Home Health care provider HEALTH CARE BRIEFING: The House Eyes Drug Cost Cap in Employer Plans

HEALTH CARE BRIEFING: The House Eyes Drug Cost Cap in Employer Plans



House Democrats agree with employer, worker and consumer groups that commercial health plans should be included in sweeping health care legislation designed to lower drug prices, sources say.

Whether employer-sponsored or insurer-sponsored plans can be covered by HR 3’s proposed cap on drug price inflation will depend on whether or not the addition is allowed in a proceeding. reconciliation that Congress will use to advance expanded Medicare benefits in the fall.

“We’re trying to see if we can make it work this year,” said a Democratic House aide who requested anonymity. “We haven’t completely solved it, but we are trying.”

The Home Drug Prices Bill is designed to offset the cost of expanded benefits by reducing what Medicare pays for prescription drugs. The main driver of the bill’s lower prices is a provision that allows the federal government to negotiate directly with drug manufacturers about the price it pays for high-priced products. Commercial plans, run by employers, insurers and unions, would pay the same amount for these drugs.

The bill would also require drug companies to reimburse the Treasury Department for the amount they raise the prices of certain drugs above inflation. Employers and unions also want such discounts in business plans. Without them, they say, they would be exposed to sharp increases in prescription prices. They have been discussing the issue with House leaders for months, according to a source involved in the talks.

Republicans don’t support the legislation, so the only route to passage is a budget process called reconciliation that bypasses the need for 60 votes in the Senate. Only policies that change spending or income can be included in reconciliation bills, so lawmakers should draft the trade insurance provision to affect the budget.

If the Senate parliamentarian does not decide that the provision is primarily budgetary, “this provision which applies inflation reduction to the commercial sector should be removed,” the House aide said. “We haven’t made a final decision on the language,” the aide said. “I think we’re going to put it in there.” Read more from Sara Hansard.

Also on lawmakers’ radars

HELP Markup: The Senate Committee on Health, Education, Work and Pensions is expected to mark four bills, including:

  • S. 1486, to eliminate discrimination and promote the health and economic security of women by ensuring reasonable accommodation in the workplace for workers whose ability to perform the duties of a job is limited by pregnancy, l childbirth or a related medical condition; and
  • S. 1543, to provide best practices in student suicide awareness and prevention and to condition state education agencies, local education agencies and tribal education agencies to establish and implement a policy of awareness and training in suicide prevention in schools.

Infections are an obstacle to the infrastructure bill: Majority leader in the Senate that of Chuck Schumer (DN.Y.) plan to pass a $ 550 billion infrastructure bill this week encountered a potential hurdle when the senator. Lindsey graham (RS.C.) announced that he had tested positive for Covid-19 and that he would self-quarantine for 10 days. One of 10 Republicans who helped negotiate the infrastructure deal, Graham said he was tested yesterday after experiencing flu-like symptoms on Saturday. He said he was vaccinated.

The Senate doesn’t allow proxy voting like the House, so quarantine would mean Graham would miss votes on legislation, which Schumer wants to pass before the end of the week. Graham’s vote alone wouldn’t necessarily delay the deal. There were 67 votes last week to advance it, including 17 Republicans. Sixty votes will be needed to complete the legislation. But the potential for a series of more positive tests among chamber senators could upend that timeline. Laura Litvan and Steven Dennis have more.

  • The infrastructure bill will create winners and losers among industries and businesses that will be affected by what would be the government’s biggest public works spending spree in decades. Pharmacy benefit managers would be one of the winners. The bill would delay a Trump-era rule to restrict the use of drug discounts, the money refunded to PBMs by manufacturers often in exchange for preferred placement on a health plan‘s formulary .
  • Meanwhile, drugmakers could appear to be losers under the deal. It contains a provision that would require drug manufacturers to reimburse Medicare for drug waste, drugs discarded by doctors due to overpack. Medicare in 2019 paid more than $ 752 million for drugs that were thrown away, according to federal government data. Drugs manufactured by Amgen, Celgene and Bristol-Myers Squibb have contributed more than $ 150 million of this waste, the data shows, Laura Davison, Ari Natter and Steven Dennis report.

Democrats push HHS on drug prices: Meaning. Elizabeth warren (D-Mass.) And Amy Klobuchar (D-Minn.) And Rep. Lloyd Doggett (D-Texas) asked the HHS secretary Xavier Becerra to inform lawmakers about the department’s use of tools such as “Section 1498 of Compulsory Licenses” and “Bayh-Dole Marching Rights” to fight drug prices, they said yesterday, referring to two laws dealing with the use of patents by government, including for patented medicines. Read the statement here.

The coronavirus pandemic

Biden calls on the CDC to weigh a new moratorium on evictions: Biden has asked the Centers for Disease Control and Prevention to consider another extension of a moratorium on evictions, but agency executives have been unable to legally justify it, the press secretary said Jen Psaki. Biden made the request on Sunday, after a CDC deportation ban expired the day before. He has been criticized by some members of his own party for waiting days before the ban expired to ask lawmakers for an extension.

secretary of the treasury Janet Yellen will speak to House Democrats today about providing rent assistance to more tenants. Congress has approved $ 46.5 billion in rent assistance since December, but most of it has not gone to Americans. Billy House has more.

US hits Biden vaccination target one month late: Seventy percent of American adults have received at least one dose of a Covid-19 vaccine, a key milestone in the fight against the pandemic the country struck almost a month later than Biden had hoped for . After dropping considerably since April, the pace of vaccinations has recently picked up due to the rapid spread of the delta variant. As of Friday, the country averaged more than 72,000 new infections a day, the CDC said. Read more from Jennifer Epstein.

The “Very True Fourth Wave” urges the FDA to approve the shots: An increase in Covid-19 cases in the United States is increasing pressure on U.S. drug regulators to fully approve the vaccine from Pfizer, the first to seek a full license in the United States. that vaccines are safe. It could also make it easier for more schools and workplaces to demand the shots. Bloomberg News spoke with Peter Marks, head of the FDA division reviewing Pfizer’s request.

Hospital staff shortages are increasing sharply in Florida: The number of hospitals reporting critical staff shortages is growing rapidly in Florida, where the Delta variant is rapidly filling beds. The Sunshine State faces 13% of its facilities reporting a shortage of medical personnel, up from 4% a week earlier, according to data from the Department of Health and Human Services. The week-long increase was the largest in the United States, the data shows. Florida accounted for nearly 20% of U.S. cases last week. Read more from Jonathan Levin.

Nursing home staff said size fueled the spread of Covid-19: Nursing homes with larger staff had about double the rate of infections and deaths from Covid-19 last year than those with fewer staff, new research shows. Facilities “in the lowest quartile of staff size had 6.2 resident cases” and nearly one death per 100 beds, compared to 11.9 cases and 2.1 deaths for facilities in the highest quartile, according to the study of more than 7,000 nursing homes published Monday in the Health Business Journal. Read more from Tony Pugh.

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What else to know today

Indiana law on reporting complications of abortion confirmed: An Indiana law requiring abortion providers to report complications to state authorities is constitutionally valid because a reasonable person would understand what needs to be reported, the Seventh Circuit said. The law does not violate the “void for the blur” doctrine, which requires criminal laws to define an offense with enough clarity that most are able to understand what is prohibited, the Seventh Circuit said, reports Mary Anne Pazanowski.

Hospitals to receive a $ 2.3 billion Medicare pay rise in 2022: Medicare will pay hospitals an additional $ 2.3 billion, a 2.5% increase, for hospital stays in 2022, under a new rule released yesterday by the Biden administration. Read more from Tony Pugh.

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To contact the reporter on this story: Brandon lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Zachary Sherwood To zsherwood@bgov.com; Giuseppe Macri To gmacri@bgov.com; Michaela ross To mross@bgov.com