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This Week in Health Care Reform: July 19th, 2019

House lawmakers debate surprise medical billing legislation; the Administration abandons its proposed rebate rule; drugmakers boost prices significantly; and, stakeholders take a look at how chronic illness affects whole-person health.

Week in Review

Surprise Medical Bills: This week, the House Energy & Commerce Committee advanced legislation aimed at addressing surprise medical bills.  As covered in a recent newsletter, surprise medical bills occur when consumers – through no fault of their own – unknowingly receive medical care from a health care provider who is not a part of their health insurance plan’s network.  (While that care is often delivered at an in-network facility, it can also be received at free-standing emergency rooms – which, studies have shown can cost 22 times more than a traditional doctor’s office.)  Wherever that care is delivered, surprise medical bills are the result of these services being provided by emergency department doctors or on-site specialists (e.g., anesthesiologists or radiologists) who are out-of-network. Legislative efforts focused on the establishment of a benchmark payment rate – the median negotiated rate in a geographic region for a service – have found support from a diverse range of health care stakeholders.  Unfortunately, last-minute efforts to include an arbitration-style model to those proposals have complicated lawmakers’ attempts to advance bipartisan, pro-consumer legislation.  Despite overwhelming opposition to its inclusion, supporters of arbitration were successful in getting it added to the Energy & Commerce Committee bill late Tuesday night, a move that was largely described as placing political value over policy value as it was meant to mollify health care providers who stood to lose access to a quietly lucrative revenue stream.  Earlier this week, we reached out to our Health Action Network members, urging you to contact your federal lawmakers to oppose arbitration in their ongoing efforts to protect consumers from surprise medical bills.  Many have already taken action, sending hundreds of letters to elected officials.  If you haven’t already, there’s still time for you to add your voice to the growing chorus. ACT NOW!

Rebate Rule: Late last week, the Administration announced that it was backing away from its proposal overhauling drug rebates in federal health programs.  That proposal, which had targeted pharmacy benefits managers (PBMs), had been widely met with opposition.  Not only did the majority of Americans support PBMs’ role in accessing affordable drugs, but independent analysis from the nonpartisan Congressional Budget Office (CBO) projected that the rule would actually cause federal spending to rise without any decrease to drug prices.  The decision to withdraw the proposed rule was immediately applauded by stakeholders as it puts the blame for rising drug prices back on pharmaceutical manufacturers where, they maintain, it’s always belonged.

Rx Price Boost: Speaking of rising drug prices, a new analysis found that, despite all the attention and scrutiny, drug companies continue to hike up the cost of their products.  Last month, data shows that drugmakers raised their prices by an average of 27 percent.  In fact, one company jacked up the price of a generic drug by 909 percent.  Looking back further, prescription drug prices have gone up 10.5 percent over the past six months – four times the rate of inflation.  Over that time, prices for 3,443 medicines increased, compared to the same period last year, when 2,919 drugs went up

Chronic Illness & SDoH:
Research has shown the impact that access to care can have on some of the most already-vulnerable populations with chronic conditions, such as diabetes, asthma, or mood disorders.  According to a new white paper – and, as recently covered – some of those same patient groups are also struggling with social determinants of health (SDoH).  Published by Anthem’s Public Policy Institute, that research took a look at how these populations perceive SDoH compared to how the issue is being discussed in the public dialogue.  Why this is important is that this misalignment can help payers and providers identify missed opportunities to better address any gaps and more effectively engage with patients.  While the larger conversation has tended to focus on structural factors (e.g., education), individuals have, instead, been focused on more easily modifiable behaviors (e.g., social supports and healthier foods).      

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