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
Congress remains without a Speaker of the House this week due to Rep. Jim Jordan, the new Republican nominated candidate repeated defeats. Without a Speaker, no legislation (including budget deals) can move in the House. There is the potential for further votes in the near term but its very unclear if any candidate can win a majority of the House.
The Supreme Court signaled via adding a case (Relentless, Inc. v Department of Commerce) to its docket in January that it will consider making changes to the Chevron deference. The Chevron deference gives federal agencies flexibility in how they interpret Congressional laws when making regulations. If the Chevron deference were to be reduced or ended, it would dramatically reduce the scope of regulating federal agencies, including CMS.
- Drug shortage – CMS is considering reimbursing hospitals for creating stockpiles for certain critical prescription drugs as a way of reducing ongoing drug shortages. The policy, in the short term, could cause further supply issues. The policy could be finalized as part of the annual Medicare hospital reimbursement regulation.
- Stars – CMS released the 2024 Star ratings (which impact 2025 Medicare bid payments). Star rating dropped this year. The drop in Star Rating was often driving by a change in cut points (i.e., methodology). To better understand the key methodology changes that impacted 2024 Star Ratings, I’d recommend this white paper by Suzanna-Grace Tritt.
- Alzheimer’s Treatment – CMS removed the cap on scans for protein beta-amyloids as part of the protocol for determining if the new Alzheimer’s treatments (e.g., Leqembi) are appropriate. This would allow providers to potentially do more diagnoses and broaden access to the treatment. CMS will allow Medicare contractors to make the actual coverage decisions.
- KFF – KFF released its annual survey of employer-sponsored health insurance. Overall, they found that family premiums increased 7% in 2023 (up to $23,968) relative to 2022. This increase was higher than the inflation rate.
- Mental Health- Politico reported that the Biden administration is close to 9.000 responses to the proposed regulation that would expand mental health parity requirements. Insurers (e.g., AHIP BCBSA) and employer groups (e.g., ERIC) voiced opposition.
- Paxlovid – Pfizer announced that the list price for Paxlovid for the commercial market would be $1,390, which is about twice the list price the government paid ($529) last year.
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