United States: Capitol Hill Healthcare Update - March 6, 2018


Lawmakers are working overtime – including on key healthcare issues – to wrap up work on a $1.2 trillion omnibus budget bill that would fund the government for the balance of the fiscal year.

Congress last month reached agreement on total spending, but now lawmakers face a March 23 deadline to finalize funding specifics for dozens of departments and agencies and thousands of federal programs. Lawmakers will add $6 billion to crack down on opioid abuse, and medical research at the National Institutes of Health and veterans' healthcare programs also are expected to receive funding boosts.

Still, some healthcare issues could prove more challenging to resolve.

Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are trying to revive their efforts to authorize Affordable Care Act cost-sharing subsidies, which help low-income consumers afford plan premiums. The senators want to add their proposal to the budget bill and couple it with giving governors new flexibility to design state-specific coverage options.

While President Trump has conceptually endorsed the idea of Congress approving cost-sharing subsidies, the idea has generated little support among House Republicans. Another potential stumbling block for the Alexander-Murray plan: resolving differences about whether insurance plans subsidized by taxpayers should include coverage for abortions.

Pharmaceutical manufacturers also are trying to unwind a provision Congress approved last month that increases their contributions to 70 percent, up from the current 50 percent, to close the Medicare Part D donut hole.


A bipartisan group of senators last week announced that they had formed a working group to study healthcare pricing issues, and the group queried dozens of stakeholders about ways to increase transparency and lower costs.

Led by Sen. Bill Cassidy (R-La.), the group sent letters to multiple stakeholders, including doctors' groups such as the American Medical Association and insurers like Blue Cross Blue Shield. Other letter recipients included chain drugstores, community pharmacists and ambulatory surgery centers as well as think tanks.

Cassidy said he wants to know what information consumers currently have about prices and their out-of-pocket costs, what entity should be responsible for providing pricing information to consumers, and how to ensure that transparency isn't an added burden on stakeholders.

Absent from the stakeholders that received the group's letter: pharmaceutical and medical device manufacturers.

Cassidy said the group wants to use stakeholders' responses to develop legislation that would improve price transparency and lower costs. Other senators participating are Sens. Chuck Grassley (R-Iowa), Todd Young (R-Ind.), Michael Bennet (D-Colo.), Tom Carper (D-Del.) and Claire McCaskill (D-Mo.).


Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa) introduced legislation last week aimed at boosting transparency among hospitals that participate in the 340B prescription drug discount program.

Grassley's bill is narrow – calling on hospitals to disclose prices paid for 340B drugs and how much Medicare reimburses for the same drugs. The senator in a statement said congressional reviews of the 340B program have revealed "several weaknesses," including that hospitals are not required to track or report program savings or how those savings are used.

Meanwhile, the Senate Health, Education, Labor and Pensions (HELP) Committee is likely to hold an oversight hearing this month on the 340B program. The committee has jurisdiction over the Health Resources and Services Administration, which has come under criticism from Congress for what lawmakers say is lax oversight of the 340B program.

The House Energy and Commerce Committee also is planning 340B hearings in the coming weeks. Committee members – including Reps. Larry Bucshon (R-Ind.) and Chris Collins (R-N.Y.) – have introduced legislation that would establish a moratorium on new hospitals entering the program and overhaul what drugs are eligible for program discounts.


A Democratic senator last week introduced legislation that seeks to strengthen the federal response to drug-resistant bacteria and a growing shortage of effective antibiotic treatments.

The bill, introduced by Sen. Sherrod Brown (D-Ohio), would renew a federal interagency antimicrobial resistance task force as well as codify sections of a 2015 Obama administration plan to curb antibiotic-resistant bacteria, promote prevention, and track antibiotic use and resistance.

The legislation also would target federal grants to healthcare facilities to study the development and implementation of antimicrobial stewardship programs aimed at stopping the overuse of antibiotics.


Bipartisan legislation introduced in the Senate last week would codify a recent Centers for Disease Control recommendation by establishing a three-day limit on initial opioid prescriptions for acute pain.

The legislation is sponsored by Sens. Rob Portman, (R-Ohio), Sheldon Whitehouse (D-R.I.), Shelley Moore Capito, (R-W.Va.), Amy Klobuchar (D-Minn.), Dan Sullivan (R-Ark.), Maggie Hassan (D-N.H.), Bill Cassidy (R-La.) and Maria Cantwell (D-Wash.).

The bill would authorize $1 billion in new opioid funding, including $300 million to make the anti-overdose drug naloxone available to first responders. Meant to build on the 2016 Comprehensive Addiction and Recovery Act, the bill also would allow physician assistants and nurse practitioners to prescribe buprenorphine, which also is used to treat opioid addiction, and increase penalties for manufacturers that don't have adequate controls to prevent opioid diversion.

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) last week raised questions about the three-day prescribing limit in the Senate bill. He said he wanted to ensure final legislation effectively balances the need to block diversion, while also ensuring patients with chronic pain can have access to the medicine.

Meanwhile, bipartisan leaders on the House Ways and Means Committee last week sent requests for information to insurers, physicians and other prescribers on ways to prevent and treat opioid abuse under Medicare. Eighty million Part D prescriptions were written for opioids in 2016 to one-third of the 42 million Americans enrolled in Medicare prescription drug programs.

Also, the Senate HELP Committee on Thursday is holding a hearing examining state-based solutions to combat opioid addiction and proposed treatment solutions.


The top Democrat on the House Ways and Means Committee last week introduced legislation that would require prescription drug manufacturers to pay rebates when prices for Medicare Part B drugs increase faster than inflation.

Rep. Sandy Levin (D-Mich.) said his legislation would curb what he called "excessive price increases" for outpatient drugs. Total spending on Part B drugs was $25.8 billion in 2015, of which $5 billion was paid out of pocket by beneficiaries.

Levin said spending on Part B drugs has grown on average by 9 percent annually since 2009.

The bill – which was introduced with no co-sponsors – was referred to Levin's committee and the Energy and Commerce Committee, which share jurisdiction over Part B.


The senator who replaced former Sen. Al Franken (D-Minn.) is asking CEOs of major pharmaceutical manufacturers how they plan to use savings from last year's tax reform law.

In letters to CEOs, Sen. Tina Smith (D-Minn.) wrote that using tax savings to buy company stock only serves "to enrich investors." She said companies instead should "take every opportunity to lower the price of the drugs."

The senator wrote letters to the heads of Abbott, AbbVie, Johnson & Johnson, Merck and Pfizer.

Smith, who in January was sworn in to replace Franken, last week introduced her first bill, which she said would effectively block brand-name and generic drug companies from reaching agreements on medicines that are nearing patent expiration.

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