House Passes Insulin Bill Over Insurers’ Opposition

House passes insulin bill over insurers' opposition - POLITICO

Source: Politico, by Alice Miranda Ollstein and Megan Wilson

The House voted Thursday in favor of a bill to cap out-of-pocket costs on insulin at $35 a month, a policy Democrats hope will give them a concrete win to campaign on when they face voters in November as the rest of their health care agenda remains stalled.

“At the end of the day, I hope that we can still bring forward a reconciliation bill with additional reforms this year. I know we need to do Medicare drug price negotiation,” Rep. Angie Craig (D-Minn.), the lead sponsor of the insulin bill, told POLITICO. “But we can’t wait any longer to act on insulin.”

Despite concerns about the bill’s policy and strategy from both sides of the aisle, nearly all House Democrats as well as a dozen Republicans voted for it Thursday. Yet it faces slim odds in the Senate, where Democratic leaders are combining an out-of-pocket cap on insulin — led by vulnerable Sen. Raphael Warnock (D-Ga.) — with a still-in-the-works bipartisan bill from Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) to cut the drug’s cost.

The insurance industry tried to persuade lawmakers to oppose the measure, arguing it does not lower the actual price of insulin and could lead to higher premiums.

One insurance industry source close to the negotiations told POLITICO they’ve stressed that the bill “lets pharma off the hook,” calling it a “giveaway” to the drug industry.

“The premium impact is going to be substantial, and this isn’t the way to address the high cost of insulin,” said the lobbyist, who was granted anonymity to speak candidly about the process. “But all these Democrats want this win.”

America’s Health Insurance Plans, the trade association for insurers, wants Congress to target the pharmaceutical industry’s price-setting power instead of simply shielding patients from it. While the Shaheen-Collins bill in the Senate aims to do so, its details haven’t yet been released.

“Insulin prices are too high because Big Pharma alone sets and controls the price,” AHIP spokesperson David Allen said in a statement to POLITICO. “This legislation continues to empower Big Pharma to raise insulin prices with impunity leaving patients, businesses, and hardworking taxpayers paying even more for health care.”

Brian Newell, a spokesperson for PhRMA, drugmakers’ leading lobbying group, told POLITICO that, while they aren’t officially taking a position on the bill, they see it as “one way to help patients at the pharmacy counter” but believe that a more “holistic solution” that also reforms the drug rebate system is also needed.

“No amount of spin by the insurance industry changes the fact that they determine what patients pay at the pharmacy,” he added. “It’s outrageous that insurance companies are forcing patients to pay more for medicines than what insurance companies pay.”

More than a half-dozen pharmaceutical lobbyists told POLITICO that the industry has not been lobbying on the bill, saying the insurance industry is doing more to oppose the bill than drugmakers are doing to support it.

While some Democrats don’t view the insurance industry’s complaints about the bill as credible given their financial stake in the matter, others say they understand the concerns, though they ultimately voted for the measure.

“We aren’t putting that burden on Big Pharma, and I don’t blame [the insurers] for being upset about that,” Rep. Susan Wild (D-Pa.) told POLITICO, adding that she talked “at length” with insurance companies and agreed that the bill’s “big flaw”is how it changes who pays for insulin but doesn’t lower its cost.

Still, she countered, “It’s a matter of do we help people who are literally dying or rationing their insulin? … I have a greater concern for patients and for people in that position.”

Republicans largely lined up against the insulin bill during Wednesday’s House Rules Committee hearing. Some GOP members compared the price cap to President Jimmy Carter’s cap on the price of gasoline and claimed it would trigger similar shortages and long lines for the drug. Other Republicans said the policy would encourage U.S. pharmaceutical companies to relocate to China.

Rep. Michael Burgess (R-Texas) criticized Democrats for using the repeal of the Trump administration’s drug rebate rule —which was never implemented — as a funding mechanism.

“Those are made-up dollars. Those are not real dollars,” he said, calling it a “budgetary gimmick.”

Other GOP members on the panel pointed to a Congressional Budget Office analysis released Wednesday that appeared to back up insurers’ arguments. The CBO predicts the measure would cost the federal government more than $6 billion over a decade because it would likely force insurers to raise premiums. That would increase government subsidies paid through the Affordable Care Act and decrease income tax revenue because workers would spend more of their wages on their employers’ health plans.

Eli Lilly, one of the country’s leading insulin makers, “has long advocated for solutions to limit out-of-pocket costs on insulin,” said Shawn O’Neail, the vice president of their global government affairs division. But the company notes it hasn’t endorsed the bill.

Though the legislation easily passed the House on Thursday, it will be a much heavier lift in the Senate, where it needs support from at least 10 Republicans and all 50 Democrats. Though Warnock told POLITICO on Wednesday that he’s hearing “bipartisan interest in capping the cost of insulin,” no Republicans other than Collins have signed onto the effort, and multiple lobbyists said they don’t think it will garner enough Republican support to reach the 60-vote threshold in the upper chamber.

Still, Democrats believe those who oppose it will pay a political price in November.

“If my Republican colleagues don’t support it, I hope my voters back home see right through that,” Craig said. “You can make the case for voting against a big reconciliation bill, that you opposed this or that individual provision, but when it’s a standalone bill like this, there’s nowhere to hide.”

Bill Would Make Home Medicare Program Permanent

Compassion & Choices praised the introduction of Independence at Home Act of 2016 (S. 3130). The bill would convert the Affordable Care Act’s home care pilot program into a permanent, national Medicare program. Under the Independence at Home program, patients with debilitating diseases get primary care at home from coordinated teams of doctors, caregivers, and other healthcare professionals. The program reduces avoidable emergency room visits, hospitalizations, and re-admissions. Mark Dann, federal affairs director for Compassion & Choices said, “A great benefit of providing care in a person’s home is advance care planning conversations seem to happen naturally more often and can be updated as their illness progresses and their care wishes change. If an individual ends up in the hospital, but did not want to be there, the whole team is aware of these wishes and can attempt to quickly correct the situation.”

H.R.5659 Would Open Medicare Advantage to End-Stage Renal Patients

Dialysis Patient Citizens (DPC) hailed the introduction of H.R. 5659 as the latest milestone toward opening Medicare Advantage enrollment to end-stage renal disease (ESRD) patients. Stephen Anderson, a patient advocate from Indianapolis said, “As a dialysis patient of five years, I am fortunate to have secondary insurance to cover what Medicare does not. However, I know many patients in my facility don’t have that luxury. Providing dialysis patients access to Medicare Advantage will greatly help to reduce our out-of-pocket costs while improving our health with care coordination measures,” said. A study comparing outcomes of dialysis patients grandfathered into Medicare Advantage plans found that they have lower mortality rates than id their peers in fee-for-service plans. For more information, visit dialysispatients.org.

Bill Would Eliminate Medicare Advocacy Services

The Senate Appropriations Committee recently approved the FY17 Labor, HHS, Education Appropriations bill, which would eliminate funding for the State Health Insurance Assistance Program (SHIP). It’s called the Health Insurance Counseling and Advocacy Program (HICAP) in California. It is the only program that provides free, unbiased, one-on-one Medicare coverage and benefit counseling for beneficiaries, family members, and caregivers. According to California Health Advocates, “This dangerous bill aims to eliminate this important, effective program that helps millions of beneficiaries nationwide better understand and navigate the increasingly complex Medicare program.”

Bill Targets Pharma Tactics to Delay Generics

The Senate Judiciary Subcommittee held a hearing on S. 3056, the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act. The bill would allow generic-drug companies to bring actions in federal court to get the drug samples they need to develop generic versions of brand drugs. It would authorize judges to award damages. Proponents say that the bill would prevent brand drug manufacturers from abusing risk evaluation and mitigation strategies to block generic competition. It would encourage more development of generic and biosimilar drugs and reduce drug costs. “This legislation will help bring generics to market faster, which is key to reducing drug costs,” said Pharmaceutical Care Management Association (PCMA) president and CEO Mark Merritt.

The bipartisan legislation was introduced by Senators Charles Grassley (R-IA), Patrick Leahy (D-VT), Amy Klobuchar (D-MN), and Mike Lee (R-UT). The legislation is supported by a broad group of stakeholders, including the Generic Pharmaceutical Association, the Academy of Managed Care Pharmacy, Public Citizen, Consumers Union, and the Blue Cross Blue Shield Assn. PCMA also suggests these solutions to bring down drug prices:

  • Accelerate FDA approvals of drugs that face little or no competition.
  • Make copay coupons an illegal kickback for all insurance that receives any federal subsidy.
  • Modernize the Medicaid pharmacy to make it more like the commercial market and Medicare Part D.
  • Create new incentives for physicians to prescribe biosimilars.

Bill Offers Alternative to Obamacare

A health plan introduced by two Republicans promises to make good on what it calls ObamaCare’s three broken promises: universal coverage, cost control, and protection for the chronically ill. Yet the proposal spends no more money than the current system and it repeals almost all of ObamaCare’s regulations. Pete Sessions (R-TX), Chairman of the House Rules Committee and one of the sponsors of the legislation said, “ObamaCare tries to tell everyone what to do – every doctor, every patient, every employer and every employee. Our goal is to liberate people by empowering them to make their own choices and by freeing the marketplace to meet their needs.” The Senate version of the bill has been introduced by Sen. Bill Cassidy (R-LA).

The centerpiece of the proposal is a health insurance tax credit that applies dollar-to-dollar to insurance premiums and deposits to Health Savings Accounts. The credit will be the same for everyone, regardless of income. The tax credit sets a floor under the insurance people will have. Everyone will have access to insurance that looks a lot like well-managed, privately administered Medicaid, said John Goodman, a health economist who helped prepare the plan. People will have more options if they and their employers spend additional money – but those dollars will be unsubsidized.

The sponsors say the plan gives employers and employees new tools to control costs and that they will be able to convert waste, fraud and abuse into higher take-home pay by being smarter buyers of health care. Also, because of free market risk adjustment, health plans will specialize in the treatment of chronic conditions and will compete to solve those problems. The Sessions/Cassidy proposal is the freest enterprise reform ever introduced in the U.S. Congress, said Goodman. It minimizes and streamlines the role of the federal government and eliminates perverse incentives caused by federal tax and spending policies and unwise regulations. Even though introduced by Republicans, Goodman says there is much in the bill that Democrats will like. It has a much better chance of actually becoming law than any Republican proposal that I have seen so far. Goodman is the author of A Better Choice: Healthcare Solutions for America, the source of many of the provisions in the plan.

Bill Aims to Protect Consumers Amid Health Care Mergers

This week, the Senate Health Committee will hear S.B. 932 (Hernandez). The bill would require state regulators to scrutinize proposed health industry consolidations to ensure that they are in the interest of consumers. The public would have opportunities to offer comment and feedback on the deals. The bill would prevent hospitals from making anti-competitive demands when negotiating with health plans and insurers. Hospitals, especially those with a large market share, would not be allowed to insist on contract provisions that result in them being the only option for care.

This bill has been introduced in the midst of a wave of pending health care mergers in California. Two of four major health insurance mergers have been finalized: Blue Shield of California acquired Care1st last year, and Centene’s proposal to acquire Health Net was approved with conditions by state regulators last month. Two other health insurance mergers are still pending, Aetna-Humana and Anthem-Cigna. Other hospital and health mergers have also taken place, including the Daughters of Charity Health System purchase by an investment firm in 2015.

Anthony Wright, executive director of Health Access California said, “Health industry mergers have led to price increases, less choice, and greater consolidation. Companies…almost always say that the merger will lead to efficiencies and savings, but they rarely…pass those [savings] to consumers, if [the savings] ever actually materialize. Companies that want to merge need to show that the merger causes no harm to consumers, and that consumers will actually benefit. Some of these health mergers are required to face public hearings and scrutiny while others fly under the radar. It’s time to set a clear standard of…oversight for all these deals that have such a profound impact on the health system.”

Bill Would Prevent Over-Prescribing

A California bill would require doctors to check California’s prescription drug database before prescribing opiates. The Controlled Substance Utilization Review and Evaluation System (CURES) is the nation’s most advanced prescription drug monitoring program, but just 35% of California providers and dispensers use it. Carmen Balber, executive director of Consumer Watchdogs said, “California loses 4,500 people a year to preventable drug overdoses–more than any other state….The legislature can help…by requiring doctors to check the prescription database before recommending patients take the most dangerous and addictive drugs. It’s clear that making use of the database voluntary does not work.”

SB 482, by California state Senator Ricardo Lara, would require doctors to check California’s CURES database when prescribing Schedule II or III drugs like Oxycontin to a patient for the first time, and annually thereafter if the treatment continues. The Centers for Disease Control and Prevention issued new prescribing guidelines that recommend doctors use prescription drug databases every time they prescribe an opioid. Last month, president Obama proposed $1.2 billion in new federal funding to fight opioid abuse, including funds to expand the use of state prescription drug databases.

Twenty-two states mandate use of a state prescription database. States that track results have seen reduced doctor-shopping and lower opioid prescription rates. Also doctors say that the databases are useful to them in prescribing the right medications. The following states have seen improvements after mandating the use of a database:

  • New York saw a 75% drop in patients seeing multiple prescribers for the same drugs.
  • Kentucky found that opioid prescriptions to doctor-shopping individuals fell 54%. Also, overdose-related deaths declined for the first time in six years in 2013.
  • Tennessee saw a 36% drop in patients who were seeing multiple prescribers to get the same drugs. Tennessee prescribers say they are 41% less likely to prescribe controlled substances after checking the database, and 34% more likely to refer a patient for substance abuse treatment. Also, 86% of prescribers say the database is useful for decreasing doctor shopping.

Governor Signs Disability Policy Bill

Governor Brown signed Assembly Bill 387 into law. It will improve the department’s ability to review and approve disability policy filings more effectively and completely in the specified timeframe. The law extends the period from 30 to 120 calendar days for the department to review and approve policy forms and any associated risks and premium rates. The bill was authored by Assembly Member Kevin McCarty and co-sponsored by Insurance Commissioner Dave Jones. The new law authorizes the Commissioner to develop and publish new guidelines on the department’s public website to expedite the department’s file review process for life and disability insurance forms. It will provide clear guidelines for insurers to follow when submitting policies for approval. AB 387 reflects an agreement between the California Department of Insurance and the Association of California Life and Health Insurance Companies.

Assisted Suicide Is Now Legal in California

Gov. Jerry Brown signed a bill allowing physician-assisted suicide. The California law will permit physicians to provide lethal prescriptions to mentally competent adults who have been diagnosed with a terminal illness and are expected to die within six months.  The law will take effect 90 days after the legislature adjourns its special session on healthcare, which would be some time from January to November.

Last Updated 06/29/2022

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