Week in Washington Included Movement on Drug Pricing, Protecting the ACA, Surprise Balance Bills > Hospital Association of Pennsylvania


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Week in Washington Included Movement on Drug Pricing, Protecting the ACA, Surprise Balance Bills

May 10, 2019

Health care coverage and associated costs took center stage in Washington, D.C. this week, with the U.S. Congress and Trump Administration working to advance policies to address drug prices, health care bills, and access to health coverage.  

Efforts in the U.S. Senate are centered on a package of bills the Health, Education, Labor and Pensions (HELP) Committee is negotiating to curb health care costs. This package seeks to address prescription drug pricing, promote greater transparency of health care pricing, and protect patients from surprise balance bills.

Senate HELP Committee Chairman Lamar Alexander (R, TN) and Ranking Member Patty Murray (D, WA) are working in conjunction with their counterparts in the Senate Finance Committee—Chairman Chuck Grassley (R, IA) and Ron Wyden (D, OR)—and have indicated that they hope to move the legislative package this summer.

In the U.S. House, numerous drug pricing proposals are moving forward. This week, the House unanimously passed two drug-pricing bills intended to increase the accuracy of documents listing drug and biopharmaceutical patents:

  • H.R. 1503, the Orange Book Transparency Act would require manufacturers to share complete and timely information with the Food and Drug Administration (FDA) and verify that the listed patents are relevant to the approved drug product
  • H.R. 1520, the Purple Book Continuity Act of 2019 would codify publication of the patents of approved biological products, specify the information should be published electronically on FDA’s website and updated routinely, and direct FDA to consider the types of patents that should be listed

The House is expected to take up a package of drug pricing bills next week—intended to stop anticompetitive actions that stall the availability of generic drugs—along with legislation that seeks to strengthen the Affordable Care Act (ACA). The ACA bills would provide federal funding to support state-based insurance exchanges and augment outreach and enrollment efforts geared to promote coverage.

Meanwhile, the Administration continues to pursue available regulatory avenues to address issues surrounding health care costs, and also negotiate directly with Congress on policy priorities including drug pricing and surprise medical bills.

On Wednesday, the Trump Administration finalized a rule to increase transparency in pharmaceutical commercials. Under the new rule, direct-to-consumer television advertisements for prescription pharmaceuticals covered by Medicare or Medicaid must include the list price if that price is equal to or greater than $35 for a month’s supply or the usual course of therapy.

On Thursday, President Trump announced new principles to protect consumers from surprise balance bills, voicing his support for holding patients harmless for bills they receive for out-of-network care in an in-network facility.

HAP is monitoring legislative and regulatory activity related to these issues. HAP continues to support efforts to expand access to coverage, and has urged the Pennsylvania Congressional delegation to strengthen and improve the ACA framework as the most viable mechanism to ensure comprehensive health coverage for all Pennsylvanians.

As Congress grapples with developing workable solutions to protect patients from surprise medical bills, HAP encourages lawmakers to consider surprise balance billing principles developed by the American Hospital Association which call for taking patients out of the middle of standard negotiations between insurers and providers while ensuring providers are able to negotiate appropriate payment rates with health plans.

Questions pertaining to federal action on drug pricing and efforts to expand access to coverage may be directed to Laura Stevens Kent, HAP’s vice president, federal advocacy.

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