (1) one amendment passed by a roll call vote; (2) seven amendments passed by voice vote; (3) 11 amendments were withdrawn; and (4) one amendment was tabled.

The Senators’ amendments generally addressed drug and vaccine research, nursing staff shortages, agency accountability, and supply chain issues to respond to the COVID-19 public health emergency (PHE) and better prepare for future pandemics. Democrats advocated for increased spending for pandemic preparedness, while Republicans focused on improving data collection and keeping health agencies accountable. Overall, there was strong bipartisan support for the PREVENT Pandemics Act as it was reported favorably as amended in a 20-2 roll call vote, with only Sens. Rand Paul (R-KY) and Mike Braun (R-IN) voting against the bill.

House Lawmakers Discuss Veterans’ Health Needs

Last week, the House Veterans’ Affairs Subcommittee on Health held a legislative hearing (TRP analysis) to consider eight bills that aim to address the health care needs of aging and disabled veterans. During the hearing, the Subcommittee heard from three panels consisting of: (1) Members of Congress who sponsored or cosponsored legislation under consideration; (2) officials from the Department of Veterans’ Affairs (VA); and (3) members of veteran service organizations (VSOs). During the hearing, members expressed bipartisan support for the Elizabeth Dole Home and Community Based Services (HCBS) for Veterans and Caregivers Act, among other legislative items.

Throughout the hearing, lawmakers expressed their desire to promote veterans’ independence in their health care decisions. Witnesses from the VA supported the goals and intentions of several of the bills but did not endorse anything explicitly. VA officials also proposed technical amendments and suggested that some of the bills would interfere with programs and initiatives they have already implemented. The VSO witnesses supported the legislation discussed during the hearing, stressing the importance of veterans maintaining autonomy over their lives while receiving care.