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
- The House of Representatives selected a Speaker of the House (Kevin McCarthy) last week. As part of the deal that resulted in Speaker McCarthy’s election, House Republicans agreed to require changes to mandatory programs in exchange for lifting the debt ceiling. This could ultimately have implications for the US economy and Medicare/Medicaid programs.
- PHE – HHS renewed the Public Health Emergency (PHE) this week. The PHE will go until April 11, 2023. Politico reported that the Administration is targeting an end of the PHE this spring. If this is the last PHE extension, HHS will announce that on February 10. As a reminder as part of the recent budget bill, regardless of when the PHE ends, Medicaid redeterminations can begin April 1.
- Medicaid – CMS released a useful document on timing around Medicaid redeterminations. State will have flexibility as to when they begin to initiate renewals. Some states have already announced that they will target April 1 as the date terminations to begin, which means notices will begin reaching beneficiaries in February. Other states may wait until April to begin initiating renewals.
- ACA OE – CMS announced that ACA Open Enrollment plan selections are up 13% year over year (15.9 million). Enrollment increases have highly been pronounced in states that HHS operates Exchanges. Open Enrollment ends for most states on January 15th.
- Overall CMS Enrollment – The large growth in both ACA Exchanges and Medicaid over the past few years has meant that CMS is covering a larger and larger portion of the US population. CMS announced that overall, it covers 158.5 million people or about 48% of the US population.
- Prescription Drugs –- CMS also released a timeline on drug price negotiations. While the first time the negotiated prices will impact consumers is January 1, 2026, there are lots of steps along the way. The first big date is September 1, 2023, where CMS will release the names of the 10 drugs selected for negotiation. CMS expects to publish guidance and begin the data collection process this winter/spring so additional details will be forthcoming over the next few months.
New Alzheimer Drug
- The FDA approved last week a new Alzheimer drug, Leqembi. It has many similarities to the controversial Aduhelm drug (intravenous infusion targeting individuals with mild cognitive impairment/early Alzheimer’s). The drug is currently approved under accelerated approval, which similar to Aduhelm, means that there is limited coverage in Medicare. However, the Leqembi, unlike Aduhelm, applied for full approval by the FDA. If the drug gets full approval, CMS will cover it. Full approval could happen this year. The drug is expected to be priced at $26,500 per year and expected to be a blockbuster if CMS approves it (Aduhelm was originally priced at $56k as a comparison).
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