Medicare

The White House Council of Economic Advisers says falling out-of-pocket prices for opioids could explain between 31% and 83% of the growth in opioid overdose deaths between 2001 and 2010, and the council’s report tied that drop in costs to more government subsidization of the drugs through Medicare Part D and the entry of generics in the market.

Progressive Caucus Co-Chair Rep. Pramila Jayapal (D-WA) said Tuesday (April 30) that progressives told Ways & Means Chair Richard Neal (D-MA) and Energy & Commerce Chair Frank Pallone (D-NJ) that progressives would not support a Medicare price negotiation proposal with arbitration as a mechanism instead of direct negotiation.

Conservative lawmakers, media, think tanks and pundits are split on the Trump administration’s proposed rule that would shift Medicare drug rebates to the point of sale.

S&P analysts conclude that health care legislation addressing surprise billing and anti-competitive pharmaceutical practices have a high chance of passing prior to the 2020 elections, but that a repeal of the Affordable Care Act, a transition to Medicare For All and aggressive drug-pricing reforms are unlikely to be implemented in the new few years.

Progressives and Medicare for All advocates warn that proposals allowing people to opt into Medicare or Medicaid could end up attracting primarily sick and older Americans, thus skewing the risk pools and raising costs for everyone.

Congressional Democrats and Republicans are considering delaying the Trump administration’s proposed ban of point-of-sale rebates and using savings from the delay to pay for other legislative priorities, sources said.

A day in advance of a meeting between progressives and key Democratic House committee chairmen to address a rift in the party’s drug-pricing priorities, a coalition of progressive consumer advocates, unions and think tanks did not take sides in the internal conflict over which enforcement mechanism to include in legislation allowing Medicare to negotiate drug prices with manufacturers.

Accountable care organizations (ACOs) and plans have expressed concern about model overlap after the Center for Medicare and Medicaid Innovation (CMMI) announced two new voluntary primary care models on Monday, prompting the National Association of Accountable Care Organizations (NAACOS) to say it will push CMS to put into writing which models ACOs can participate in even as CMS clarified for Inside Health Policy how model participation will work.

Plans and provider advocates are optimistic about new models for primary care introduced Monday (April 22) by HHS, but questions remain about who might be able to participate, how benchmarks might be set, and what services the models might include.