President Trump’s address to Congress calls for the repeal and replacement of the ACA.

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Mar. 3, 2017

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FEATURED STORY
 

This Time With Feeling. Trump Renews Call for ACA Repeal and Replace

 
 

In his address to a joint session of Congress on Tuesday, President Donald Trump reiterated his wish to see the Affordable Care Act (ACA) repealed and replaced. He outlined reforms that would, in his words, expand choice, increase access, and lower costs while improving healthcare.

Trump stated that mandating every American to buy government-approved health insurance was not the solution, and lowering costs was a better avenue to make health insurance available to everyone. He did not provide details for the Republican plan but described 5 principles to guide Congress as it moves forward:

  • Ensure that Americans with pre-existing conditions have access to coverage and provide a stable transition for those enrolled in the exchanges
  • Help Americans purchase their own coverage through tax credits and expanded health savings accounts
  • Provide state governors the resources and flexibility they need with Medicaid
  • Implement legal reforms to protect patients and doctors from unnecessary costs that drive up insurance premiums
  • Give Americans the freedom to purchase health insurance across state lines

At this point, the process and timeline are either fluid or chaotic, depending on your perspective. The secretive nature of the House Republicans’ deliberations is frustrating not only Democrats but also some Republicans. Given other Congressional priorities (ie, addressing the continuing resolution to fund the government during the first week in April and the President’s nomination for the Supreme Court, Neil Gorsuch, by the end of April), a bill likely needs to be passed by the end of March. Given the division in the Republican caucuses on approaches to ACA repeal and replace, and this week’s “hide and seek” for the most current House-backed bill, it seems unlikely Republicans will come to some kind of agreement in that time frame—remember the ACA came together over 14 months—but we’ve learned to expect the unexpected.

 

18th Annual Patient Assistance and Access Programs Conference

 
 

March 16–17 | Baltimore, MD

Each year, CBI’s Patient Assistance and Access Programs Conference brings together hundreds of key industry stakeholders who are all focused on improving patient access to care. This is an invaluable forum to hear from the top minds in healthcare on the latest developments and innovations that help ensure access to treatment for patients.
 
At PAP 2017, Lash Group’s Christina Knight, Director of Product Management, and Amy Jones, Director of Product Strategy, will co-present on innovations in healthcare technology that lead to an enhanced experience for both patients and providers. Join us at this important event where we pave a new path forward for meaningful and effective patient support services. Learn more

 
 

 

 
LEGISLATIVE UPDATE
 

California Bill Would Ban Manufacturer Coupon/Copay Programs

 
 

California recently introduced a bill that would ban manufacturers from offering drug discounts. Proponents argue this authority is needed to counteract coupon practices they believe ultimately drive up the cost of prescription medications.

The proposed measure, A.265, would prohibit “any discount, rebate, product voucher, or other reduction in an individual’s out-of-pocket expenses, including, but not limited to, a copayment or deductible, for any prescription drug if a lower cost brand name or nonbrand name prescription drug is available” that is “therapeutically equivalent to, or interchangeable with, the prescription drug.” Similar proposals are being considered in New Jersey with S.2769 and New Hampshire with H.443.

A.265 has been referred to the Assembly Committee on Health.

As expected, the bill has met criticism from the Pharmaceutical Research and Manufacturers of America (PhRMA) and the California Life Sciences Association (CLSA). While the Centers for Medicare & Medicaid Services (CMS) and commercial payers oppose such drug-discount programs, it may be difficult to garner public support for the bill because many see the programs as beneficial.

 

More State Action: Drug-Pricing Transparency Proposed in PA

 
 

Another bill calling for pharmaceutical cost transparency is now being considered, this time in the Keystone State. If successful, Pennsylvania would join a growing number of states attempting to utilize cost transparency as a tool to manage drug prices.

State bill H.161 would require manufacturers to disclose certain pricing-related information if the drug’s average wholesale price (AWP) is deemed excessively costly or has rapid increases in cost; specifically, if the AWP exceeds $5,000 annually or $5,000 per course of treatment, or increases greater than 50% over 5 years or more than 25% over 12 months. Any of these cost scenarios would trigger the requirement for manufacturers to release cost-related details of the drug, such as research and development and clinical trials costs, patents and licensing costs and coupons, discounts, and other financial assistance given to patients under assistance programs.

Pennsylvania’s H.161 has been referred to the House Committee on Insurance.

As discussed in the June 3, 2016 issue of Health Policy Weekly, Vermont became the first state to require pharmaceutical manufacturers to publicly disclose factors when drugs had significant pricing increases. A similar bill, H.326, is being reviewed by the Montana Legislature, while S.1010 failed to pass the California State Assembly late last year.

PhRMA and Biotechnology Innovation Organization (BIO) oppose cost transparency, having submitted statements (PhRMA, BIO) in opposition to a similar bill in Oregon in 2015 in which they noted that such legislation does not recognize the cost savings pharmaceuticals bring to the healthcare system, jeopardizes the competitive market, and removes incentives for manufacturers to provide discounts and additional rebates.

To date, there is no evidence that forcing a manufacturer to be more transparent results in lower drug prices. Nevertheless, the approach has surface-level appeal to those not steeped in the intricacies of drug development. And, because of that appeal, Pennsylvania joins the ranks of some 65 (and counting) state-led legislative initiatives introduced this year to address drug pricing.

 
REGULATORY UPDATES
 

Stabilizing the Situation: Trump Meets With Health Insurance CEOs

 
 

On Monday, President Trump led a listening session with the CEOs from some of the largest health insurance companies in the US, including Aetna, Humana, Kaiser Permanente, Cigna, Anthem, and UnitedHealth Group. Trump spoke about how “Obamacare has been a disaster,” citing increased premiums and limited plan options as examples of the issues with the ACA. Trump said to the industry leaders, “I’m asking Secretary Price to work with you to stabilize the insurance markets and to ensure a smooth transition to the new plan.” More specifically, Trump mentioned expanding healthcare savings accounts, increasing state flexibility, and allowing plans to be sold across state lines as reforms included in the new plan.

After the meeting, the America’s Health Insurance Plans (AHIP) issued a statement to show their appreciation for the meeting and their commitment to working with the Administration to improve healthcare in the US.

Although the listening session seemed to go well, with a few attendees stating they appreciated Trump taking steps to stabilize the market, it is difficult to predict how “stabilizing the market” will play out in the coming months considering the constantly changing political atmosphere. It is unclear why an insurance company would stay in a market without clear indications of potential gains and a lot of opportunity cost.

 

Latest Report: Exchange Plans Topping the Charts in Drug Spending

 
 

A new report by Express Scripts highlights a downward trend in prescription utilization and unit cost from 2015 to 2016 and emphasizes significant spending differences among payer types.

Prescription drug spending growth in the ACA’s health insurance marketplaces vastly outpaced spending by employer health plans, Medicare, and Medicaid in 2016. On average, per-person spending on prescription drugs for the exchange population rose 14%.

Comparatively, per-person drug spending by employer plans saw a dramatic 27% decrease year over year. According to Express Scripts, commercially insured members with plans managed by the pharmacy benefit manager experienced a decrease in the total share of pharmacy costs, despite using more prescriptions over the past 2 years.

In regard to Medicaid, the increase in per-member drug spending for 2016 was 5.5%. In addition, Medicaid managed care plans continued cost-containment measures such as utilization management, a diverse set of benefit designs, and formulary-administration techniques.

Medicare Part D plans experienced a 4.1% increase in year-over-year prescription drug spending for 2016. It is worth noting there are CMS-imposed requirements that limit mechanisms Part D plans can employ to further drive down costs, such as needing to cover all drugs in 6 protected classes. The annual spending for beneficiaries enrolled in Medicare Advantage (MA) was nearly half that of those enrolled in prescription drug plans (PDPs). On average, MA beneficiaries spent $2,600, while PDP beneficiaries spent $5,500.

The ability of commercial plans as compared to Part D plans to restrain drug spending may increase the pressure for CMS to again consider changes to the Part D program. Several years ago, CMS withdrew a proposed rule that would have implemented multiple Part D changes (eg, removal of certain protected classes) after a storm of protest. But these data may provide the ammunition necessary to enact such changes to the Part D program.

 

Adapting to ACA Uncertainty: The Future of Patient Support Programs

 
 

March 16–17 | Baltimore, MD

Join Xcenda’s Corey Ford, MHA, and Jennifer Johnson, MS, both Associate Directors of Reimbursement & Policy Insights, as they present a timely and very relevant session at the upcoming CBI Patient Assistance and Access Programs (PAP) Conference in Baltimore, MD.

Mr. Ford and Ms. Johnson will discuss the future of the ACA and its likely repeal or replacement by the current Administration. They will also provide insight on the impact to both patient access and patient support programs, as well as identify areas of consideration to facilitate patient access in this time of change.

 
 

 

 
HEARD ON THE STREET
 

“I have to tell you, it’s an unbelievably complex subject. Nobody knew that healthcare could be so complicated.”

– President Donald Trump, in remarks to the National Governors Association, February 27

 
 
POLICY BY NUMBERS
 

100 Hours

 

Democrats have criticized the ACA repeal-and-replace process, noting that the legislation has not been evaluated publicly by outside policy experts or given a Congressional Budget Office score. They contrasted that with how the ACA was originally debated in 2009, which included more than 100 hours of hearings across 3 House committees before heading to markup.

Source: Letter from House Ways and Means Committee Democrats to Kevin Brady (R-TX), House Committee on Ways and Means Chair, March 2

 
UPCOMING MEETINGS & CONFERENCES
 

AHIP National Health Policy Conference

March 8–9 l Washington DC
Join Xcenda’s Amanda Forys, MSPH, Director of Reimbursement Policy Insights, as she presents a breakfast briefing at this year’s AHIP National Health Policy Conference in Washington DC. Ms. Forys’ session titled, “Biosimilars: Policy and Reimbursement Considerations for a New Market,” will provide insights on key policy and reimbursement issues in the biosimilar marketplace. She will discuss recent FDA guidance, biosimilar naming, interchangeability, and more. Learn more

 

CBI 18th Annual Patient Assistance and Access Programs

March 16–17 l Baltimore, MD
Join AmerisourceBergen companies, Lash Group and Xcenda, at the premier conference for patient assistance and access programs. Tracy Foster, President of Lash Group, presents the keynote address titled, “Serving Patients Through the Power of Partnership.” In addition, Lash Group’s Christina Knight and Amy Jones will present, “Optimizing Reimbursement Support Programs with Electronic Benefit Verification (eBV).” Xcenda’s Corey Ford and Jennifer Johnson, both Associate Directors of Reimbursement & Policy Insights, will present a session titled, “Adapting to ACA Uncertainty: The Future of Patient Support Programs.” Learn more

 

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

Loreen Brown, LMSW
Senior Vice President | Product, Strategy & Commercialization Excellence | Lash 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:

Jennifer Le | Scott Shields | Debbie Stanton | Stephen Wilson 

PRODUCTION:

Laurie Kozbelt | Ellen Olson

 

Mar. 3, 2017

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