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 continues to debate what to do about the looming Medicare provider cuts. There hasn’t been much movement lately on it or the larger question about the budget. While technically an agreement is needed in a few weeks, there are discussions of having a short-term stop-agreement that would push the timeline on an agreement towards the end of December. In other words, while there will be certainty by the end of the year on how Congress is handling provider cuts, it might now be closer to the end of the month rather than the middle.
CMS announced initial 2023 Open Enrollment figures for the ACA Exchanges. Initial activity (around mid-November) has enrollment at nearly 3.4 million people, which is a 17% increase over last year. Additionally, new enrollment was up about 40%. Open enrollment for most states goes until January 15th.
CMS also released a request for information (RFI) on how to change requirements around essential health benefits (EHBs) in the future. The RFI hinted that CMS is considering ways to change EHB requirements to fill in benefit gaps of currently unmet needs. It is unlikely that potential changes would affect the 2024 benefit year and more likely for either 2025 or 2026.
Politico reported that next year’s state legislative could include several discussions around expanding Medicaid. Kansas and North Carolina are both expected to seriously debate whether to have Medicaid expansion in their respective state. While the actual chances of passage are low, these two states represent the two most likely states to expand Medicaid over the next few years.
Biosimilar for Humira
The Wall Street Journal reported that biosimilars for Humira will be coming to the US in 2023. While it may take time for Humira to change cost tiers, there will be lower cost options available starting next year. Biosimilars have been estimated to save Medicare approximately $1.5 billion between 2015 and 2020.
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