House Oversight and Accountability Committee Holds Hearing on PBMs. Republicans and Democrats shared concerns about the role and practices of PBMs. While generally supportive of free market principles, Republicans criticized PBMs for alleged lack of transparency and anticompetitive behaviors, such as vertical integration and the use of arrangements that allow PBMs to fall outside certain regulatory requirements. Democrats expressed concern about the opaqueness and complexity that PBMs add to the healthcare system as well as their impacts on patients. This bipartisan agreement highlights a common ground for potential legislative reform aimed at increasing transparency and reducing PBMs’ overall impact on drug pricing. For more information on the committee’s activities, including a recently released report, read this press release.
House Energy & Commerce Health Subcommittee Holds Hearing on CDC. Witnesses were the heads of the CDC’s main divisions. During the hearing, Republicans expressed concerns that the CDC has moved too far from its initial focus on infectious diseases and now includes focus areas that are duplicative of other federal agencies’ work. Democrats expressed concerns regarding the proposed cuts to CDC funding in House Republicans’ FY 2025 appropriations bills and urged the committee to sustain CDC funding. Democrats in particular mentioned concerns about the impacts of eliminating the National Center for Injury Prevention and Control. The CDC witnesses urged sustained support and investment in the CDC to continue its work, including data modernization efforts.
Senate Judiciary Human Rights and the Law Subcommittee Holds Hearing on Georgia Abortion Ban. The hearing discussed the dangers to Georgia women’s health and human rights caused by the state’s six-week abortion ban. The field hearing took place in Decatur, Georgia, and featured a panel of OB/GYNs and residents. Senator Jon Ossoff (D-GA) was the only senator present. Witnesses discussed how the Georgia law will exacerbate workforce shortages because medical residents are choosing to learn and practice in states without abortion restrictions. Witnesses also provided statistics on the maternal mortality rate and OB/GYN shortage in Georgia. Chairman Ossoff focused his questioning on the vague language and exceptions policy in the Georgia law, specifically regarding how it influences providers’ decisions and harms their ability to provide essential care.
CMS Announces Actions to Stop Unauthorized Agent and Broker Marketplace Activity. To address growing complaints of brokers switching consumer health plan enrollments without consumers’ consent in the Affordable Care Act Marketplace, CMS announced that starting on July 19, 2024, it will block an agent or broker from making Federal Facilitated Marketplace enrollment changes unless the agent is already associated with the consumer’s enrollment. Unassociated or “new” agents and brokers will be required to take additional steps to update a consumer’s Marketplace enrollment. They must now conduct a three-way call with the consumer and the Marketplace Call Center or direct the consumer to submit the change themselves through HealthCare.gov or via an approved Classic Direct Enrollment or Enhanced Direct Enrollment partner website with a consumer pathway.
CMS Releases Final Part Two Guidance on Medicare Prescription Payment Plan. CMS finalized additional Inflation Reduction Act guidance on the Medicare Prescription Payment Plan. Under the plan, beginning in 2025, Medicare Part D enrollees will have the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy. Part one of the guidance, released in August 2023, focused on operational requirements for the program, while part two focuses on Part D enrollee education, outreach and communications.
The part two guidance includes:
Read more in the CMS press release.
After failure of the energy-water appropriations bill on the House floor this week, House leadership announced that the House would begin its summer recess early, starting July 26, 2024. This provides members an additional week at home with their constituents and on the campaign trail. The House is scheduled to return to session on September 9, 2024. Next week is scheduled to be the Senate’s final week of session before its recess. The Senate is also scheduled to return on September 9. We anticipate some Senate healthcare activity at the committee level next week, including a Senate HELP Committee markup of health legislation. On the regulatory front, we are also looking towards publication of the final Inpatient Prospective Payment System rule.
For more information, contact Debra Curtis, Kristen O’Brien, Julia Grabo, Priya Rathakrishnan or Erica Stocker.
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