Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.
Week in Washington
HHS Regulations and Guidance
This week saw a slew of HHS/CMS related regulations, guidance, and other announcements.
Commercial COVID OTC Testing Requirements: The Biden Administration released a new requirement that Commercial Insurers (individual and group health plans) would need to cover the cost of over the counter COVID tests. Insures would need to reimburse up to 8 tests per months. More details can be found here
Adulhelm: CMS also released the proposed National Coverage Determination (NCD) for Aduhelm (and other forthcoming monoclonal antibody treatments for Alzheimer’s). The NCD stated that Medicare would only cover treatment for those enrolled in ongoing clinical trials. The public has 30 days to comment on it after which CMS would finalize the NCD.
Even before the announced NCD, HHS Secretary Becerra asked CMS to re-evaluate 2022 Medicare Part B premiums. Biogen, the maker of Adulhelm, recently cut the annual price of the drug 50%. A large part of the reason for the large (nearly 15% increase) Medicare Part B increase was due to potential costs associated with Adulhelm. The reduced price and potentially reduced utilization (if the NCD is finalized as proposed) would result in a much lower Medicare Part B premium.
Medicare Rule: CMS also release the proposed Contract Year 2023 rule for Part C and Part D. The rule proposes changes such as: 1) require that the negotiated price reflect the lowest possible pharmacy reimbursement, inclusive of performance-based payment arrangements, for purposes of determining beneficiary cost-sharing at the point of sale; 2) making changes to network adequacy; 3) changes MA MLR reporting, and 4) CMS is proposing that DSNPs administer the MOOP as if State-paid cost sharing counts toward the MOOP
Congress (specifically the Senate’s) attention was focused on voting rights this week so there’s been no updates on Build Back Better bill.
COVID cases continue to climb to record numbers. Currently COVID cases are average around 780,000 a day with covid-related hospitalization numbers reaching around 150,000 cases. While the Omicron variant appears to be milder, the volume of cases is resulting in large increases in ICU hospitalizations as well as deaths.
The Bureau of Labor and Statistics released a report that inflation rose at 7 percent in December, the highest rate in 40 years. To date, Medical services/prices have risen only 2.5 percent, or below overall inflation. There are concerns that this Medical prices could increase in 2022 due to similar pressures affecting the overall economy.
Medicaid Expansion will officially be on the ballot in South Dakota this fall. To date this is the only state that will vote on expanding Medicaid in 2022.
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