Massive Opioid Package Gives Congress Opportunity To Roll Back ‘Doughnut Hole’ Change That Pharma Hates
In February, Congress passed a provision forcing drug manufacturers to pay more for drugs used by Medicare beneficiaries. The industry has been railing about the change ever since, and the bipartisan opioid package might be lawmakers' chance to hand pharma a big win.
The Hill:
Lawmakers Consider Easing Costs On Drug Companies As Part Of Opioids Deal
Lawmakers are considering adding a provision easing costs on drug companies to an opioid package currently being negotiated. The powerful pharmaceutical industry has been pushing for months to roll back a provision from February’s budget deal that shifted more costs onto drug companies, and they sense they have a chance to attach the change to the bipartisan opioid package currently moving through Congress. (Sullivan, 9/20)
Stat:
GOP Lawmakers Seeking To Use Opioids Bill To Deliver Drug Industry Major Victory
The provisions that made it into law in February leave drug makers on the hook for 70 percent of prescription costs for seniors who reach the so-called donut hole in 2019 — that is, after they’ve spent $3,750 a year on drugs. The figure was previously 50 percent. Republicans are negotiating the deal without Democrats, according to multiple lobbyists, who spoke on the condition of anonymity. But a good chunk of the Democratic Party is likely to support the change, particularly if it includes the CREATES Act to offset the cost. (Facher and Florko, 9/20)
Modern Healthcare:
Pharma Push For Medicare Donut Hole Change Tangles Opioid Negotiations
Proposals on the table to offset some of the costs of the Part D policy change included watered-down version of the CREATES Act, pushed this year by Sens. Charles Grassley (R-Iowa) and Patrick Leahy (D-Vt.), to expedite approvals of new pharmaceutical alternatives to brand-name drugs as one way to off-set the cost. The bill being considered would save about $2.6 billion. Another potential proposal is to delay the Medicare Part D "cliff" that will increase the donut hole for seniors starting in 2020 by two years, rather than establishing a permanent fix, according to an aide. The measure in question would offload about $4 billion in financial liability that drugmakers are supposed to shoulder starting Jan. 1, 2019, under the Bipartisan Budget Act of 2018. (Luthi, 9/20)
CQ:
Lawmakers Could Revisit 'Doughnut Hole' Fix In Opioid Bill
The drug industry is seeking to reduce the percentage they pay to 63 percent, with health insurers paying the rest. House GOP leaders seemed to be leaning toward granting the drug industry's request. In a letter sent Tuesday, 155 Republican lawmakers thanked GOP leaders for their “extraordinary efforts” to address the Medicare issue and “attach a fix to an upcoming vehicle.” (McIntire and Siddons, 9/20)
Meanwhile, the American Medical Association is worried about privacy protections in the sprawling package —
Stat:
AMA Urges Congress: Don't Loosen Privacy Restrictions For Patients With Addiction
The American Medical Association is opposing a change to patient privacy laws that would allow doctors to more freely share information about a patient’s history of substance use, a proposal that has divided the health care community and highlighted some of the challenges of addressing the opioid epidemic. In a letter to lawmakers obtained by STAT, the AMA said it believed there was a “fundamental misunderstanding” among groups working to incorporate the proposal into a sprawling opioids bill. Relaxing restrictions on patient privacy, the AMA wrote, could prevent individuals with addiction from seeking medical treatment in the first place. (Facher, 9/21)
