Policy + Advocacy News for June

June 1, 2022

Accessia Health monitors American health policy updates at the state and federal levels in order to inform our organizational policy decisions and agenda. Following are some recent highlights you may find interesting.*

Federal News

  • Eighty-seven organizations representing patients with chronic and acute health conditions, including Accessia Health, sent a letter to Congress this month urging them to improve the diversity of enrollment in clinical trials as part of this year’s Prescription Drug User Fee Act (PDUFA) reauthorization. Reauthorizing PDUFA would allow the Food and Drug Administration (FDA) to continue its vital mission of reviewing and approving drugs.


  • CMS recently issued a variety a new policies that pertain to the patients we serve. They will impact patients to varying degrees, but this new policy regarding beneficiary cost sharing is particularly interesting:
    • Lowering Beneficiary Cost-Sharing at the Pharmacy Counter In recent years, more Part D plans have been entering into arrangements with pharmacies that may pay less money for dispensed drugs if pharmacies do not meet certain criteria. The negotiated price for a drug is the price reported to CMS at the point of sale, which is used to calculate beneficiary cost-sharing and generally adjudicate the Part D benefit. With the emergence of these payment arrangements, the negotiated price is frequently higher than the final payment to pharmacies. Higher negotiated prices lead to higher beneficiary cost-sharing and faster beneficiary advancement through the Part D benefit. CMS is finalizing a policy that requires Part D plans to apply all price concessions they receive from network pharmacies to the negotiated price at the point of sale, so that the beneficiary can also share in the savings. Specifically, CMS is redefining the negotiated price as the baseline, or lowest possible, payment to a pharmacy, effective January 1, 2024. This policy reduces beneficiary out-of-pocket costs and improves price transparency and market competition in the Part D program.
    • For more: CY 2023 Medicare Advantage and Part D Final Rule (CMS-4192-F) | CMS


  •  AARP: Medicare Spending On Rxs Outpaces Development Costs A new AARP analysis finds that the billions of dollars Medicare Part D spent over five years for just 10 top brand name prescription drugs more than made up for the money drugmakers say it costs to research and develop new medications. AARP’s Public Policy Institute looked at total Medicare spending between 2016 and 2020 on the 10 brand name drugs that the program spent the most on in 2020. This research found that, for example, Medicare spent $27.2 billion during that period to pay for Eliquis, a blood thinner used to treat atrial fibrillation (Afib), a condition that causes an irregular heartbeat. That’s more than 10 times what the pharmaceutical industry says is the average cost to develop a new drug: $2.6 billion. (Bunis, 5/11)


  • Nearly 36M people have ACA-related coverageNearly 36 million Americans have health care coverage through Affordable Care Act marketplace plans, Basic Health Plan policies and coverage enabled through expanded Medicaid eligibility, HHS reports. The percentage of uninsured Americans dropped from 10.3% in the fourth quarter of 2020 to 8.8% in the same period last year, which translates to around 4.9 million people gaining coverage. Full Story: CNN (4/29), Becker’s Payer Issues (4/29)


  • A Kaiser Family Foundation report estimates Medicaid enrollment will have increased by 25% over 2019 enrollment by the end of fiscal 2022, marking an increase of 22.2 million people, but as many as 14.2 million people could lose coverage when the COVID-19 public health emergency ends and states resume eligibility redeterminations. Some people who lose coverage may do so because of difficulty navigating redetermination, rather than true lack of eligibility, and the authors of the report recommend states invest in outreach, education and enrollment support. Full Story: FierceHealthcare (5/10)


  • CMC Highlights How MA Delivers on Mental Health Needs of Seniors and People with Disabilities The Coalition for Medicare Choices (CMC) published a new resource in recognition of Mental Health Awareness Month that shares stories from Medicare Advantage (MA) enrollees and advocates about the mental health support they’ve received. In response to the intensified demand for mental health support during COVID-19, MA plans adapted to help members navigate telehealth resources including tele-mental health appointments and virtual fitness classes. CMC member, Anne, described finding a counselor through her MA coverage as, “an easy process.”Medicare Advantage continues to provide high-quality, affordable, and comprehensive health coverage, including mental health support, to over 28 million seniors and people with disabilities. To hear other mental health support stories, watch the video recordings from CMC members here.


  • MarketWatch: The Amount Of People Who Have Medical Debt Has Declined During The Pandemic, But It Could Bounce Back Soon, Researchers Warn Although the COVID-19 pandemic has sent more than 4.6 million people to the hospital, the share of Americans with medical debt declined last year, new research shows. However, that trend could reverse soon, researchers warned. The share of adults with medical debt, problems paying medical bills, and medical debt in collections fell in 2021 compared to 2018, an Urban Institute study published Wednesday found. The UrbanInstitute is a left-leaning nonprofit think tank that conducts research regarding economic and social policies. … The authors of the paper, Michael Karpman, Kassandra Martinchek, and Breno Braga, suggested that the drop in consumers with medical debt was likely due to fewer people seeking health care because of a fear of coronavirus exposure, as well as help from temporary government financial relief and increasing enrollment in Medicaid. (Han, 5/13)


  • Modern Healthcare: Employer Health Plans Pay Hospitals 224% Of Medicare Employers continue to pay hospitals more than double the amount Medicare would pay for the same services, a new study shows. Private employer-sponsored health plans paid hospitals 224% of Medicare prices, on average, according to an updated RAND Corp. analysis of claims from 4,000 hospitals across every state except Maryland. Hospitals with higher market shares tended to have higher prices, according to the study, which supports past research. A 10% increase in hospital market share was associated with a 0.5% increase in a hospital’s price relative to Medicare, researchers found. Still, some researchers noted that a 0.5% increase for a significant 10% boost in market share was relatively small. (Kacik, 5/17)



*Helping patients better access and afford their health care is what we strive to do. We know that patients can’t benefit from medications and care that they can’t afford, so we will continue to advocate for policy change that will enable patients to directly benefit from payment assistance programs. If you have questions or comments about Accessia Health’s government affairs and policy work, please contact Ashlea Christiansen at achristiansen@accessiahealth.org.