Week in Washington 110421

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



This week a new version of Build Back Better legislation was released. The new version has several changes in regards to health policy, the biggest of which entail prescription drugs. The additional provisions in regards to prescription drugs had the following:

  • Allows negotiation of drug costs in Medicare Part B and Part D.  Medicare would negotiate 10 drugs in 2023 (for plan year 2025) and up to 20 drugs in 2028. Certain drugs older than 9 years (or 12 years for more complex biologics) are eligible.  

  • Cap out-of-pocket expenses for Part D at $2,000 per year (also includes some smoothing to limit monthly costs)

  • $35 out of pocket maximum per month for insulin for Medicare beneficiaries.

  • Requires drug-makers to reimburse the federal government if they raise the price of drug faster than the inflation rate (inflation rate benchmarked to 2021). The inflation cap also applies to private insurance markets.

You can find a good summary of the new prescription drug provisions here and the latest version of the bill here.

Both the timing and outlook of passage are cloudy at the time of writing this blog. House Leadership is pushing for a vote on the bill in the next week (alongside the infrastructure bill) but it’s unclear if that will happen. If it passes the House, there is uncertainty when a vote in the Senate would take place/if it will pass. Consequently, all of the provisions could change.

Things to Watch


The  Supreme Court recently started its session. While there’s no ACA case this year, there is a case that could have large health policy implications.  In particular SCOTUS will hear a case on the Environmental Protection Agency’s (EPA’s) authority to regulate greenhouse gases. It is possible that SCOTUS will rule more broadly which could limit agencies (including HHS’) ability to issue regulations.

ACA Open Enrollment

The annual ACA open enrollment for 2022 also started this week. Kaiser Family Foundation has a good summary of some of the changes and trends to watch this year. As a reminder, Open Enrollment goes later this year - until January 15th for most states (although a few are extending it later).

Previous editions: 

10/28/2021: Week in Washington

10/21/2021: Week in Washington

10/14/2021: Week in Washington

10/07/2021: Week in Washington



09/30/2021: Week in Washington

09/23/2021: Week in Washington

09/09/2021: Week in Washington

09/02/2021: Week in Washington


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