Week in Washington: Regulation Watch

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: Regulation Watch

This week’s spotlight has been regulations. There are a number of regulations currently as OMB. The last stop for a regulation before it’s published is at OMB. In other words, a regulation arriving at OMB typically means that a regulation release will happen within a few weeks. However, there is no regulatory requirement on a timeline so in theory a regulation can sit at OMB for months (as the ACA Payment Notice did). Here’s a few regulations to keep an eye out for that are currently at OMB:

  • Removal of Safe Harbor/Prescription Drug Rebate Final Rule
  • Third Party Payments (for End-stage Renal Disease) Proposed Rule
  • Health Reimbursement Arrangements Final Rule

My guess is that HRA final rule will be the first one released.

Congressional Action Watch

  • Drug Negotiations House Democrats are considering a bill that would provide CMS the power to negotiate prescription drug costs. No bill is expected until late summer and would unlikely pass the Senate.
  • Senate Moving Forward On Bipartisan Bill – The Senate Health Committee is pushing forward on a bipartisan bill to address surprise billing and increase transparency on drug pricing. Senate voting on the bill isn’t expected until July.
  • Cadillac Tax – There’s an increased push to repeal the Cadillac tax (the tax on high-cost health insurance) before it takes effect in 2022. A vote could happen this month.

Preventative Services Changing

The United Preventative Service Task Force (USPTF), yesterday, issued a recommendation on

pre-existing prophylaxis (PrEP) for HIV Infection. You can read the full recommendation here but PrEP (the HIV preventative drug) is now classified with an A rating for people at high risk of HIV acquisition. Yesterday, the drug Truvada (PrEP) was classified with an A rating and therefore, effective for the 2021 benefit year, will be classified as preventative treatment. This means issuers would need to provide the medication without cost-sharing (no deductibles or co-pays) to individuals who are at high risk for being infected with HIV starting in 2021. The medication is fairly pricey (obvious caveats of list price aside) with the list prices running around $21,000. NPR has a good summary here as does CNBC here of everything going on.

State Watch

  • FL Rx – The state of Florida passed a bill that will allow the state to import prescription drugs for public programs albeit still needs CMS approval.
  • SC Work RequirementsSouth Carolina joined the list of states asking CMS for permission to impose work requirements on its Medicaid beneficiaries. As a reminder work requirements are currently still under injunction due to a court order.

Research You Can Use

Emergency Department CostsNew analysis for Health Care Cost Institute shows that the average of an emergency department visit is up 176% between 2008 and 2017. HCCI found that hospitals also billed patients for more complex care.  


Previous editions: 

06/07/2019: Block Grant Regulation Coming?

05/30/2019:  New and Notes of Note

05/23/2019:  Potential Healthcare Legislation Unveiled 

05/17/2019:  Surprise Billing-Proposed Laws

05/09/2019: Balanced Billing, New Regs & More

05/02/2019:  Medicare for All, CBO Scores & More

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