THIS WEEK’S DOSE

• House Oversight and Accountability Committee Holds Hearing on PBMs. The committee questioned the three largest pharmacy benefit managers (PBMs) over their role in rising healthcare costs.
• House Energy & Commerce Health Subcommittee Holds CDC Hearing. This highly partisan hearing brought the heads of each Centers for Disease Control and Prevention (CDC) division before the committee to examine the CDC’s priorities and public trust in the agency.
• Senate Judiciary Human Rights and the Law Subcommittee Holds Hearing on Georgia Abortion Ban. The field hearing examined how Georgia’s abortion ban impacts women’s health.
• CMS Announces Actions to Stop Unauthorized Agent and Broker Marketplace Activity. The Centers for Medicare & Medicaid Services (CMS) aims to protect consumers from bad actors and ensure the program integrity of the Federally Facilitated Marketplace.
• CMS Releases Final Part Two Guidance on Medicare Prescription Payment Plan. The guidance includes information regarding plan outreach and education.

CONGRESS

House Oversight and Accountability Committee Holds Hearing on PBMs. Republicans and Democrats shared concerns about the role and practices of PBMs. While generally supportive of free market principles, Republicans criticized PBMs for lack of transparency and anticompetitive behaviors, such as vertical integration and the use of arrangements that allow PBMs to fall outside certain regulatory requirements. Democrats expressed concern about the opaqueness and complexity that PBMs add to the healthcare system as well as their impacts on patients. This bipartisan agreement highlights a common ground for potential legislative reform aimed at increasing transparency and reducing PBMs’ overall impact on drug pricing. For more information on the committee’s activities, including a recently released report, read this press release.

House Energy & Commerce Health Subcommittee Holds Hearing on CDC. Witnesses were the heads of the CDC’s main divisions. During the hearing, Republicans expressed concerns that the CDC has moved too far from its initial focus on infectious diseases and now includes focus areas that are duplicative of other federal agencies’ work. Democrats expressed concerns regarding the proposed cuts to CDC funding in House Republicans’ FY 2025 appropriations bills and urged the committee to sustain CDC funding. Democrats in particular mentioned concerns about the impacts of eliminating the National Center for Injury Prevention and Control. The CDC witnesses urged sustained support and investment in the CDC to continue its work, including data modernization efforts.

Senate Judiciary Human Rights and the Law Subcommittee Holds Hearing on Georgia Abortion Ban. The hearing discussed the dangers to Georgia women’s health and human rights caused by the state’s six-week abortion ban. The field hearing took place in Decatur, Georgia, and featured a panel of OB/GYNs and residents. Senator Jon Ossoff (D-GA) was the only senator present. Witnesses discussed how the Georgia law will exacerbate workforce shortages because medical residents are choosing to learn and practice in states without abortion restrictions. Witnesses also provided statistics on the maternal mortality rate and OB/GYN shortage in Georgia. Chairman Ossoff focused his questioning on the vague language and exceptions policy in the Georgia law, specifically regarding how it influences providers’ decisions and harms their ability to provide essential care.

ADMINISTRATION

CMS Announces Actions to Stop Unauthorized Agent and Broker Marketplace Activity. To address growing complaints of brokers switching consumer health plan enrollments without consumers’ consent in the Affordable Care Act Marketplace, CMS announced that starting on July 19, 2024, it will block an agent or broker from making Federal Facilitated Marketplace enrollment changes unless the agent is already associated with the consumer’s enrollment. Unassociated or “new” agents and brokers will be required to take additional steps to update a consumer’s Marketplace enrollment. They must now conduct a three-way call with the consumer and the Marketplace Call Center or direct the consumer to submit the change themselves through HealthCare.gov or via an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway.

CMS Releases Final Part Two Guidance on Medicare Prescription Payment Plan. CMS finalized additional Inflation Reduction Act guidance on the Medicare Prescription Payment Plan. Under the plan, beginning in 2025, Medicare Part D enrollees will have the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy. Part one of the guidance, released in August 2023, focused on operational requirements for the program, while part two focuses on Part D enrollee education, outreach and communications.

The part two guidance includes:

• Requirements for how Part D plan sponsors must educate their Part D enrollees on the Medicare Prescription Payment Plan.
• Requirements on how Part D plan sponsors should target specific Part D enrollees who are likely to benefit from the Medicare Prescription Payment Program.
• Information on how CMS plans to educate Part D enrollees about this new program
• Information on how CMS plans to engage other interested parties and what resources CMS will provide to assist interested parties’ education efforts on the new program.

Read more in the CMS press release.

QUICK HITS

• HHS Announces ONC Reorganization to Streamline Technology, Data Functions. The US Department of Health and Human Services (HHS) announced that the Office of the National Coordinator for Health Information Technology (ONC) will be renamed the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology. Oversight of technology, data and artificial intelligence policy and strategy will move under this roof (and away from the assistant secretary for administration). The public-private effort between the health sector and the federal government on cybersecurity will move to the Administration for Strategic Preparedness and Response, as other similar efforts are already housed there. For more information, register for an informational webinar here.
• CMS Hosts AHEAD Model Webinar. CMS staff provided an update on the Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model’s CMS-Designed Medicare Fee-for-Service Hospital Global Budget Methodology. The presentation slides can be viewed here.
• Kids Online Health and Safety Task Force Releases New Report with Recommendations. The task force is co-led by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the US Department of Commerce’s National Telecommunications and Information Administration. The task force released a new report that provides a summary of the risks and benefits of social media on the health, safety and privacy of young people; best practices for parents and caregivers; recommended practices for industry; a research agenda; and suggested future work, including for the federal government. Read more in the agency’s press release.
• Administration Awards Funds to Expand Mental Health and Substance Use Services Across the Lifespan. SAMHSA announced grant awards totaling $45.1 million, of which $15.3 million will fund services specifically for children and youth. The funds for children and youth will specifically serve them through supporting their mental health in school settings, serving children and families who have experienced traumatic events and grief, and providing services specific to young people of transitional ages who have or are at risk for serious mental health conditions.

NEXT WEEK’S DIAGNOSIS

After failure of the energy-water appropriations bill on the House floor this week, House leadership announced that the House would begin its summer recess early, starting July 26, 2024. This provides members an additional week at home with their constituents and on the campaign trail. The House is scheduled to return to session on September 9, 2024. Next week is scheduled to be the Senate’s final week of session before its recess. The Senate is also scheduled to return on September 9. We anticipate some Senate healthcare activity at the committee level next week, including a Senate HELP Committee markup of health legislation. On the regulatory front, we are also looking towards publication of the final Inpatient Prospective Payment System rule.