Week in Washington 060222

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

6/02/2022

Congress

There continues to be two distinct patterns in the US Senate these days. The first is generally no progress or details on potentially viable legislation. The other stories about building pressure for Senate Democrats to pass health care legislation that includes ACA premium subsidies and Medicare drug negotiations. While the overall chances of major legislation are decreasing, there remains a strong belief if something passes it will include health care items. The general clock is ticking. If legislation is passed after August, the subsidies will unlikely be able to be operationalized in time for ACA Open Enrollment for 2023.

Medicare Part B and Aduhelm

HHS announced this week that Medicare beneficiaries will have to wait until next year (2023) for a premium cut stemming from lower-than-expected costs covering the Alzheimer's treatment Aduhelm. OACT included into 2022 Part B premiums additional costs due to Aduhelm. These additional costs never materialized given CMS decisions on coverage. HHS Secretary Becerra asked CMS to examine if it would be possible to adjust 2022 Part B premiums to account for the overestimate.  CMS determined that such a roll back was not feasible. CMS instead concluded that savings from lower than expected Medicare Part B spending on Aduhelm can be passed onto Medicare beneficiaries by lower 2023 Part B premiums (which will be announced in the fall). You can read the CMS report here

Medicaid

Oklahoma’s state legislature approved a bill that would transition the state’s Medicaid program to managed care by October 1, 2023.

Research to Read

• PBMs and Generic Drugs - New research focuses on the role of pharmacy benefit managers in increasing generic drug costs in the United States. While generics make up 90% of U.S. prescription they account for only about 18% of total drug expenditures. The authors found that PBM agreements resulted in significant overpayment in generic drugs. You can read more here
• Liquidity Sensitivity of Healthcare Consumption - New research by Timothy Layton et al found that Medicare prescription fills spike on social security paydays on very small ($2-$4) copays. The research highlights how even small copays affect utilization and probabilities of delayed care. 
• care.

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