The CBO and JCT estimate that 14 million more people will be uninsured under the American Health Care Act in 2018. Learn more.

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Mar. 17, 2017

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FEATURED STORY
 

Whip It, Whip It Good: Coming Up With the Votes Needed on AHCA

 
 

On Monday, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released their analysis of the American Health Care Act (AHCA), which estimates that 14 million more people would be uninsured under the AHCA than under the Affordable Care Act (ACA) in 2018; this number would further increase to 21 million in 2020 and 24 million in 2026. Federal deficits would be reduced by $337 billion.

The CBO said that the reductions in the number of insured over the 2018-2026 time period would stem mostly from changes in Medicaid enrollment, as some states would discontinue their expansion of eligibility while some states would choose not to expand in the future. By 2026, an estimated 52 million people would be uninsured, compared with the 28 million the CBO estimates would lack insurance that year under current law.

The largest savings in the federal deficits would be from reductions in outlays for Medicaid and from the elimination of the ACA’s subsidies for nongroup health insurance in the exchanges.

The legislation would increase average premiums in the nongroup market before 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders would be 15% to 20% higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.

The Trump administration immediately denounced the budget office’s conclusions. Health and Human Services (HHS) Secretary Tom Price suggested the report offered an incomplete picture because it did not take into account regulatory steps he intends to take, as well as other legislation that Republicans plan as part of their multistep strategy to repeal and replace the ACA.

Democrats immediately used the CBO’s estimates to excoriate the AHCA. “Today’s analysis from the CBO confirms that the Republicans’ repeal bill isn’t a healthcare bill at all. It’s an ideological document with real and incredibly damaging consequences for American families,” said Representative John Yarmuth (D-KY), the ranking Democrat on the House Budget Committee.

The House Energy and Commerce Committee and the House Ways and Means Committee voted approval to the legislation last week, with the bill passing both panels along party lines. Yesterday, the AHCA passed out of the House Budget Committee on a 19-17 vote, with 3 Republican members of the House Freedom Caucus voting against the bill.

Next up? The bill heads to the Rules Committee before it lands on the House floor for consideration. With bipartisan opposition to the bill, it’s unclear if the Republicans have the votes needed to move the bill in its current form to the Senate.

 

AMCP Webinar: Driving Value and Outcomes in Oncology

 
 

Webinar l Wednesday, March 22 | 2:00 PM ET

Kellie Meyer, PharmD, MPH, Senior Director of Global Health Economics, joins a panel of experts for a live webinar discussing the proceedings of a recent AMCP Partnership Forum titled, “Driving Value and Outcomes in Oncology.” Forum stakeholders will share the ideas and concepts discussed at the forum to help sort through a wave of new oncology products coming to market each year. Register now.

 
 

 

 
LEGISLATIVE UPDATE
 

There’s a New Sheriff in Town: Verma Confirmed as CMS Administrator

 
 

On Monday, Vice President Mike Pence's protégé and architect of the Healthy Indiana Plan (HIP) Medicaid program, Seema Verma, was confirmed by the Senate as the new head of the Centers for Medicare & Medicaid Services (CMS). The vote was mostly along party lines.

Verma has 20 years of health policy experience and worked previously as head of SVC, Inc., a national health policy consulting company. Much of her specialization has been in the crafting of Medicaid reforms for Indiana, Iowa, Kentucky, Ohio, Michigan, and Tennessee. Indiana Medicaid operates the first consumer-directed plan. A long-time critic of Medicaid, she explained at her confirmation hearing she believes that low-income people are fully capable of making healthcare decisions based on rational incentives. A common expectation is that she will direct CMS to authorize states to apply more restrictive criteria on Medicaid beneficiaries, such as copayments, premiums, lifetime caps, and documentation of employment-search attempts.

Along with the long-standing conservative proposal of block-granting Medicaid, she is expected to push for termination of all recent Medicaid expansions by 31 states under the ACA. A detailed accounting of Medicare reforms she supports are noted in a 2011 report to which she contributed, titled, “A New Medicaid: A Flexible, Innovative and Accountable Future.”

In her first action in her capacity as CMS head, Verma penned a joint letter with HHS Secretary Pence signaling changes to the Medicaid program that would allow states to impose work requirements, premiums, and copays on some low-income adults receiving Medicaid—and a stronger signal that the new duo is expected to make significant policy changes through their regulatory authority. Additional information on the letter is in a story below.

 

Peek-A-Boo, I See You: Forcing PBMs to Disclose Rebates

 
 

On Wednesday, Senator Ron Wyden (D-OR) introduced a drug-transparency bill that would force pharmacy benefit managers (PBMs) to disclose their rebates.

The Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act (S. 637) would have CMS include on its website the total amount of rebates that PBMs receive from manufacturers and the proportion of those rebates directed to Part D beneficiaries. After 2 years of public reporting, PBMs would have to pass along minimum percentage of rebates and discounts to health plans, which (presumably) would lower premiums or other beneficiary cost-sharing in Medicare Part D.

PBMs have largely escaped the spotlight in the continuing debate over drug pricing; however, their roles of negotiating drug prices with manufacturers, dictating reimbursement prices to dispensing pharmacies, and managing the patient-support programs that manufacturers fund to protect patients from high copays and coinsurance are coming under increasing scrutiny.

PBMs benefit from high launch prices because they have more room negotiating rebates with manufacturers. However, Wyden says the high initial launch prices result in higher cost-sharing from consumers, who may not see their drug costs decrease concomitantly. There are rumors Wyden is seeking support among fellow Democrats for a second bill requiring manufacturers to justify price hikes, but there is nothing concrete yet.

 
REGULATORY UPDATES
 

Walmart Isn’t the Only One With Rollbacks: Feds Look at Medicaid

 
 

On Tuesday, 2 new federal health agency administrators appointed under President Trump sent a letter to state governors advocating for the rollback of the Medicaid expansion championed under Obamacare.

The letter from HHS Secretary Tom Price and CMS Administrator Seema Verma comes as Republican lawmakers are working to build support for legislation that would repeal the ACA, which expanded Medicaid eligibility for millions of uninsured, low-income, childless adults.

The letter did not provide many specifics on how the federal government planned to scale back Medicaid enrollment. But it did call the ACA’s Medicaid expansion “a clear departure from the core, historical mission” of the Medicaid program, which in the past served mainly low-income children, pregnant women, and elderly individuals. The letter said tax dollars should instead be used to help the most vulnerable Americans and encouraged states to switch to private insurance models and to use waivers to encourage Medicaid-eligible, non-disabled adults to enter the workforce.

“By providing a much higher federal reimbursement rate for the expansion population, the ACA provided states with an incentive to deprioritize the most vulnerable populations,” the letter states. “The enhanced rate also puts upward pressure on both state and federal spending.”

The letter further said that HHS would review all managed care regulations, fast-track state requests for waivers and demonstration projects, and delay enforcing the 2014 home and community-based services rule, which mandates that Medicaid beneficiaries at home or in the community receive the same services they would receive in a nursing home or institution.

ACA backers say the statements in the letter made it sound like expansion beneficiaries are not as deserving of coverage as other beneficiaries and signals forthcoming changes to include higher cost-sharing and reduced benefits.

The letter cuts to the core of the current health coverage argument: the role of government (if any) of ensuring all people have access to comprehensive, affordable health coverage.

 

Chutes and Ladders: Former Bush FDA Official Tapped to Lead FDA

 
 

Last Friday, President Donald Trump nominated Scott Gottlieb to be commissioner of the Food and Drug Administration (FDA). Before his health policy consulting career as a resident fellow for the conservative-leaning think tank American Enterprise Institute, Gottlieb served as Deputy Commissioner for the FDA’s Medical and Scientific Affairs for President George W. Bush and held other positions within the FDA and CMS.

Gottlieb is considered the most traditionally qualified of the potential nominees for the role as FDA commissioner Trump was considering. He is on the record for supporting both a deregulatory approach and maintaining that drugs will need to be both safe and effective before being approved by the FDA; however, he will have to answer questions at his confirmation about his partnership at New Enterprise Associates and consulting fees accepted from the pharmaceutical industry.

Get your popcorn ready for the hearings and remember that while the public is cautious of those with ties to the pharmaceutical industry, it also does not want anyone who lacks an understanding of the FDA and the main players.

 

I’m Doing Numbers: 2017 Marketplace Enrollment Numbers

 
 

On Wednesday, HHS released the final 2017 marketplace enrollment numbers, which were below the 2016 marketplace-enrollment figures. According to the 2017 Open Enrollment Period Report, approximately 12.2 million individuals (down from 12.7 million in 2016) enrolled, or were auto-enrolled, into marketplace plans for 2017; this includes the estimated one-third, or 3.8 million, new enrollees for the 2017 benefit year.

This is the first year since the marketplaces opened in 2014 that enrollment has declined from the previous year. However, consistent with previous years, the majority of enrollees opted for silver plans (71% in 2017), and the national average for enrollees receiving advance tax credits was 83% and 58% for cost-sharing reductions. In 10 states, more than 88% of enrollees qualified for advance tax credits.

Additionally for 2017, healthcare.gov reports that, on average, 53% of enrollees switched plans in 2017. Consumer marketplace choice may become challenging in subsequent benefit years as payers consider discontinuing participation in the marketplaces due to losing money because of an increase in higher-risk enrollees and a comparative lack of healthier enrollees.

The Obama administration estimated close to 14 million individuals would sign up for a marketplace plan for 2017, but a withdrawal of consumer outreach efforts following the new administration may have contributed to fewer enrollees signing up for 2017 coverage in the final weeks of open enrollment.

 

Information Buffet (AKA, Other Stuff That Caught Our Attention)

 
 

We kept running into stories we wanted to bring to your attention, so here’s a quick hit list of other news we thought you should know:

  • FDA extends comment period for draft guidance on demonstrating interchangeability with a reference product from March 20 to May 19
  • The increase in drug utilization attributable to Medicare Part D saved lives, according to a study in the Journal of Health Economics
  • The Institute for Clinical and Economic Review (ICER) released an Evidence Report assessing the comparative clinical effectiveness and value of targeted immunomodulatory drugs for the treatment of rheumatoid arthritis (RA)
 

Heading to AMCP? Join Your AmerisourceBergen Colleagues in Denver.

 
 

Join leaders from AmerisourceBergen, US Bioservices, and Xcenda in Denver, Colorado for the 29th Annual AMCP Meeting and Expo.

Stop by booth #513 and learn more about the integrated solutions that will drive success across healthcare delivery. Meet payer marketing professionals and global HEOR consultants and gain insights from experts in specialty pharmacy.

Xcenda also continues excellence in scientific research and proudly presents 5 posters on Tuesday, March 28 and Wednesday, March 29. Learn more about our research on value frameworks, relative vs absolute risk framing, and our insights on FDAMA 114. Read more

 
 

 
HEARD ON THE STREET
 

“I firmly believe that nobody will be worse off financially in the process that we're going through. They'll have choices that they can select the kind of coverage that they want for themselves and for their family, not that the government forces them to buy.”

– HHS Secretary Tom Price, referring to his belief about Americans’ experiences with the AHCA

Source: “HHS Sec. Tom Price: ‘Nobody Will Be Worse Off Financially’ Under GOP Health Plan,” Meet The Press, March 12

 
POLICY BY NUMBERS
 

2 billion

 

The Trump administration budget proposes doubling medical product user fees the same year the Prescription Drug User Fee Act is being negotiated

Source: “America First: A Budget Blueprint to Make America Great Again,” March 16

 
UPCOMING MEETINGS & CONFERENCES
 

AMCP Webinar: Driving Value and Outcomes in Oncology

March 22 l Webinar
Kellie Meyer, PharmD, MPH, Senior Director of Global Health Economics, joins a panel of experts for a live webinar discussing the proceedings of a recent AMCP Partnership Forum titled, “Driving Value and Outcomes in Oncology.” Forum stakeholders will share the ideas and concepts discussed at the forum to help sort through a wave of new oncology products coming to market each year. Register now

 

AMCP 2017 Annual Meeting & Expo

March 27–30 l Denver, CO
Join leaders from AmerisourceBergen, US Bioservices, and Xcenda for the 29th Annual AMCP Meeting & Expo at booth #513. Learn more about the integrated solutions and insights that will drive success across healthcare delivery. Learn more

 

Asembia Specialty Pharmacy Summit 2017

April 30–May 3 l Las Vegas, NV
Join Xcenda at the largest US conference for specialty pharmacy. Matt Sarnes, PharmD, Senior Vice President of Commercial Consulting at Xcenda, will present, “The Future of FDAMA 114—How Will It Impact Access to Specialty Therapies?” Learn more

 
 
 

Count on Health Policy Weekly for an at-a-glance view of legislative and regulatory developments and news that impacts the healthcare industry.

 
 
 
 
 
FEATURED CONTRIBUTORS
 

EDITOR-IN-CHIEF:
Jennifer Snow
Director,
Health Policy
Xcenda

MANAGING EDITOR:
Scott Shields
Associate Director,
Health Policy
Xcenda

 

ADVISORY BOARD:

Peyton Howell, MHA
President | Global Sourcing & Manufacturer Relations | AmerisourceBergen Corporation

Amy Grogg, PharmD
Senior Vice President | Strategy & Commercialization | AmerisourceBergen Specialty Group

Tommy Bramley, PhD, RPh
President | Xcenda

Stacie Heller
Vice President | Government Policy | AmerisourceBergen Corporation

Rita Norton
Senior Vice President | Government and Public Policy | AmerisourceBergen Corporation

Ana Stojanovska
Vice President | Reimbursement & Policy Insights | Xcenda

CONTRIBUTING AUTHORS:

Katherine Bridges Maness | Scott Shields | Jennifer Snow | Aileen Soper | Diane Wilson | Stephen Wilson

PRODUCTION:

Kylie Matthews | Ellen Olson

 

Mar. 17, 2017

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