Medicare

HHS’ proposal to ban drug rebates, unless they’re shared directly with seniors at the pharmacy counter, would significantly lower out-of-pocket retail-drug spending for the minority of seniors on expensive drugs, but it would raise premiums for all Medicare beneficiaries.

The Trump administration’s proposal to let exchange plans prohibit some manufacturer drug coupons from counting towards patients’ out-of-pocket cost caps is praised by insurers and generic drug makers as a way to lower consumers’ costs and promote generics, but patient advocates and brand-drug companies say it would increase patients’ costs.

Medicare Advantage plan revenue is expected to increase by about 1.6 percent in 2020 -- a smaller increase than plans received in 2019 -- though that does not take into account rising risk scores or changes to pay based on rebasing the county rates on which MA benchmarks are set, CMS said in a fact sheet on the draft Medicare Advantage and Part D rate notice and call letter.

HHS Deputy Secretary Eric Hargan anticipates implementing physician self-referral, or Stark, law and anti-kickback statute reforms by the end of this year, and one CMS official said the agency has wide flexibility, within the confines of the current law, to make changes to the Stark regulation.

House Energy & Commerce Democrats launched an investigation into rising insulin prices on Wednesday (Jan. 30), one day after two other committees highlighted the plight of diabetics who can’t afford new versions of the drug.

CMS Administrator Seema Verma on Tuesday (Jan. 29) previewed new demonstrations the agency is working on, including rural telehealth and multi-payer demonstrations, and she said the agency has spent the last year developing a way to increase provider participation in value-based care.

CMS Administrator Seema Verma says the agency is taking a closer look at medically necessary dental benefits for Medicare beneficiaries -- coming as beneficiary advocates say CMS already has authority to cover medically necessary oral health care and lawmakers on both sides of Capitol Hill are weighing changes to the statute to establish a Medicare oral health benefit including preventive care.

The Senate Finance Committee kicks off its first hearing on prescription drug pricing Tuesday (Jan. 29), but Sen. John Cornyn (R-TX) already tweeted that a future topic of investigation will be abuses of the rebate system by pharmacy benefit managers -- an announcement that would typically be made by committee chairman Sen. Chuck Grassley (R-IA).

Lobbyists say a BioCentury report Friday (Jan. 25) that the board of the Pharmaceutical Research and Manufacturers of America is considering a cap on drug price increases is correct, but a brand drug lobbyist said it is difficult to determine whether the board will vote to commit its members to such a pledge.