Health Policy Report – March 19, 2024

Texas Oncology Hosts State Senator Brandon Creighton for Site Visit

Texas Oncology recently welcomed Texas State Senator Brandon Creighton for a site visit at The Woodlands location near Houston. This event, held on February 28th, was led by Texas Oncology’s medical and administrative personnel, including Dr. Christine Lee, Dr. Paula Ryan, Dr. Kruti Nair, Dr. Andrew Jackson, Dr. Diana Hook, Practice Director Ali Holamon, Executive Director Kristy Penza, Regional Senior Vice President Anne Hoang, and General Counsel Kate Bowen. During the visit, Senator Creighton gained insights into community oncology care available in his district and the advantages of community-based care.

During the visit, Senator Creighton heard about the challenges confronting community oncology care, particularly issues surrounding pharmacy benefit managers (PBMs) and payer relations. Senator Creighton also learned of the strides Texas Oncology is making towards the integration of value-based care models. Given his position as Chair of Education, Senator Creighton’s active involvement and collaboration with Texas Oncology and The Network is instrumental to achieve positive policy change.

Congress Passes Spending Bill to Avert Shutdown, Includes Partial Pay Fix for Doctors

On March 9, President Joe Biden signed into law a $460 billion spending package funding a subset of federal agencies through September 30, 2024. The agreement blunts the 3.37% physician pay decrease enacted in the 2024 Medicare Physician Fee Schedule final rule by providing a 1.68% bump from March 9 to December31, 2024. Notably, the partial fix does not apply retroactively to when the full cut went into effect on January 1, 2024. While provider groups commended lawmakers for the partial fix, many highlighted the need for long-term reform.

“While we appreciate the challenges Congress confronted when drafting the current 2024 appropriations package, we are extremely disappointed that about half of the 2024 Medicare physician payment cuts will be allowed to continue. There were many opportunities and widespread support to block the 3.37% Medicare cuts for physician services that took place Jan. 1, but in the end, Congress opted to reverse only 1.68 of the 3.37 percentage payment reduction required by the Medicare Fee Schedule. The need to stop the annual cycle of pay cuts and patches and enact permanent Medicare payment reforms could not be more clear,” Jesse Ehrenfeld, M.D., president of the American Medical Association (AMA), said in a statement.

Additionally, the funding package pushed back an $8 billion-per-year cut to Medicaid Disproportionate Share Hospital (DSH) payments. However, many other priorities, including healthcare transparency, site neutral payment reform, and PBM reform, were excluded from the funding bill, leaving many to set their sights on a potential healthcare package in the lame duck session later this year.

To read more about the legislative package that passed, CLICK HERE and HERE.

To read the bill text, CLICK HERE.

To read the AMA’s statement about the partial alleviation of the cuts, CLICK HERE.

House Energy and Commerce Health Subcommittee Holds Markup on Seniors’ Access to Critical Medications Act (H.R. 5526)

On March 12, the House Energy & Commerce Health Subcommittee held a markup on 19 bills, including H.R. 5526, the Seniors’ Access to Critical Medications Act of 2023, legislation that would remedy the recent restrictions on a practices’ ability to deliver critical medications to a patient’s home. The bill would allow patients to receive medications prescribed by their doctor by mail or allow for caregivers and family members to obtain medications for them.

In a 19-6 vote, the bill was passed out of the subcommittee and is waiting to be taken up by the full committee. Full Committee Ranking Member Frank Pallone (D-NJ) opposed the bill, expressing concern that this would broaden the Physician Self-Referral law and undermine the integrity of the Medicare program.

During the markup, lawmakers discussed how CMS’ interpretation that home-delivered drugs be excluded from the in-office ancillary services exception (IOASE) to the Physician Self-Referral Law, known as the Stark Law, has created access challenges for patients, particularly those in rural areas. “No mission is no more important and fundamental than this one,” said Rep. Diana Harshbarger (R-TN), the bill’s sponsor, during the hearing. “We shouldn’t put obstacles in the way of cancer patients or patients receiving their needed medications.” 

To watch the hearing, CLICK HERE.

To read the bill, CLICK HERE.

To ask your Representative to restore access to home delivery of oral oncolytics, CLICK HERE.

To read Rep. Harshbarger’s press release about the bill, CLICK HERE.

President Biden Releases Proposed Budget for 2025

On March 11, President Biden unveiled a $7.3 trillion proposed budget for the federal government in 2025, which includes plans to increase spending on healthcare priorities that the administration has championed over the past few years. The White House requests $130.7 billion in discretionary funding for the Department of Health and Human Services (HHS) — a 1.7% boost from fiscal 2023. This would come on top of the $1.7 trillion the department will spend on mandatory programs such as Medicare and Medicaid, which are not subject to annual congressional appropriations.

“While my administration has seen great progress since day one, there is still work to do. My budget will help make that promise real,” Biden wrote in his budget.

The Biden Administration said that its budget proposal will lower healthcare costs and drug prices, expand access to prescription drugs and build upon the Affordable Care Act. The budget calls for expanding Medicare’s drug price negotiation program, extending a $35 cap on insulin, and extending Medicare caps on out-of-pocket costs for those with private insurance. It also calls for a more than $2 billion increase for the Cancer Moonshot Initiative, a signature part of President Biden’s healthcare agenda. The budget also includes substantial funding for cybersecurity in the healthcare sector.

To read more, CLICK HERE.

To read the budget, CLICK HERE.  

Senators Wyden and Crapo Urge Senate Finance Committee to Prioritize PBM Reforms 

In a bipartisan move aimed at reducing healthcare costs and increasing access to pharmacy services, Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Michael D. Crapo (R-ID) sent a letter on March 14th urging their colleagues on the Senate Finance Committee to prioritize pharmacy benefit manager (PBM) reforms. The letter highlights the urgency of addressing policy challenges that continue to escalate healthcare costs and reaffirms the commitment of both senators to push forward meaningful legislation targeting the practices of PBMs. PBMs have been criticized for contributing to high drug prices and reduced access to medications due to misaligned incentives and lack of transparency.

The senators emphasized the committee’s achievements in enacting meaningful pharmacy benefit manager (PBM) reforms, noting the near-unanimous approval of the Modernizing and Ensuring PBM Accountability Act (S. 2973) and the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (S. 3430) last year. These important bills have garnered broad bipartisan support and are focused on cost-cutting competition, mitigating misaligned incentives that drive up drug prices, and bolstering transparency across the medication supply chain. Senators Wyden and Crapo outlined the impacts of current PBM practices on American communities, including the closure of over 300 pharmacies last year alone, as well as the exorbitant cost-sharing burdens placed on patients, which are often based on inflated drug prices. They also highlighted restrictive PBM policies on low-cost medications and the alleged marking up of generic drug prices, which jeopardize patient access and financial sustainability.

The letter calls for bipartisan, bicameral action to address these challenges, emphasizing that the proposed reforms would not only lower consumer costs but also protect small businesses and save taxpayer dollars. The senators committed to collaborating with all relevant committees and congressional leadership to ensure the enactment of these critical reforms.

To read Senator Wyden and Senator Crapo’s letter to the entire Senate Finance Committee, CLICK HERE.  

Change Healthcare Attack Creates Billing Issues for Small Healthcare Providers

On February 21, Change Healthcare, a division of United Health’s Optum unit and the country’s largest billing and payment clearinghouse, began experiencing a major cybersecurity breach, leaving medical providers without the ability to verify insurance coverage, quickly send claims to payers, and schedule care.

In response, the American Medical Association (AMA) sent a letter to the Department of Health and Human Services (HHS) to use all its available authorities to ensure that physician practices can continue to function, and patients can continue to receive the care that they need. Meanwhile, the Medical Group Management Association (MGMA) wrote a similar letter outlining disruptions to medical groups, including billing and cash flow disruptions, issues with prior authorizations, inability to perform patient eligibility checks, and delays in e-prescriptions, that are disproportionately impacting smaller providers. 

In a statement on March 7, UnitedHealth Group said that all pharmacy services had been restored, though it expects that medical-claims and electronic-payment systems will be restored later in the month. 

UnitedHealth Group started a loan assistance program for providers exclusively paid through Change, but industry groups blasted the proposal. On March 11, the Centers for Medicare & Medicaid Services (CMS) announced that it would accelerate payments to Medicare Part A providers and advance payments to Part B providers. 

While many advocates called on insurance plans to streamline utilization management policies in order to ensure patients’ access to care during this time of prolonged disruption, AHIP issued a statement urging caution. “Broad exemptions in prior authorization at a time of advanced payments could expose patients and employers to fraud, waste and unnecessary costs,” AHIP President Mike Tuffin said in a statement on March 12.

To read more, CLICK HERE.

To read UnitedHealth Group’s March 7 update, CLICK HERE.

To read MGMA’s letter, CLICK HERE. 

To read AMA’s letter, CLICK HERE. 

To read more about CMS’ payment program, CLICK HERE. 

To read AHIP’s statement, CLICK HERE.