Payer Roundup—PBM reform gathering sparks new hope; Centene talks ACA subsidies
15 Mar 2024
Gene Therapy
Preview
Source: FierceHealthcare
Keep up with some of the latest headlines in the payer space with our weekly roundup.
Wyden, Crapo push PBM reform again
Senate Finance Committee leaders Ron Wyden, D-Oregon, and Mike Crapo, R-Idaho, gathered with pharmacists and patients to advocate for PBM reform Thursday morning.
They said there would be an opportunity to advance reform in the next few days, despite Wyden previously lamenting the absence of PBM-related items in the recent spending package, warning the provisions might be delayed until December or longer. Both senators want PBM reform included in the upcoming spending bill later this month.
The senators referenced their committee's unanimous passage of the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, which included provisions from the Modernizing and Ensuring PBM Accountability Act, in November.
Wyden called that accomplishment "just about impossible" during a hearing on Biden's proposed fiscal year 2025 budget later on Thursday.
Department of Health and Human Services Secretary Xavier Becerra said the administration is ready to collaborate on PBM reform and eliminate unnecessary middlemen in healthcare. He noted the White House just held an event to raise awareness of the issue.
Crapo asked the administration to more forcefully use the bully pulpit to get legislation moved through Congress.
National Association of Chain Drug Stores President and CEO Steve Anderson stated that more than 300 advocates from 50 states would be meeting with Congress this week to fight for change.
Sarah London talks ACA subsidies
Centene CEO Sarah London is again downplaying concerns over how the election will impact the Affordable Care Act (ACA).
Enhanced ACA subsidies expire by the end of 2025, after a three-year extension was implemented once the Inflation Reduction Act was signed into law. Should these marketplace subsidies expire, premiums could increase and insurers could be negatively impacted.
President Joe Biden stated his intention to make those subsidies permanent during his State of the Union address, but she said even Republicans understand their base is coming around to the subsidies' benefits. She said she thinks lawmakers on both sides of the aisle could come together to make the extension permanent.
"There are sort of different levers that could be pulled," London said. "The biggest one to note is they expire coincident with the Trump tax cuts, and so the prevailing view is that the Republicans are going to want to make those permanent. That intentionally brings both sides of the table together for a conversation.
"We don't see it as a binary event," she added.
9 issues not in Biden's budget
The Biden administration effectively balked on nine key issues in the president's proposed fiscal year 2025 budget, law experts from McDermott Will & Emery observed.
His budget did focus on drug price negotiations, Medicare solvency, cybersecurity and behavioral health, among other policies.
Here are nine areas in which the Biden administration did not lay out a comprehensive plan:
Medicare Advantage
Physician payment reform
Merit-based incentive payment system
Alternative Payment Model extension
Telehealth
Site-neutral policies
AI strategy in healthcare
Healthcare worker well-being
PBM reform
Many of these policies have been debated regularly in Congress in recent months.
More from Fierce Pharma: Bluebird bio inks first Medicaid coverage agreement for sickle cell gene therapy, signing on with Michigan
For more details,please visit the original website
The content of the article does not represent any opinions of Synapse and its affiliated companies. If there is any copyright infringement or error, please contact us, and we will deal with it within 24 hours.
Organizations
Indications
-Targets
-Drugs
-Hot reports
Get started for free today!
Accelerate Strategic R&D decision making with Synapse, PatSnap’s AI-powered Connected Innovation Intelligence Platform Built for Life Sciences Professionals.
Start your data trial now!
Synapse data is also accessible to external entities via APIs or data packages. Leverages most recent intelligence information, enabling fullest potential.