United States: Capitol Hill Healthcare Update - May 13, 2019

Below is this week's "Capitol Hill Healthcare Update," which is posted on Mondays when Congress is in session.


The House is scheduled to vote on legislation Thursday that would package new funding for state-based marketplaces and enrollment outreach efforts under the Affordable Care Act (ACA), with provisions designed to lower prescription drug prices.

Some of the drug pricing provisions enjoyed bipartisan support when considered earlier this year in the Energy and Commerce Committee and the Judiciary Committee. But House Republicans aren't expected to support the overall bill because of the ACA funding and provisions that would roll back the Trump administration's plan to lower insurance premiums for healthier Americans, which Democrats have derided as "junk" insurance plans.

The drug pricing provisions include legislation by Rep. David Cicilline, D-R.I., to allow generic drug companies to gain quicker access to treatments approved under the Food and Drug Administration's risk evaluation and mitigation systems safety protocol. It also would allow civil suits against drugmakers that refuse to provide samples for bioequivalence testing of a generic version of a brand-name drug.

Also included is legislation by Rep. Bobby Rush, D-Ill., that would prohibit patent settlements with brand-name manufacturers that delay a generic drug's entry into the market. A provision by Rep. Kurt Schrader, D-Ore., would prevent a generic drug company from delaying market entry of another generic drug.

The underlying bill, by Rep. Lisa Blunt Rochester, D-Del., would provide $200 million for states to create insurance exchanges for individuals and small businesses to purchase coverage, provide $100 million for ACA navigators to aid consumers enrolling in health plans, and block a Trump administration plan to sell short-term health plans.


Sen. Elizabeth Warren, D-Mass., and House Oversight Chairman Elijah Cummings, D-Md., introduced sweeping legislation last week that would spend $100 billion over the next decade to address the opioid crisis.

The bill would bolster funding for evidence-based treatment and establish new state grants to help workers who are at risk of or struggling with addiction to maintain or find employment while in treatment and recovery.

Cummings said Congress could pay for the new funding "by rolling back just a fraction of the massive tax cuts recently granted to opioid manufacturers and other drug companies [that] played such a key role in creating this crisis."


President Donald Trump's urging last week for Congress to address unexpected bills for out-of-network medical care drew bipartisan support from key congressional leaders.

House Ways and Means Committee Chairman Richard Neal, D-Mass., and the top Republican on the panel, Rep. Kevin Brady, R-Texas, said in a joint statement that they were willing to work across party lines and with the White House to find a bipartisan solution to protect patients from surprise medical billing.

House Energy and Commerce Committee Chairman Frank Pallone, D-N.J., and the committee's ranking Republican, Rep. Greg Walden, R-Ore., said they hope to announce a bipartisan solution "soon."

The need to address surprise medical billing is a rare area of bipartisan agreement, but an actual solution may be challenging to achieve as physicians, hospitals and insurers lobby to not bear a disproportionate burden of solving the issue.

Sens. Bill Cassidy, R-La., Michael Bennet, D-Colo., and Maggie Hassan, D-N.H., are working on bipartisan legislation. Senate HELP Committee Chairman Lamar Alexander, R-Tenn., said he and the panel's top Democrat, Sen. Patty Murray, D-Wash., would introduce legislation this summer putting limits on surprise billing.


A key senator last week praised a Trump administration final regulation that would require pharmaceutical manufacturers to state the list price of a 30-day supply of any drug covered by Medicare or Medicaid in their direct-to-consumer advertising.

"The Trump administration rule is a smart idea because the more consumers know about drug prices, the more likely those prices are to be lower," said Senate HELP Committee Chairman Lamar Alexander, R-Tenn.

Several pharmaceutical manufacturers are voluntarily including pricing information in their consumer advertising. But the industry opposes requiring list prices in ads because few if any consumers pay list prices and consumers' out-of-pocket costs are determined by their insurance policies.


The House Appropriations Committee last week approved on a party-line vote the fiscal 2020 spending bill for the Department of Health and Human Services (HHS).

The 30-23 vote sends the bill to the House floor, where a vote hasn't been scheduled. The Senate is separately working on its HHS appropriations bill, with potential committee consideration in early June.

The Democratic House and Republican Senate are likely headed for a political confrontation over the spending package, which includes thorny policy and funding issues on abortion, immigration and the Affordable Care Act.

The House bill would provide HHS with $99 billion, excluding appropriated money for the Food and Drug Administration, which receives taxpayer money from a separate spending bill and from industry user fees. In addition to giving HHS $8.5 billion in new funding, the bill also would add $2 billion to the National Institutes of Health's $39 billion budget.

The Centers for Disease Control and Prevention would see a $921 million increase, to $8.3 billion.

The bill includes report language on several key health provisions, including promoting the Orphan Drug Act and urging Centers for Medicare & Medicaid Services to support access to biologic and gene therapies for rare diseases with testing of health insurance benefit designs that eliminate specialty tiers.

The committee criticized a Trump administration proposed regulation that could affect Medicare Part D coverage of six therapeutic categories of drugs, including HIV, cancer, mental health conditions and other serious illnesses. The Trump proposal would allow increased use of prior authorizations and step therapy requirements that could delay access to these treatments, the committee said.

Added by Rep. Marcy Kaptur, D-Ohio, the committee report also would direct HHS to report on price changes of prescription drugs since 2008, including the 10 most frequently prescribed drugs and the 10 highest-cost drugs between ambulatory settings and retail settings.


Sen. Mitt Romney, R-Utah, introduced legislation last week that he said would bring transparency to drug pricing and help reduce out-of-pocket costs for consumers at the pharmacy.

Some healthcare plans require enrollees to pay coinsurance, or a percentage of the total cost for prescription drugs. But the enrollee's coinsurance obligation is often based on a drug's list price, rather than the price net of rebates and discounts negotiated by pharmacy benefit managers and insurers.

The legislation, which was co-sponsored by Sen. Mike Braun, R-Ind., would require all patients' coinsurance obligations be set as a percentage of net price, rather than list price, before or after a deductible is met.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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