Health Policy Report – August 20, 2024

The US Oncology Network’s State Policy Team Attends the National Conference of State Legislatures (NCSL)

The US Oncology Network’s state government relations team recently attended the National Conference of State Legislatures (NCSL) Annual Summit in Louisville, Kentucky, from August 3-8. Since its inception in 1975, NCSL has been a crucial resource for America’s 50 states, commonwealths, territories, and the District of Columbia, providing legislators and legislative staff with access to the latest bipartisan policy research, training resources, and technical assistance.

As foundation members of NCSL for over 15 years, The US Oncology Network has consistently demonstrated its commitment to state policy. This year, we continued that tradition by hosting our branded booth in the exhibit hall, where we highlighted our Network partners from across the country.

The summit, which brought together over 900 legislators and 3,000 attendees, provided an invaluable opportunity for our team to engage in more than 60 meetings with legislative members and staff. These discussions centered on community oncology and our key priorities for 2025. We also connected with several industry partners, further strengthening our collaborative efforts.

For more information on the State Government Relations team, please contact Angela Storseth-Cooper, Sr. Director, Government Relations, angela.storseth@mckesson.com.  

Comprehensive Cancer Centers of Nevada Holds Site Visit with State Senators Stone and Lange

Comprehensive Cancer Centers of Nevada (CCCN) hosted two site visits with state senators Jeff Stone and Roberta Lange. Senator Stone, a practicing pharmacist, was knowledgeable about many of the pressures practices face from pharmacy benefit managers (PBMs) and the overall frustration with many of the utilization management tactics that payers deploy. He also expressed interest in working with CCCN on many of the workforce issues facing the practice. He left with a better understanding of the important role community oncology plays in Las Vegas.

Senator Roberta Lange, a long-time ally of CCCN and cancer patients in the legislature, visited the Twain clinic. As a member of the leadership in the Nevada legislature, she reaffirmed her support for community oncology and cancer patients. She also provided insight into legislation she is working on that will increase access to lung cancer screenings, as well as a bill that will create a license for genetic counselors.

Both senators left the visits with a positive outlook on community oncology, and we look forward to working with them during the session next year.

White House Releases Results of Medicare Drug Price Negotiations for First 10 Drugs

On August 15, the Biden Administration announced that it will lower the price of 10 widely used drugs from between 38% and 79% as part of the first round of drug price negotiations authorized by the Inflation Reduction Act (IRA). These negotiations, which began last October, involve major drugs like Bristol Myers Squibb’s Eliquis, Johnson & Johnson’s Xarelto, and Boehringer Ingelheim’s Jardiance.

The price changes, which will take effect in 2026, are set to save taxpayers $6 billion and seniors $1.5 billion in out-of-pocket costs. “It’s a relief for the millions of seniors that take these drugs to treat everything from heart failure, blood clots, diabetes, arthritis, Crohn’s disease, and more — and it’s a relief for American taxpayers,” said President Biden in a statement.

Pharmaceutical companies have brought a series of lawsuits challenging the constitutionality of the Medicare drug price negotiation program. However, these legal challenges have so far been unsuccessful. “There are no assurances patients will see lower out-of-pocket costs because the law did nothing to rein in abuses by insurance companies and PBMs who ultimately decide what medicines are covered and what patients pay at the pharmacy,” Steve Ubl, CEO of the drug industry trade group PhRMA, said in a statement.

Medicare will select another 15 drugs for the next round of drug price negotiations on February 1, 2025. Those negotiated prices will take effect in 2027.

To read the Biden Administration’s statement, CLICK HERE.

To read a fact sheet, CLICK HERE.

To read PhRMA’s statement, CLICK HERE.

To read more, CLICK HERE.

Drug Pricing Analysis Shines New Light on 340B Program

A new report conducted by Avalere for the Community Oncology Alliance (COA) reveals that a large share of 340B contract pharmacies are associated with a pharmacy benefit manager (PBM). The 340B program was established to allow safety-net providers, also known as covered entities, to purchase covered outpatient drugs at a substantial discount from pharmaceutical manufacturers. Under current law, covered entities can dispense eligible drugs in-house or through arrangements with contract pharmacies. 

The report reveals, however, the extent to which PBMs and affiliated for-profit corporations have become involved with the 340B program. According to the findings, 69% of 340B contract pharmacies were associated with a PBM through either vertical integration (53%) or contractual arrangement (16%). 

The analysis comes as lawmakers and regulators are scrutinizing not only the 340B program but PBMs and their affiliated mail-order pharmacies. Last month, the Federal Trade Commission (FTC) found that mail-order pharmacies owned by the three largest PBMs now account for nearly three-quarters of total dispensing revenue. 

To read the report, CLICK HERE. 

To read more, CLICK HERE.

To read the FTC interim report, CLICK HERE.

New KFF Reporting Reveals How Patients Are Charged Hospital Prices for Doctor’s Office Care

A recent installment of InvestigateTV and KFF Health News’ “Costly Care” series reveals how hospitals are rebranding doctor’s offices for the purpose of billing. The report featured an interview with Caren Blanzy, a patient who received regular injections that gave her relief from an involuntary muscle contraction. 

However, the health system that owns her doctor’s office began billing her treatment as an outpatient hospital service, rather than an office visit. Blanzy soon received a bill of over $1,100 for the treatment, which was previously covered by her insurance. 

“For them to change the way they bill it and say it’s a hospital service, as an outpatient, it just didn’t make sense to me,” Blanzy said. She soon stopped receiving injections because she could no longer afford them. This issue is a growing concern as hospitals buy up independent physician practices and generate revenue under higher reimbursement rates.

Stories like Blanzy’s, however, generate support for site neutral payment reform. With site neutral payment, “it’s the treatment that determines the charge,” explained Elisabeth Rosenthal, KFF Health News’ senior contributing editor, who was interviewed for the piece. “That just seems much, much fairer than expecting patients to figure it out.”

To watch the interview, CLICK HERE.

New Report Reveals High Use of Prior Authorizations in Medicare Advantage

A new report from the Kaiser Family Foundation (KFF) highlights the high use of prior authorization requests, and a corresponding number of denials for Medicare Advantage enrollees. In 2022, Medicare Advantage plans handled more than 46 million prior authorization requests, with 54% approved and 10% immediately denied or requiring resubmission. The report found that 82% of denied requests were later overturned. 

The prior authorization process, intended to control healthcare costs and ensure the delivery of appropriate care, has raised widespread criticism for creating administrative burdens and barriers to patient care.

The study found that high-cost services like MRIs, home healthcare, and inpatient rehabilitation were denied more often than less-expensive care, delaying necessary treatments – especially for patients requiring more advanced or serious levels of care.

To read the report, CLICK HERE.