The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the list of 43 prescription drugs for which Medicare Part B beneficiaries’ coinsurances may be lower between July 1, 2023, as part of the health care cost-saving provisions under the Inflation Reduction Act, more than doubling the current number of drugs subject to rebates. Additionally, HHS released a report on Medicare Part B coverage, revealing that Medicare Part B drug spending per enrollee had an annual increase of 9.2 percent from 2008 to 2021, with the top 20 drugs accounting for more than 50 percent of spending, compared to a 2.6 percent increase for Medicare Part D. More information on the prescription drug rebates and the report can be found here.

The Centers for Medicare & Medicaid Services (CMS) announced on Thursday a new primary care model, the Making Care Primary (MCP) Model, to be tested in eight states, including Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. More information can be found here.

The House Ways and Means Committee on Wednesday advanced six health bills including several insurance measures. These measures are intended to simplify employer reporting on health insurance coverage (HR 3797, HR 3801, HR 3798), expand health reimbursement arrangements (HR 3799), expand telehealth (HR 1843) and improve chronic disease benefits in high-deductible health plans (HR 3800).

The Senate Committee on Finance held a hearing on Thursday to examine the impact of health care consolidation, certain ownership structures, and data transparency on health care costs for purchasers and patients. Mehlman Consulting’s summary of the hearing can be found here.

Next Wednesday, the leaders of the House Energy and Commerce Committee announced that the Health Subcommittee will hold a legislative hearing to examine the reauthorization of several programs impacting access to care for certain vulnerable patients. The full statement and list of bills expected to be considered can be found here.

House Energy and Commerce Committee Ranking Member Frank Pallone, Jr (D-NJ) and Senate Finance Committee Chairman Ron Wyden (D-OR) wrote to Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure raising concerns regarding the actions of certain Republican-led states regarding Medicaid redeterminations. The full letter can be found here.

President Joe Biden announced the departure of White House COVID-19 Response Coordinator, Dr. Ashish Jha, after joining the administration back in 2022. Dr. Jha is expected to leave the White House next week and return to his previous post as dean of the School of Public Health at Brown University.

On Tuesday, pharmaceutical giant Merck filed a lawsuit against the Biden Administration challenging its legal authority to negotiate drug prices under the recently-enacted Inflation Reduction Act. More information can be found here.

The U.S. Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) announced a new Pediatric Specialty Loan Repayment Program. More information about the program can be found here.

Last week, the Biden Administration outlined eligibility for Medicare coverage for a new class of Alzheimer’s drugs. Centers for Medicare and Medicaid (CMS) Administrator Chiquita Brooks-LaSure announced that “If the FDA grants traditional approval CMS is prepared to ensure anyone with Medicare Part B who meets the criteria is covered”. As a condition of coverage, the agency intends to require physicians and clinical teams treating Alzheimer’s patients to participate in a registry that allows the collection of evidence of how these drugs work overtime in a much broader class of patients beyond FDA-required clinical trials. The press release can be found here.

On May 25^th, the Centers for Medicare and Medicaid Services (CMS) announced that it would temporarily stop implementation of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program starting on January 1, 2024. The report can be found here.

On June 1^st, The U.S. Department of Health, and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), awarded $5.9 million to states, tribes, and college campuses for youth suicide prevention programs. The press release can be found here.

On Tuesday, a federal appeals court seemed hesitant to impose a nationwide freeze on Obamacare’s rules for no-cost coverage of preventive care while litigation continues. More information about the case can be found here.

Ranking Member Bill Cassidy, M.D. (R-LA) and Senator Tommy Tuberville (R-AL) are looking for answers from the National Institutes of Health (NIH) in light of the suicide death of two youth participants who were involved in a NIH-funded study that observed the effect of hormone treatments on transgender youth. The full letter can be read here. 

Today, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the list of 43 prescription drugs for which Medicare Part B beneficiaries’ coinsurances may be lower between July 1, 2023, as part of the health care cost-saving provisions under the Inflation Reduction Act, more than doubling the current number of drugs subject to rebates. Medicare Director Meena Seshamani stated that Medicare beneficiaries could save anywhere from $1 to $449 per average dose of a drug on the list during the three-month period ending on September 30. Additionally, HHS released a report on Medicare Part B coverage, revealing that Medicare Part B drug spending per enrollee had an annual increase of 9.2 percent from 2008 to 2021, with the top 20 drugs accounting for more than 50 percent of spending, compared to a 2.6 percent increase for Medicare Part D. More information on the prescription drug rebates and the report can be found here.

On Thursday, the Centers for Medicare & Medicaid Services (CMS) announced a new primary care model, the Making Care Primary (MCP) Model. The new model will be tested in eight states, including Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. CMS announced that the primary goals of the MCP are to 1) ensure patients receive primary care that is integrated, coordinated, person-centered and accountable; 2) create a pathway for primary care organizations and practices – especially small, independent, rural, and safety net organizations – to enter into value-based care arrangements; and 3) to improve the quality of care and health outcomes of patients while reducing program expenditures. MCP will run for 10.5 years, from July 1, 2024, to December 31, 2034. More information can be found here.

The House Ways and Means Committee on Wednesday advanced six health bills including several insurance measures. Ways and Means Committee Chairman Jason Smith(R-MO) released the following statement “These bills will help small businesses attract and retain workers by giving them the option to provide more health benefit choices for their employees. As a result, American workers will get more options and relief from the exploding cost of health care due to Washington-driven inflation. Washington needs to cut the red tape that is blocking workers from making the best possible health care choices for their families.” These measures are intended to simplify employer reporting on health insurance coverage (HR 3797, HR 3801, HR 3798), expand health reimbursement arrangements (HR 3799), expand telehealth (HR 1843) and improve chronic disease benefits in high-deductible health plans (HR 3800).

On Thursday, the Senate Committee on Finance held a hearing to examine the impact of health care consolidation, certain ownership structures, and data transparency on health care costs for purchasers and patients. Mehlman Consulting’s summary of the hearing can be found here. Witnesses featured at the hearing included:

Next Wednesday, the leaders of the House Energy and Commerce Committee announced that the Health Subcommittee will hold a legislative hearing to examine the reauthorization of several programs impacting access to care for certain vulnerable patients. According to a joint statement released by Committee Chair Cathy McMorris Rodgers (R-WA) and Health Subcommittee Chair Brett Guthrie (R-KY), the Committee “is working to reauthorize key programs that provide access to care for mothers, children, cancer patients and first responders, as well as support research for rare diseases. This legislative hearing will give our members a chance to evaluate the effectiveness of these programs and discuss legislation to continue them,”. The full statement can be read here. The bills being considered by the Subcommittee are:

On Thursday, House Energy and Commerce Committee Ranking Member Frank Pallone, Jr (D-NJ) and Senate Finance Committee Chairman Ron Wyden (D-OR) wrote to Health and Human Services (HHS) Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure raising concerns regarding the actions of certain Republican-led states regarding Medicaid redeterminations. Pallone and Wyden stated, in part: “We are troubled by early reports that suggest that some states in the first month of redeterminations have disenrolled hundreds of thousands of individuals for procedural reasons, rather than because they were found to be no longer eligible. We are equally troubled that many of those individuals who have lost coverage are children, including newborns.” The full letter can be found here.

On Thursday, President Joe Biden announced the departure of White House COVID-19 Response Coordinator, Dr. Ashish Jha, after joining the administration back in 2022. Dr. Jha is expected to leave the White House next week and return to his previous post as dean of the School of Public Health at Brown University. President Biden’s full statement can be found here.

On Tuesday, pharmaceutical giant Merck filed a lawsuit against the Biden Administration challenging its legal authority to negotiate drug prices under the recently-enacted Inflation Reduction Act. The Centers for Medicare and Medicaid Services is set to publish the first 10 Medicare Part D drugs chosen for negotiation in September. The report claims that the negotiations are set to occur throughout 2023 and 2024 with the effects being seen in 2026. White House Press Secretary Karine Jean-Pierre said “We are confident we will succeed. There is nothing in the Constitution that prevents Medicare from negotiating lower drug prices.” More information can be found here.

Today, the U.S. Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) announced the new Pediatric Specialty Loan Repayment Program. This $15 million investment aims to recruit and retain clinicians who provide health care to children and adolescents by providing up to $100,000 to eligible clinicians in exchange for three years of service working in a health professional shortage area. More information about the program can be found here.

Last week, the Biden Administration outlined eligibility for Medicare coverage for a new class of Alzheimer’s drugs. Centers for Medicare and Medicaid (CMS) Administrator Chiquita Brooks-LaSure announced that “If the FDA grants traditional approval CMS is prepared to ensure anyone with Medicare Part B who meets the criteria is covered”. As a condition of coverage, the agency intends to require physicians and clinical teams treating Alzheimer’s patients to participate in a registry that allows the collection of evidence of how these drugs work overtime in a much broader class of patients beyond FDA-required clinical trials. The press release can be found here.

On May 25^th, the Centers for Medicare and Medicaid Services (CMS) announced that it would temporarily stop implementation of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program starting on January 1, 2024. During this time, CMS will try to ‘establish sustainable prices’ through rulemaking to save money for people with Medicare. CMS announced that the Medicare payment will continue at current allowances established through competitive bidding, adjusted by inflations, and following payment provisions in statute and regulation. The report can be found here.

On June 1^st, The U.S. Department of Health, and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), awarded $5.9 million to states, tribes, and college campuses for youth suicide prevention programs. Of the $5.9 million, $3.6 million was awarded to states and tribes under the Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Program with the other $2.3 million being awarded to college campuses also under the GLS Campus Suicide Prevention Program. In a press release HHS Secretary Xavier Becerra stated that “Thanks to President Biden, we are finally and seriously saying to young Americans struggling with their mental health: We hear you. Support is here. Support is here for young people through their colleges and universities, foster care programs, and countless other youth serving organizations.” The press release can be found here.

On Tuesday, a federal appeals court seemed hesitant to impose a nationwide freeze on Obamacare’s rules for no-cost coverage of preventive care while litigation continues. In the suit, the attorneys representing the Texas employers assert that the 1.) the United States Preventive Services Task Force, the agency in charge of establishing these polices, is made up of officials who are not Senate confirmed or are not overseen by senate approved officials. 2.) The Obamacare requirement for insurance to cover pre-exposure prophylaxis pill to prevent the transmission of HIV, also known as PrEP, violates the religious rights of insurers. The challengers in this case believe this pill encourages homosexuality. More information about the case can be found here.

The Centers for Medicare and Medicaid Services (CMS) announced this week that the ESRD Treatment Choices (ETC) Model Performance Payment Adjustment (PPA) Reports for Measurement Year (MY) 3 are now available in the 4Innovation Platform. The MY3 PPA Reports provide the Modality Performance Score (MPS) and the associated PPA at the Aggregation Group level based on performance during MY3 of the ETC Model, which corresponds to Calendar Year 2022. Achievement Benchmarks for MY6, which begins July 1, 2023 have also been posted to the ETC Model website and may be found here.

GOP Leaders of Senate Committee on Health, Education, Labor & Pensions Seek Answers from NIH Regarding Transgender Youth Study

Ranking Member Bill Cassidy, M.D. (R-LA) and Senator Tommy Tuberville (R-AL) are looking for answers from the National Institutes of Health (NIH) in light of the suicide death of two youth participants who were involved in a NIH-funded study that observed the effect of hormone treatments on transgender youth. The participants were recruited from gender clinics at children’s hospitals in Chicago, San Francisco, Boston, and Los Angeles, and ranged from 12 to 20 years old. At the end of the letter, Ranking Member Cassidy and Senator Tuberville sent NIH a list of questions that they want answered by the end of June. The letter can be read here. 

Senate Veterans’ Affairs Committee - Hearing

Register here.