Health Policy Report – November 28, 2023

In A New Op-Ed, Dr. Jamal Misleh Urges States to Take Action on White Bagging Mandates

Dr. Jamal Misleh, hematologist-oncologist and Practice President at Medical Oncology Hematology Consultants, recently penned an op-ed in MedCity News urging state legislators to restrict the use of white bagging mandates. 

In the piece, Dr. Misleh shared his experience treating a patient with non-Hodgkin’s Lymphoma. Unbeknownst to Dr. Misleh, the patient’s health insurance plan included a white bagging policy, which mandated the practice to obtain medication from a specialty pharmacy, rather than utilize the on-site drug inventory. 

“Eventually, we were able to negotiate coverage through our practice’s internal inventory, but by the time the patient was able to receive the drug four weeks had passed,” Dr. Misleh explained. “This extensive delay took a devastating toll on my patient’s physical and mental health and well-being.”

Dr. Misleh went on to highlight reform efforts in his home state of Delaware, which recently prohibited specialty pharmacies from delivering white bagged drugs unless the dispensing pharmacist and prescribing physician agree that such an approach is in the individual patient’s best interest. Delaware’s attention to this issue follows reforms in states like Texas, where state policymakers recently passed legislation to limit how and when insurers can use white bagging. 

“I urge state legislators around the country to prohibit white bagging mandates and enact legislation to stop insurance companies and PBMs from forcing patients into this dangerous practice,” Dr. Misleh concluded. 

To read more, CLICK HERE.

House, Senate Pass Funding Bill, Leaving Uncertainty About Health Care Priorities

On November 15, the Senate approved in an 87-11 vote a two-tiered stopgap spending measure previously passed in the House, which will keep some agencies funded through January 19 and others into February 2. President Biden signed the bill on Thursday, November 16. 

Since the government is now funded into the New Year, this will mark the first December since 2012 without a critical funding deadline. As a result, it is unclear when Congress will move forward with other key health care policies under consideration, such as an increase in Medicare physician payment, an extension of Advanced Alternative Payment Model incentive payments, site neutral payment reforms, or a provision to allow for the resumption of home delivery of needed oral medications.

This is a marked change from previous years, where lawmakers engaged in year-end dealmaking around an omnibus spending bill that addressed telehealth, Medicare physician payment cuts, and FDA fast-track drug approvals. 

To read more, CLICK HERE. 

Senator Cassidy Pursues 340B Probe, Requests Data from Community Health Centers

On November 16, Sen. Bill Cassidy (R-LA), Ranking Member of the Senate Health, Education, Labor and Pensions (HELP) Committee, sent two separate letters to Sun River Health and Yakima Valley Farm Workers Clinic, two of the largest community health center systems in the country, asking them to provide information about revenue derived from the 340B drug discount program and how the revenue is being spent. 

The letters are the latest in Cassidy’s recent efforts to revamp the 340B program and increase transparency amongst covered entities. In September, Cassidy sent similar letters to Bon Secours Mercy Health and Cleveland Clinic.

In the letters, Cassidy noted that the Government Accountability Office and HHS’ Office of the Inspector General have both raised issues with the 340B program’s integrity. Further, other lawmakers on Capitol Hill have been increasingly eyeing 340B reform. In June, the Senate’s 340B working group sent a request for information on the lack of transparency and accountability in the program. Meanwhile, GOP lawmakers on the House Energy and Commerce Committee passed a bill that included 340B reporting requirements in May, though this bill has been stalled in the House since. 

To read a press release from Sen. Cassidy’s office, CLICK HERE. 

Energy and Commerce Panel Advances 21 Health Bills

The House Energy and Commerce Health Subcommittee voted unanimously on November 15 to advance 21 legislative proposals, including several pharmacy benefit manager (PBM) reform bills. Specifically, the panel passed legislation to delink PBM compensation from prescription drug list prices and ban spread pricing, as well as a proposal to create public quality measures to determine direct and indirect remuneration payments to pharmacies. The subcommittee also passed H.R. 6371, the Provider Reimbursement Stability Act, which would make meaningful updates to the Medicare physician fee schedule, and H.R. 6369, which would extend incentive payments for physician participation in advanced alternative payment models.  

The reforms passed by the E&C panel are similar to bipartisan reforms recently passed out of the Senate Finance Committee, increasing the likelihood that these measures will be brought to the floor; however, the exact timing remains unclear.

To watch the hearing and view a summary of the bills, CLICK HERE.

To read more, CLICK HERE.

Chairman Sanders Invites Drug Companies to Testify on High Drug Prices

On November 21, HELP Committee Chair, Bernie Sanders (I-VT), joined by Democrats on the Committee, invited CEOs from Johnson & Johnson, Merck, and Bristol Myers Squibb to testify before the committee in a public hearing on “the outrageously high cost of prescription drugs.”

The hearing is titled “Why Does the United States Pay, By Far, The Highest Prices In The World For Prescription Drugs?” and is set for January 25, 2024. In a press release accompanying the hearing announcement, the lawmakers compare the price of certain drugs made by those drug manufacturers in the United States compared to other countries and note how much each company made in profit and their CEO’s compensation for 2022.

“The American people have a right to know why it is that they pay, by far, the highest prices in the world for prescription drugs while the pharmaceutical industry in the U.S. makes hundreds of billions in profits and pays their CEOs tens of millions of dollars in compensation,” said Chairman Sanders.

To read a press release from Senator Sanders and letters to drugmakers, CLICK HERE.

Biden Appoints Dr. Kimryn Rathmell to Lead National Cancer Institute

On Friday, November 17, President Biden announced plans to appoint Dr. Kimryn Rathmell to lead the National Cancer Institute (NCI), filling the role formerly held by Dr. Monica Bertagnolli, who was recently confirmed to lead the National Institutes of Health. 

As a medical oncologist, Dr. Rathmell’s work has been primarily focused on kidney cancer and its drivers. Dr. Rathmell currently serves as the Hugh Jackson Morgan Chair in Medicine, Chair of the Department of Medicine and Physician-in-Chief at Vanderbilt University Medical Center (VUMC) in Nashville. She also currently serves on NCI’s Board of Directors. 

As NCI director, Dr. Rathmell will oversee several of the administration’s initiatives, including the Cancer Moonshot, that are intended to reduce cancer deaths and boost clinical breakthroughs. “Dr. Rathmell is the talented and visionary leader the National Cancer Institute needs to drive us toward ending cancer as we know it,” Biden said in a statement. 

To read a statement from President Biden, CLICK HERE.

To read more, CLICK HERE.