Health Provisions in House’s $3.5 Trillion Domestic Policy Proposal

House Passes $3.5 Trillion Budget Plan for Vast Expansion of Safety Net -  The New York TimesSource: News Quick24

House Democrats are devising a $3.5 trillion domestic policy package that includes billions of dollars in hospital infrastructure, health manpower, nursing shortages and increased insurance coverage.

The House Energy and Commerce Committees, and Method and Means Committees that share jurisdiction over health spending and programs, passed their bill provisions this week in line with party politics, with the House hoping to pass the full Efficiency Improvement Act recovery “by the end of the month.

“The Committee on Energy and Trade today passed a Transformation Act that invests in the American people, responds to the challenges of our times, and builds a better future for future generations,” said Chairman of the Energy and Trade Council Frank Pallone (DN.J.) in a statement …

Republicans argue it’s too expensive and are frustrated by Democrats who use a process that denies the need for bipartisan support.

In the Senate, Democratic leaders are still working on a package that could win the support of all 50 party members. Senator Joe Manchin, a moderate West Virginia Democrat, is a key voice and has said he will not support the $3.5 trillion bill, which means anything that happens in the House of Representatives could be cut back.

Here are some key messages from the House of Representatives proposals that could impact the healthcare industry:

Infrastructure

In particular, leaders of social welfare hospitals say their facilities are in desperate need of modernization, as they were originally built for small populations.

The Greater New York Hospital Association has demanded at least $100 billion, but only $10 billion was included in a bill passed this week by the Energy and Trade Committee. This funding will be a priority for projects that increase capacity, renovate communities in need, prepare for public health emergencies or natural disasters, and protect against cybersecurity threats.

The bill also includes:

  • * $10 billion in grant funding for federally certified health centers to renovate, renovate, expand, or build facilities.
  • * $500 million to improve, upgrade or modernize the infrastructure of mental health centers and health education centers.

Health workforce

The pandemic highlighted the limited health workforce, especially in rural and underserved parts of the country. There is a shortage of healthcare workers across the country, especially nurses, and the problem is expected to worsen in the coming years as the US population ages.

Bills passed by committees of the House of Representatives include:

  • * A new program that will fund 1,000 scholarships per year for medical students from rural and underserved communities if they agree to practice in these communities after graduation.
  • * 1,000 new residency places per year starting in 2026 for medical schools committed to providing cultural skills training, community learning, and increased mentoring for students.
  • * $1 billion in grants for underserved areas medical schools that can be used to recruit and retain students, including racial and ethnic, underrepresented medical students, rural people, and low-income people. Funding can also be used to develop a curriculum that focuses on caring for rural and underserved populations, building medical schools in areas where they do not exist, hiring teachers, or modernizing or expanding facilities.
  • * $1 billion to increase the number of teachers and students in medical schools with a priority for people from rural areas or underrepresented racial or ethnic groups. Schools providing care in underserved areas will have priority.
  • * $6 billion in training at medical centers to create new postgraduate medical education programs or to maintain or expand existing programs.
  • * $300 million to help pay off loans for Registered Nurses and Advanced Registered Nurses who agree to work in a nursing shortage or teach in a nursing school.

Pandemic preparedness

Public health departments say they have been underfunded by states and the federal government for decades, making it difficult for them to respond to COVID-19. While President Joe Biden has called for at least $30 billion in public health funding, Democrats in Congress, faced with competing priorities, have included about half of that amount.

  • * $16 billion in funding to strengthen the country’s response to the pandemic, including $5 billion to renovate, expand, and modernize state and local public health and CDC laboratories, and $8 billion to replenish strategic national stockpiles and strengthen supply chains …
  • * Of this amount, $1.25 billion will be used to improve and strengthen public health surveillance in hospitals and other healthcare facilities.

Health insurance

After passing the Affordable Care Act in 2010, Democrats lost control of Congress and lost the ability to make any changes to the law. When Democrats regained their Senate and White House majority this year, they pledged to “lean” on the ACA. Bills passed this week:

  • * Continuously expand the Affordable Care Act subsidies for people with incomes of 400% of the federal poverty level or higher, and make subsidies more generous for people on low incomes. In the COVID-19 relief package passed by Congress earlier this year, these changes were only made for two years.
  • * Provide coverage for over 2 million low-income adults in 12 states who have not accepted the Medicaid ACA extension. Initially, these people will be eligible for ACA grants. Beginning in 2025, they will be eligible for a new federal Medicaid-like program that will be run by managed care organizations in non-expanding states.
  • * $10 billion a year in government reinsurance programs to reduce premiums, deductibles, and other personal expenses.
  • * Require states to provide health insurance to prisoners 30 days before they are released.

Maternal and Child Health

According to the Centers for Disease Control and Prevention, black women are three times more likely to die from pregnancy-related causes than white women. Several provisions in bills passed this week address maternal health with a greater focus on inequities in health, including several proposals from Rep. Lauren Underwood, Illinois. The bills will be:

  • * Requires states to give postpartum women 12 months of full Medicaid and Child Health Insurance benefits. Requires states to grant 12 months of continuous entitlement to children enrolled in CHIP, rather than excluding them due to income changes.
  • * Include $1 billion in support of maternal mortality, including grant programs to improve the social determinants of health, diversify the health workforce, tackle mental health and substance use disorders, and reduce discrimination and bias in health care.
  • * Continuously fund the Children’s Health Insurance Program, which currently requires congressional reapproval every few years, sometimes resulting in state funding delays.
  • * Get Medicare coverage for vision, dentistry, and hearing benefits.

Medicines prices

The House Methods and Remedies Committee this week passed a regulation that would allow Medicare to negotiate lower prices for prescription drugs with pharmaceutical companies. The same provision did not pass after three moderate Democrats raised concerns about the potential impact on new drug development. The House of Representatives will need to resolve these differences before voting on the full package of proposals. The nonpartisan Congressional Budget Office estimates that this version of the policy will save the federal government about $450 billion over ten years. Since the House bill is counting on those savings to pay for part of the package, it could ultimately be cut if Democrats don’t come to an agreement on drug prices.

“While I am disappointed that we were unable to move the price negotiations outside of the committee today, lowering the cost of prescription drugs remains a top priority for Democrats,” Pallone said. “The most effective way to curb the skyrocketing drug prices is to finally allow Medicare to negotiate lower prices, and I am confident that this will be part of the final drug improvement bill.”

Moderate Democrats Sink Pelosi’s Aggressive Drug Pricing Bill In Key Committee Vote

Democrats push proxy voting amid coronavirus relief battle - POLITICO

Source: STAT, by Rachel Cohrs

House Speaker Nancy Pelosi’s aggressive drug pricing package failed a key committee vote on Wednesday, prompting questions about whether the measure can survive a full House vote.

Reps. Scott Peters (Calif.), Kurt Schrader (Ore.), and Kathleen Rice (N.Y.), all Democrats, followed through on their threats to vote against the provision in the House Energy and Commerce Committee’s markup. Republicans unanimously opposed the measure, too, leading to a tie vote that means the provision failed to advance to a full House vote.

Before the vote, Peters said he opposed the legislation on the grounds that it would stifle future investment in drug development. He cited a Sept. 8 letter in which over 400 biotechnology investors argued that the Democrats’ bill was “draconian” and would “immediately halt funding of drug discovery and development.”

“This bill can be fixed,” Peters said. “It needs to be. I hope my colleagues on both sides will consider a different approach, one that protects both our patients and our future.”

Peters said he planned to introduce an amendment that would substitute his own bill for House Democrats’ current bill, which would create a dramatically scaled-back Medicare negotiation scheme that applies only to drugs whose market exclusivity has expired, but still lack market competition. And it would have only applied to outpatient drugs, which the committee chairman, Rep. Frank Pallone (D-N.J.), said was not broad enough.

But following Peters’ remarks, Pallone said Peters had agreed to withdraw his amendment without forcing members to vote.

The three Democrats’ votes came despite the fact that they voted to support a nearly identical version of the legislation in December 2019, and again in June 2020. But during his remarks, Schrader called the old bill “a partisan approach,” and said he only supported the old bill “reluctantly.”

Pelosi’s current proposal, Schrader said, is “an unacceptable solution to the high cost of drugs that sets up a vicious cycle of killing jobs and innovation.”

The vote may not stop House leadership from pushing forward with the bill, however, as a separate panel is also marking up the legislation. House Democrats only have a three-vote margin on the House floor, and the vote attracted the attention of House leadership. The drug pricing provision will “remain a cornerstone of the Build Back Better Act as work continues between the House, Senate and White House on the final bill,” Pelosi spokesperson Henry Connelly said in a statement.

Pallone alluded to ongoing negotiations between the House and Senate on drug pricing policy, as Senate Finance Chair Ron Wyden (D-Ore.) said Tuesday that Pelosi’s measure does not have the votes to pass the Senate.

“I do believe that we are going to have a provision in this reconciliation bill with the Senate’s support that will pass that will address drug pricing. And I would really like to have you at the table over the next couple of weeks as we negotiate this,” Pallone said, addressing the three moderate members.

Social Security Works, an advocacy group that supported Pelosi’s proposal, did not hold back in its criticism of the three moderates.

“It is disgusting when politicians who supported Medicare negotiation in the past switch their votes in exchange for pharma cash,” said executive director Alex Lawson.

Peters accepted a flood of campaign cash from drug makers after co-authoring a letter that criticized Pelosi’s drug pricing plan for being partisan. Rice and Schrader also signed that letter, which was sent in May.

The failed vote represents a major win for Republicans, who have long derided Pelosi’s drug pricing bill as “socialist” or as a “government takeover” of health care. In a statement, Rep. Cathy McMorris Rodgers (Wash.), the committee’s top Republican, called the plan “a radical price control scheme” that would lead to less innovation.

Drug makers also took a victory lap Wednesday, as they have opposed Pelosi’s bill for years. The brand drug lobby PhRMA said the vote signals that lawmakers have real concerns with Pelosi’s plan.

“These concerns have been known for months yet they’ve been ignored by House leaders,” said PhRMA Executive Vice President for Public Affairs Debra DeShong.

Companies Move To Mandate Coronavirus Shots As FDA Grants Full Approval To Pfizer Vaccine

Overnight Health Care: FDA grants full approval to Pfizer's COVID-19 vaccine  | TheHill

Source: The Washington Post, by Jena McGregor

A growing number of companies were moving to impose vaccine requirements as the Food and Drug Administration issued full approval of the Pfizer-BioNTech coronavirus vaccine, eliminating one of the central remaining arguments used by the vaccine-hesitant.

CVS Health, Deloitte and Walt Disney Co. said they would add or expand vaccine requirements for workers — while in a sign of increasing vaccine requirements at sporting events, Louisiana State University said Tuesday it will require all spectators at Tiger Stadium over the age of 12 to provide proof of vaccination or a recent negative test.

In taking the new measures, some companies cited the spread of the delta variant as well as the FDA approval, saying it would put more workers at ease with requiring the vaccine.

“We took this step because of the spread of the delta variant and the dramatic rise in cases among the unvaccinated,” Michael DeAngelis, a CVS Health spokesman, said in an email. “However, the FDA approval underscores the vaccine’s safety and effectiveness, and we are pleased that it may help reassure any employees who have been hesitant to get vaccinated.”

CVS Health, which owns a chain of nearly 10,000 retail pharmacies, as well as the health insurer Aetna and pharmacy benefits manager CVS Caremark, said it will require nurses, care managers and all corporate staff to be fully vaccinated by Oct. 31, and all pharmacists working in its retail stores to be vaccinated by Nov. 30.

Deloitte told staff Tuesday it would require employees to be vaccinated by Oct. 11 to access its U.S. facilities, a date it noted in a statement was “seven weeks after full FDA approval of a major vaccine.”

And Walt Disney Co. will require employees who are members of its largest union at Walt Disney World in Florida to be fully vaccinated by Oct. 22, under a deal reached Monday with a union coalition.

Disney’s move came several weeks after it announced a vaccine mandate for all salaried and nonunion hourly employees in the United States.

Eric Clinton, president of Unite Here Local 362, which represents unionized workers at Walt Disney World in Florida, said the union had been negotiating for four weeks. He noted that a majority of the union’s members are already vaccinated, but that “any FDA approval is helpful. Our organization has made no bones about it — we are pro vaccine.” (Disney said it had also reached a deal with the Actors Equity Association Monday and is continuing discussions with other unions.)

Oil and gas company Chevron said in an emailed statement Monday that it is requiring expatriate employees, workers traveling abroad, Gulf of Mexico offshore workers and some onshore support personnel to be vaccinated.

The company said its decision predates the FDA approval.

As the delta variant surged, scuttling workplace reopening plans, a number of employers had already begun to impose vaccine mandates — even before the FDA decision about full approval of the Pfizer vaccine. Google and Facebook announced mandates for certain employees in late July, and meat processor Tyson Foods and United Airlines did so in early August.

Those moves accelerated over the summer as the federal government announced that workers would have to get a coronavirus vaccine or comply with regular testing, mandatory masking and other restrictions.

In remarks made Monday at the White House, President Biden urged companies to increase vaccine requirements.

“If you’re a business leader, a nonprofit leader, a state or local leader who has been waiting for full FDA approval to require vaccinations, I call on you now to do that — require it. Do what I did last month and require your employees to get vaccinated or face strict requirements,” Biden said.

Lawyers and human resources experts who work with businesses said they anticipate that more companies will add mandates in the coming weeks.

“With the full FDA approval, and the president’s comments, that will prompt companies to move those discussions forward,” said Wade Symons, a partner with Mercer. He said he spoke with a client who decided to go “all the way” on a mandate rather than just incentivize workers to get their shots.

“We may not hear today or tomorrow, but within the next couple of weeks,” he said. “These are big weighty decisions that employers need to make, and they’ve been proceeding carefully.”

Full approval may make employers who were considering mandates more comfortable.

“Legally, an employer was allowed to mandate a vaccine even when it was only authorized under the emergency use authorization,” said Sharon Perley Masling, a partner at Morgan Lewis and former senior counsel to a commissioner at the Equal Employment Opportunity Commission.

But she said: “I think there were some employers who were more hesitant to require employees to vaccinate themselves with a vaccine that had not received full approval. … I think this will put those employers at ease.”

Others agreed that more companies will follow suit. “I think it is going to have a meaningful impact,” said Brett Coburn, a labor and employment lawyer with Alston & Bird in Atlanta.

“Some employers may decide [to mandate] for the first time; others may speed it up,” Coburn said.

Employers that still choose not to mandate the vaccine may be doing so out of concern about replacing workers at a time when many industries are scrambling to find staff.

“Which part of your workforce are you going to frustrate: Those who don’t want to get vaccinated or those who want everyone to get vaccinated?” said Brian Kropp, vice president of research at Gartner.

While he expects vaccine mandates to increase, he predicted that most companies still won’t enact them: Employers are evaluating which groups are harder to replace, or more likely to leave, and responding to those workers when thinking through the “calculus” of mandates.

Mandates for hourly workers can be particularly challenging because they often involve large workforces with high turnover rates.

“If they haven’t been vaccinated you have to wait six weeks, and that just doesn’t work when the average tenure is six months” in some industries, he said. “Given how competitive the labor market is, companies don’t want to put any more constraints on themselves when they want to hire.”

The United Food and Commercial Workers union, which represents 1.3 million essential workers in the grocery, retail, pharmacies and meatpacking industries, said Monday it welcomed the FDA’s move, as “a key step to addressing vaccine hesitancy and boosting vaccination efforts.” The union had previously expressed concern about a vaccine mandate at Tyson before full approval.

Some employers said they were not yet changing their policy following the full FDA approval.

Delta Air Lines said in an emailed statement that it will continue to encourage employees to get vaccinated and that its overall workforce vaccination rate is 75 percent. (It is requiring new hires in the U.S. to be vaccinated.)

American Airlines said it will continue to encourage and incentivize vaccinations.

U.S. To Recommend COVID Vaccine Boosters At 8 Months

US to recommend COVID vaccine booster shots for all Americans 8 months  after receiving 2nd shot: Sources - ABC7 Chicago

Source: Associated Press, by Zeke Miller

U.S. health experts are expected to recommend COVID-19 booster shots for all Americans eight months after they get their second dose of the vaccine, to ensure longer-lasting protection as the delta variant spreads across the country.

Federal health officials have been looking at whether extra shots for the vaccinated would be needed as early as this fall, reviewing case numbers in the U.S. as well as the situation in other countries such as Israel, where preliminary studies suggest the vaccine’s protection against serious illness dropped among those vaccinated in January.

An announcement on the U.S. booster recommendation is expected as soon as this week, according to two people familiar with the matter who spoke to The Associated Press on the condition of anonymity to discuss internal deliberations.

Doses would only begin to be administered widely once the Food and Drug Administration formally approves the vaccines, which are being dispensed for now under what is known as emergency use authorization. Full approval of the Pfizer shot is expected in the coming weeks.

Last week, U.S. health officials recommended boosters for some people with weakened immune systems, such as cancer patients and organ transplant recipients, citing their higher risk of catching the virus and evidence that the vaccines’ effectiveness wanes over time.

The director of the National Institutes of Health, Dr. Francis Collins, said Sunday the U.S. could decide in the next couple of weeks whether to offer booster shots to Americans this fall.

Among the first to receive them could be health care workers, nursing home residents and other older Americans, who were some of the first to be vaccinated once the shots were authorized last December.

Since then, more than 198 million Americans have received at least one dose of a COVID-19 vaccine, according to the Centers for Disease Control and Prevention, with more than 168 million fully vaccinated.

Still, the country is experiencing a fourth surge of virus cases as a result of the more contagious delta variant, which is spreading aggressively through unvaccinated communities but is also responsible for an increasing number of “breakthrough infections” of fully vaccinated people.

Israel, which exclusively administered the Pfizer shot, has been offering a booster to people over 60 who were vaccinated more than five months ago in an effort to control its own surge in cases of the delta variant.

On Tuesday, European medical regulators said they are talking with vaccine developers about the need for boosters but haven’t made any decisions.

On Monday, Pfizer and its partner BioNTech announced they submitted data to the FDA to support authorizing a booster shot for the general public. Pfizer said a small study showed people who received a third dose had higher levels of antibodies against several strains of the coronavirus, including the delta variant. The company is working on a larger study, the results of which will soon be submitted to regulators.

Studies show the shot remains highly protective against severe COVID-19, but results released last month suggested the effect wanes about six months after the second dose. Its effectiveness against symptomatic infection dropped gradually, from a peak of 96% two months after study participants got their second dose. Four months later, it was down to 90%, and by six months, it was about 84%.

Americans who received the earliest doses of Pfizer’s vaccine — mainly health care workers and nursing home residents — are approaching the eight-month mark from when they received their second dose.

“There is a concern that the vaccine may start to wane in its effectiveness,” the NIH’s Collins said. “And delta is a nasty one for us to try to deal with. The combination of those two means we may need boosters, maybe beginning first with health care providers, as well as people in nursing homes, and then gradually moving forward” with others.

He said because the variant only started hitting the country hard in July, the next couple of weeks of case data will help the U.S. make a decision.

The Pfizer and Moderna vaccines are administered in two doses. Officials are continuing to collect information as well about the one-shot Johnson & Johnson vaccine, which was only approved in the U.S. in late February, to determine when to recommend boosters.

The White House has said that even though the U.S. has begun sharing more than 110 million vaccine doses with the world, the nation has enough to deliver boosters to Americans.

Global health officials, including the World Health Organization, have called on wealthier and more-vaccinated countries to hold off on booster shots to ensure the supply of first doses for people in the developing world.

Here Are 3 Major Policy Areas That Health Industry Groups Are Closely Watching In $3.5T Infrastructure Bill

Here are 3 major policy areas that health industry groups are closely  watching in $3.5T infrastructure bill | FierceHealthcare

Source: Fierce Healthcare, by Robert King

The Senate is getting into the nitty-gritty of what exactly will be included in a massive $3.5 trillion infrastructure package that seeks to make major reforms to Medicare.

And that means healthcare industry groups are watching very closely.

Democrats have called for the $3.5 trillion package to tackle drug prices and add dental, hearing and vision benefits to Medicare, as well as efforts to expand coverage. But the actual legislation on how to do that will now be crafted by Senate committees and considered by lawmakers when they return from their August recess next month.

Democrats aim to use a procedural pathway called reconciliation that lets budget bills pass the Senate via a simple majority and avoid a legislative filibuster. The Senate took its first step toward creating the package when it approved a budget resolution earlier this week.

Here are some of the major issues several payer and provider groups are keeping an eye on and what they want to include in the final package.

Expanding healthcare coverage

Several provisions in the $3.5 trillion package aim to expand health insurance coverage, but how that can happen is still going to be hammered out.

Payers and provider groups were in favor of making permanent enhanced income-based subsidies for Affordable Care Act (ACA) exchange coverage. The American Rescue Plan Act boosted subsidies but only for the 2021 and 2022 coverage years.

But the ACA enhancements aren’t the only coverage expansions that Congress is mulling.

The framework for the $3.5 trillion package calls for legislation to close the Medicaid coverage gap, which refers to low-income residents that don’t qualify for ACA income-based subsidies but reside in states that didn’t expand Medicaid under the ACA.

Some groups were surprised the issue has gotten so much traction in Congress over the past several months.

“The momentum for that has been pretty impressive,” said Dan Jones, vice president of federal affairs for the Alliance of Community Health Plans (ACHP), which represents nonprofit health plans.

But now committees will decide how the coverage gap gets filled, and some groups are pushing for a quick solution to the issue.

Several Senate Democrats introduced legislation last month that would create a new program resembling Medicaid through which residents in states that didn’t expand the program can get coverage. However, such a program could take a while to set up, said Chip Kahn, president and CEO of the Federation of American Hospitals (FAH).

Kahn instead endorsed a stopgap that would make people in the coverage gap eligible for subsidies on the ACA’s exchanges.

“If we make these people eligible, they would be fully subsidized and have good coverage,” he told Fierce Healthcare.

The additional subsidies could run for a few years and give more states time to expand Medicaid under the ACA, Kahn said. The American Rescue Plan Act did increase the federal matching rate for Medicaid for newly expanded states, but the sweetener hasn’t enticed more states.

“The great opposition to ACA is blowing over to an extent,” he said. “We will have to wait and see how it plays out, but we could find other ways to get those other states to move.”

Finally tackling drug prices, but how?

Senate Democrats signaled that they want to address drug prices in the infrastructure bill, but to what degree remains uncertain.

Progressive lawmakers want to give Medicare broad authority to negotiate for lower drug prices, a desire shared by President Joe Biden. Implementing price negotiation authority could also produce savings that could help pay for the package. But more moderate members could balk at broad negotiation authority.

Some groups see an opportunity to get more bipartisan proposals to be included into the bill.

The advocacy group Campaign for Sustainable Rx Pricing is pushing lawmakers to adopt a series of bipartisan reforms that include capping out-of-pocket drug costs for seniors. The campaign is a coalition of hospital, pharmacy, payer and other provider groups as well as advocacy groups such as AARP.

“We called for action on solutions that have garnered bipartisan support in the past,” said spokesman Jon Conradi in an interview with Fierce Healthcare.

Another potential issue is forcing drugmakers to pay a larger share of coverage in the catastrophic phase in Medicare Part D. Drugmakers now cover 50% of the costs of their products when a beneficiary reaches the catastrophic phase, which is the maximum out-of-pocket limit beneficiaries pay for drugs.

“Now is the time for action,” Conradi said. “There is truly unprecedented momentum for Congress to act on prescription drug prices.”

Ditching the rebate rule for good

Drug price negotiations isn’t the only item Congress has identified as a potential pay-for to help cover the costs of the package.

Several payer groups are hoping Congress also decides to fully repeal a controversial Trump-era rule that eliminates safe harbor protections for Medicare Part D drug rebates and creates a new safe harbor for discounts at the point of sale.

The bipartisan infrastructure package that passed the Senate recently includes a three-year delay in implementing the rule until 2026. The delay netted roughly $50 billion in savings for the package.

Now, payers are hoping to put the final nail in the coffin.

Conradi said the campaign wants the rule to be fully repealed because it can “increase overall drug costs.”

The Pharmaceutical Care Management Association, which represents pharmacy benefit managers, called for a permanent repeal.

“We are encouraged that there is bipartisan support for repealing the Medicare rebate rule, which if allowed to take effect will drastically increase premiums for seniors and other Medicare Part D beneficiaries,” said President and CEO JC Scott in a statement after passage of the bipartisan infrastructure package.

Payer and provider groups are also keeping a watchful eye on any other pay-fors that could be employed as committees start drafting the legislation.

“Any changes to the Medicare Advantage program are things we are paying close attention to,” said Jones of ACHP. “Those are always things that we want to keep a close eye on.”

FAH was disappointed that the bipartisan infrastructure package restarted a 2% sequester cut to Medicare payments next year as a pay-for.

“I don’t anticipate on the hospital front any major changes on the payment side of this bill,” Kahn said. “Until the fat lady sings, you need be wary.”

Biden Calls On Congress To Act On ‘Outrageously’ High Drug Prices

Biden calls on Congress to act on 'outrageously' high drug prices

Source: The Hill, by Peter Sullivan

President Biden on Thursday called on Congress to act to lower the “outrageously” high price of prescription drugs as lawmakers prepare to press forward on the issue.

The presidential backing comes ahead of what is sure to be an intense fight with pharmaceutical companies and Republicans on the issue, with Democrats looking to include drug pricing measures in their coming $3.5 trillion budget package.

“Prescription drug prices are outrageously expensive in America,” Biden said in remarks at the White House, calling on Congress to allow Medicare to negotiate lower prices.

“I look forward to Congress getting this done,” he added. “This is another area we can come together and make a difference in people’s lives.”

Biden outlined policies that largely match what Democrats in Congress are working on. He said Medicare should be able to negotiate lower prices, and those prices should apply to people with private insurance through their jobs as well, not just people on Medicare.

He also appeared to back a feature of House Democrats’ legislation that would impose a steep tax of up to 95 percent if drug companies refused to come to the table and negotiate.

Senate Finance Committee Chairman Ron Wyden (D-Ore.) is working on his own drug pricing legislation, which is expected to be somewhat less far-reaching than the House bill, in a bid to keep moderate Senate Democrats on board, given that Democrats cannot lose a single vote in the Senate.

There had been some doubts as to Biden’s commitment to drug pricing earlier this year when he left it out of his American Families Plan, but the speech on Thursday provided a new jolt of energy to the issue.

Alex Lawson, executive director of the progressive group Social Security Works, used it to warn moderate Democrats not to try to hinder the effort.

“Any Democrat who tries to block or water down drug pricing reform is betraying President Biden and his agenda,” Lawson said in a statement ahead of Biden’s speech. “Worse, they are betraying the American people.”

Senate Democrats said earlier this week that they expected to get “hundreds of billions” in drug pricing savings to help pay for their package, but the exact amount is unclear, in part depending on negotiations among Senate Democrats.

The specifics of Wyden’s legislation remain to be seen, though he has endorsed negotiation in broad terms as well.

Illustrating the fight ahead, the Pharmaceutical Research and Manufacturers of America, a powerful lobbying group, quickly blasted Biden’s remarks on Thursday.

“Unfortunately, the policies the president outlined today would undermine access to life-saving medicines and fails to address an insurance system that shifts the cost of treatments onto vulnerable patients,” said PhRMA CEO Steve Ubl. “Many in Congress know that access to medicine is critical for millions of patients and Medicare is not a piggy bank to be raided to fund other, unrelated government programs.”

Biden pointed to surveys showing 1 in 4 Americans taking prescription drugs struggle to afford them.

“These prices have put the squeeze on too many families and stripped them of their dignity,” he said.

Biden did note that drug companies have received some goodwill and deserve praise for developing COVID-19 vaccines.

But he added: “We can make a distinction between developing these breakthroughs and jacking up prices on a range of medications for a range of everyday diseases and conditions.”

Employers Key To Ending Pandemic: Vaccinations Imperative, Not A Personal Choice

Source: BenefitsPRO, by Scott Conard, Mohannad Kusti, Wayne Rawlins and Stan Schwartz

The US is in the throes of a fourth wave of the pandemic as the delta variant sweeps across the nation, threatening to crush many parts of our country in ways we cannot imagine. We are only beginning to see the escalating consequences: increased infections; hospital ICUs at and over capacity; lifelong and life-changing side effects; deaths that leave behind stunned friends and families; and a tattered economy.

The gamble used to be, “maybe I’ll get it, maybe I won’t.” Predictive modeling shows that those who are not vaccinated will get the delta variant. They may not all get sick and die, but they will eventually be infected and likely infect others. And those at greatest risk in this wave are not just the elderly or those with health conditions as the numbers are rising for the young and healthy.

Physician members of the National Alliance of Healthcare Purchaser Coalitions’ Medical Director Advisory Council agree there are only two things we know will work to combat the surge: complete lockdown and vaccination.

Recent history has proven that lockdowns harm not only our economy, but also our mental health. The National Alliance, along with Total Brain, the American Health Policy Institute and One Mind at Work have been monitoring the effects monthly since the pandemic began. The findings are concerning – the risk of social anxiety disorder among workers in the 40-59 age group is 108% higher than pre-pandemic and 70% of workers’ brain capacity has been impaired to some degree by stress and high risk of mental health conditions. Eye-popping reminders that the pandemic amplified an existing national mental health crisis.

Vaccination continues to be the fastest and most effective course to end the pandemic. With fewer than 50% of Americans fully vaccinated, and many with no plans to get it, we liken the situation to tobacco smoking. While smoking used to be considered a “personal choice,” when research revealed that exposure to secondhand smoke led to hundreds of thousands of deaths and countless serious and life-threatening illnesses, smoking in public places became prohibited by law. Behaviors were changed and lives saved.

Much like endangering others as a smoker is no longer acceptable, COVID-19 vaccinations are imperative to preventing future loss of life, and as such should not be viewed as simply a “personal choice.” While those who have had the COVID-19 virus already may have triggered an immune response for that original virus, the evidence is not clear that that will be sufficient to block the variants that have emerged. The delta variant has raised the stakes for vaccination for all of us, making it critical to maximize protection and prevent spreading it to others. As such and based on the interim recommendation from the Centers for Disease Control and Prevention, it’s also important to wear a mask indoors in public, especially when in an area of high transmission.

Employers play a big role in influencing employees and their families’ health decisions. The dam is finally starting to break as private and public employers in increasing numbers are requiring their employees to get vaccinated. We applaud those taking the courageous and necessary actions to mandate vaccination and mitigation strategies including stringent masking and testing to ensure not only the safety of their workforce, but their customers and communities. We urge more employers and policy makers to quickly do the same.

Biden To Pull The Plug On “Most Favored Nation” Drug Rule

Biden signs executive orders to reverse, pause Trump-era rules | Modern  HealthcareSource: Modern Healthcare, by Michael Brady

Framework For $3.5T Senate Package Seeks To Close Medicaid Gap, Add New Medicare Benefits And Tackle Drug Prices

Framework for $3.5T Senate package seeks to close Medicaid gap, add new  Medicare benefits and tackle drug prices | FierceHealthcare

Source: Fierce Healthcare, by Robert King

Senate Democrats want to give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare and close a Medicaid coverage gap in a new $3.5 trillion infrastructure package.

Democrats unveiled on Monday their budget resolution for the package, the first step to passing the legislation in the Senate.

The budget resolution, set to be considered in the chamber this week, outlines ambitious and long-held Democratic healthcare policies that the final legislation is likely to include.

The policies included in the resolution include:

  • * Adding dental, hearing and vision benefits to Medicare.
  • * Giving Medicare the power to negotiate lower drug prices. Sen. Bernie Sanders, I-Vt., a leading negotiator on the package, tweeted Monday that the savings from drug price negotiations will help pay for other parts of the package such as adding the new benefits to Medicare.
  • * Creating a new federal program to cover Americans who would be eligible for Medicaid if their state had expanded the program under the Affordable Care Act. Several senators have proposed legislation to create a separate, Medicaid-like program to cover these residents.
  • * Making new investments in home and community-based services to “help seniors, persons with disabilities and home care workers,” the resolution said. A roughly $1 trillion bipartisan infrastructure package originally included investments for home care, but that money didn’t make it into the final package to be considered this week.
  • * Extending a boost to ACA income-based subsidies that were included in the American Rescue Plan Act. The boosted subsidies are set to expire after the 2022 coverage year.

Democrats in the House and Senate aim to pass the $3.5 trillion package via reconciliation, a procedural move that allows budget bills to move through the Senate via a simple majority and avoid a legislative filibuster.

Each committee will craft and pass its own part of the package and then the Senate will bundle them together for final passage, which is likely to occur after the nearly monthlong August recess.

The Senate is expected to pass this week a roughly $1 trillion bipartisan infrastructure package that would delay until 2026 a controversial Part D rebate rule and restart Medicare sequester cuts that were on pause during the pandemic.

House Speaker Nancy Pelosi has said that she wants to pass the bipartisan infrastructure package and the $3.5 trillion legislation at the same time.

The hospital advocacy group Federation of American Hospitals praised most of the health proposals, including making the enhanced ACA subsidies permanent and closing the Medicaid gap.

FAH President Chip Kahn said in a statement that the best way to close the Medicaid gap is to build on the ACA and not to create a separate program, as legislation endorsed by several Democrats aims to do.

Kahn also cautioned Democrats against raising the corporate tax rate to help pay for the package.

“Raising the corporate tax rate is the wrong prescription at the wrong time,” he said. “It punishes the very domestic companies still recovering from the ongoing pandemic, and which we count on to grow the economy and create jobs.”

Legislation To Control Drug Prices Advances From Committee To Full Senate

Legislation to control drug prices advances from committee to full Senate |  BenefitsPRO

Source: BenefitsPRO, by Alan Goforth

The U.S. Senate Judiciary Committee in late July voted unanimously to advance four pieces of legislation aimed at reining in prescription drug prices. The legislation, which would enhance the Federal Trade Commission’s ability to initiate enforcement actions against drug companies, now moves to the Senate floor for a vote.

  • * The Stop STALLING Act would give the FTC authority to take action against companies that file sham petitions with the FDA to delay market entry for generics and biosimilars.
  • * The Preserve Access to Affordable Generics and Biosimilars Act would limit “pay-for-delay” deals in which companies compensate generic manufacturers to delay the entrance of their products into the market. Sen. Amy Klobuchar, D-Minn., explained that the bill still would allow companies to pursue agreements but would narrowly target the type of settlement agreements that raise serious competitive concerns.
  • * The Prescription Pricing for the People Act calls on the FTC to examine the pharmaceutical supply chain and determine whether pharmacy benefit managers are engaged in anti-competitive behavior.
  • * The Affordable Prescriptions for Patients Act would curb drug companies’ abuse of patents through “product hopping,” in which companies extend exclusivity by switching patients to a tweaked version of a drug while an older version succumbs to generics.

Proponents said the bills target tactics used by drug companies to extend patent protections and stifle competition from less-expensive generic and biosimilar drugs. Sen. Dick Durbin, D-Ill., who co-sponsored the legislation, specifically mentioned Humira from AbbVie. The drug has 130 patents, 90% of which were obtained after its initial approval, he said.

Eliot Fishman, director of health policy at Families USA, a consumer health care advocacy organization pushing for drug price reforms, lauded the initiative.

“Effective prescription drug reform needs to get prices down and also close off dysfunctional incentives that suppress innovation,” he said. “The Judiciary Committee took a major step to the second part of this agenda. We are optimistic that both Medicare prescription drug negotiation and reforms to patent, pay for delay and PBM abuses will become law in this Congress.”

Sen. Chris Coons, D-Del. cautioned against lumping all pharmaceutical companies together.

“I agree with the general proposition across these four bills,” he said. “But I also am concerned that we continue to protect the patent system itself. Overly aggressive use of the tools created in this legislation could sweep up good actors as well as bad actors and could have unintended negative consequences.”

Last Updated 09/22/2021

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