Week in Washington 110923

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

11/09/2023

Medicare Rules Released

CMS released its proposed annual Policy and Technical Changes to the MA/Part D rule this week. The rule lays out key changes for the rules governing MA, Part D, Medicare costs plans, PACE and Health Information Technology standards for the 2025 benefit year. Of a particular note, CMS proposed to limit agent/broker compensation for MA plans. CMS had received pressure from various stakeholders to reduce deceptive marketing. The rule also proposes to require MA organizations to establish bibliographies about SSBCI to demonstrate compliance, inclusion of health equity as part of the utilization management committee, permit biosimilar biologics to be substituted more easily, limit D-DNP PPO’s out of network cost-sharing, lower the D_SNP look-alike threshold, and standardized MA RADV appeals. Comments are due January 5th. 

Other CMS Regulations

The final interoperability rule and the proposed 2025 ACA Payment Notice are two regulations at OMB. Both rules should be coming in the near term. Administrations typically finalize rules earlier in election years and have fewer of them put forth.

Congress

• Shutdown – Still no deal on a budget that would keep the government open past the November 17th deadline.
• Healthcare Package – A key Senate committee passed a bipartisan bill that would increase Medicare reimbursement rates for doctors by 1.25 percent in 2025. Currently, doctors face a 3.4 percent cut next year. The bill would also extend bonus incentives for doctors when they are part of an alternative Medicare payment model. The bill faces an uncertain pass forward but could be included as part of a budget deal. 

New Weight Loss Drug

The FDA approved a second diabetes drug, Eli Lilly’s Mounjaro for weight loss. The drug has a list price of $1,060 (i.e., below Wegovy). GLP-1 class drugs are expected to put pressure on Commercial insurance premiums.

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