Healthcare Today | September 22, 2023

House Energy and Commerce holds legislative hearing on Medicare innovation. On Tuesday, legislators from the House Energy and Commerce Subcommittee on Health held a legislative hearing considering potential policies to help seniors gain access to new medical drugs and enable more coverage of diagnostic treatments to potentially lower costs. The committee addressed dozens of measures, including H.R. 5393, the Transparency and Fairness for Pharmacies Act to address Medicare contracts between PBMs and pharmacies, as well as legislation to allow Medicare to cover obesity drugs and bills on transitional coverage for breakthrough devices and other aspects of national coverage determinations.

House Energy and Commerce holds hearing on oversight of the IRA. On Wednesday, the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations held a hearing to investigate the IRA’s price-setting practices and the effect that the law has had on access to care for patients. Witnesses included a Professor of Medicine at Harvard Medical School, the Chair of the Drug Development Council, International Cancer, among others. House GOP Members argued that CMS’s implementation of the Drug Price Negotiation Program established by the IRA will result in fewer lifesaving cures and treatments and increase negative outcomes for patients with serious long-term illnesses.

PBMs caught in the middle of bipartisan criticism. On Tuesday, the House Oversight and Accountability Committee held their second hearing looking into pharmacy benefit managers (PBMs) and their role in the healthcare industry. Pharmaceutical Care Management Association (PCMA) President and CEO J.C. Scott appeared as a witness and was subjected to sustained questioning into PBM practices. Members from both sides expressed concern that three PBMs have monopolized the market and that the current system incentivizes them to engage in anticompetitive practices and will often lean towards self-benefit over service to patients. Chairman Comer (R-KY) committed to continue “shining a light” on PBMs.

Senate Finance holds hearing on state of CMS Home Health Program. On Tuesday, the Senate Finance Subcommittee on Health held a hearing on at-home health services for elderly Americans. The hearing focused on Medicare's Home Health program and witnesses testified on a gradual decline of CMS reimbursement and quality of care nationwide. Almost all witnesses stated support for S.2137 Preserving Access to Home Health Act of 2023, while others recommended increased CMS reimbursements for rural providers to prevent closures and lengthy referral processes. Senator Maggie Hassan (D-NH) also discussed CMS' limited definitions for eligible reimbursement towards mobility equipment for elderly Americans.

House Ways & Means Committee holds hearing on the fallout of No Surprises Act implementation. On Tuesday, the House Committee on Ways & Means held a hearing to examine the implementation of surprise medical billing protections. Members on both sides agreed that the implementation of the NSA has had unintended consequences, including a large backlog of cases currently in holding patterns with independent dispute resolution entities (IDR’s), and a pattern of large insurers opting out of network coverage for regional hospitals which has resulted in significantly reduced payments to providers.

Senate HELP passes Primary Care and Health Workforce Act out of committee. On Thursday, the Senate HELP committee marked up the Bipartisan Primary Care and Health Workforce Act and reported it favorably out of committee with the support of all Democrats and Republican Senators Murkowski, Braun, and Marshall. Ranking Member Cassidy led a group of GOP Senators who expressed concerns about how the bill we be paid for. The bill was voted out of committee by a vote of 14-7.

House Republicans release belated balanced-budget blueprint. Earlier this week, House Republicans released their federal budget plan Tuesday and advanced it out of committee with no amendments on a party-line vote Wednesday. Republicans purport that the measure will balance the budget over the next decade, saying that the total amount saved would be more than $16 trillion. Of interest in the budget resolution are SNAP work requirements for able-bodied recipients, work requirements for Medicaid, and lowering the federal share of healthcare services paid to states.

Lower Costs, More Transparency Act removed from House floor vote. With the bill set to be voted on Monday evening, the Lower Costs, More Transparency Act was removed from the suspension calendar late Monday afternoon. The bipartisan bill would require healthcare providers and insurers to publicly disclose the prices for services and would require pharmacy benefit managers to give detailed information on their prescription drug spending to employers.  There is as yet no public explanation for the last-minute removal.

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