On The Hill

Health Update (March 25)

Mar 26, 2019 | SHARE  
This week, the White House released additional budget documents and, including an appendix, analytical perspectives, and a document entitled “Major Savings and Reforms.” The documents are available from the White House website by clicking here.


Surprise Medical Bills


A Brookings Institution paper discussion and a series of two panels this week examined the current landscape of surprise medical bills as well as state and federal legislative solutions to the problem. While patients, stakeholders, and politicians widely agree on the existence of a problem, there is not uniform agreement on solutions to the problem. Two key principles seem to generate the most agreement: patients need to be removed from the equation when settling out of network costs, and any government solution should not contribute to a rise in health care costs. While emergency services and ambulance services contribute to almost half of surprise bills, they are not the only scenarios that result in a surprise bill. Roughly 1 in 5 emergency room visits and 1 in 10 elective inpatient care visits result in a surprise bill. Surprise bills contribute to a rise in premiums for all commercial insurance. Legislative solutions pursued at the state level include surprise billing prohibitions, setting billing rates, and arbitration. While some states have achieved varying degrees of success, stakeholders agree that a federal solution is needed. Federal stakeholders want to take care to avoid further consolidation of health care negotiating power and ensure that a legislative response is proportional to the problem at hand. A full readout of the event is available here.


E-Cigarette Regulation


Perhaps in an attempt to ease fears that FDA Commissioner Scott Gottlieb’s departure could result in reduced regulatory action against youth e-cigarette use, Health and Human Services Secretary Alex Azar reaffirmed the message that the federal government would continue to focus on the epidemic of teen vaping. In a joint op-ed with Commissioner Gottlieb, the two health leaders wrote, “The country is at a crossroads when it comes to these products. Though the FDA’s leadership will change at the end of the month, the agency’s focus will carry on. If the surge continues, more drastic regulatory action will be considered.”[1]


Pharmacy Benefits Managers Will Testify Before Senate Finance Committee


All five pharmacy benefits managers have confirmed the attendance of executives at the April 9th Senate Finance Committee meeting on drug pricing. Four of the five companies have confirmed who will be in attendance: William Fleming will testify for Humana, Mike Kolar will testify for Prime Therapeutics, Derica Rice will testify for CVS Caremark, and John Prince will testify for OptumRx. A participant for representative for Cigna has been confirmed but not identified.[2]



[1] Alex Azar and Scott Gottlieb. “The future of e-cigarettes depends on the industry’s willingness to protect teens.” Washington Post, 20 Mar 2019. https://www.washingtonpost.com/opinions/2019/03/19/future-e-cigarettes-depends-industrys-willingness-protect-teens/?utm_term=.5534185baac8

[2] Sarah Karlin-Smith and Sarah Owermohle. “All 5 PBMs agree to testify at Senate drug cost hearing.” South Dakota Association of Healthcare Organizations via POLITICO Pro, 21 Mar 2019. https://sdaho.org/2019/03/21/all-5-pbms-agree-to-testify-at-senate-drug-cost-hearing/


The Week Ahead

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The Week Ahead

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