PBMs Placed In The Crosshairs
While a House subcommittee advances a bill to make pharmacy benefit managers' business more transparent, the FTC widens its probe into their impact on drug prices. Separately, some senators are probing Medicare Advantage plans.
Modern Healthcare:
House Panel Advances Bill To Promote PBM Transparency
Pharmacy benefit managers would be subject to new transparency rules under legislation that cleared a key House subcommittee on Wednesday. The Transparent PRICE Act of 2023, which received a unanimous vote in the the House Energy and Commerce Committee's Health Subcommittee, would require PBMs to annually provide employers with detailed data on prescription drug spending, including acquisition costs, out-of-pocket spending, formulary placement rationale and aggregate rebate information. The bill also would order the Government Accountability Office to report on group health plan pharmacy networks, including those owned by health insurance companies. (Nzanga, 5/17)
Stat:
FTC Widens Probe Into Pharmacy Benefit Managers To Include Group Purchasing Organizations
The Federal Trade Commission is widening its probe into pharmacy benefit managers and their impact on drug pricing by looking into a pair of group purchasing organizations that are owned by these industry middlemen, but are not well understood outside the industry. By seeking documents from Zinc Health Services and Ascent Health Services, the agency is attempting to unravel what critics complain is an opaque set of business practices and relationships. Pharmacy benefit managers are linchpins in the pharmaceutical pricing system, and are under increased scrutiny for allegedly driving up consumer costs. (Silverman, 5/17)
Stat:
House Panel Takes First Steps Toward Reining In Hospitals With ‘Site-Neutral’ Changes
A key House panel on Wednesday advanced several health care bills on Wednesday, including its first step toward a controversial effort to equalize Medicare payments between hospitals and physician offices. The Energy and Commerce health subcommittee passed a provision that would ensure Medicare pays the same amount to doctors who administer drugs whether they’re given in a hospital or a physician’s practice. (Cohrs, 5/17)
Stat:
Senators Probing Largest Medicare Advantage Plans Over How Algorithms Factor In Care Denials
Senators warned the country’s largest Medicare Advantage insurers at a hearing on Wednesday that they must abide by Medicare’s coverage rules and cannot rely on algorithms to deny care that patients need. Congress is ramping up its oversight, too. Lawmakers in both parties have asked UnitedHealth Group, Humana, and CVS Health’s Aetna for internal documents that “will show how decisions are made to grant or deny access to care, including how they are using [artificial intelligence],” said Sen. Richard Blumenthal, the top Democrat on a subcommittee with the power to investigate government affairs, during the hearing. (Herman and Ross, 5/17)
On the debt-limit crisis —
Politico:
Biden Indicates He’s Willing To Make A Debt Ceiling Compromise
President Joe Biden on Wednesday left the door open to expanding some work requirements as part of a debt ceiling deal, committing only to opposing new restrictions that affect health care programs. “I’m not going to accept any work requirements that’s going to impact on medical health needs of people,” he said, before adding that “it’s possible” a deal could expand work rules for other federal programs. (Cancryn and Daniels, 5/17)
In updates on military health care —
Modern Healthcare:
VA Seeks To Hold Oracle Cerner Accountable With Revised EHR Deal
The Veterans Affairs Department has renegotiated its agreement with Oracle Cerner to hold the electronic health record company more accountable, the VA said on Thursday. The new contract has been restructured from a single, five-year term to five, individual one-year terms, said Dr. Neil Evans, acting director of the VA's Electronic Health Record Modernization Integration Office, in an email. Evans said the new agreement “dramatically increases VA’s ability to hold Oracle Cerner accountable across a variety of key areas.” (Turner, 5/17)
Military.com:
Fewer Tricare Pharmacy Patients Renewed Auto Refills After Confirmation Requirement
Five percent of Tricare users who previously received automatic prescription refills by mail didn't renew their drugs under a new policy requiring them to confirm the orders, according to the Defense Health Agency. Those patients either disenrolled or didn't consent to renew their prescription between January and the end of March, which was the first three months of the new refill policy, DHA spokesperson Peter Graves told Military.com by email. (Miller, 5/17)
