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The Weekly Scan

Last Updated: 1:00 PM EST


  • Sen. Bernie Sanders (I-Vt.) and Reps. Elijah Cummings (D-Md.) and Ro Khanna (D-Calif.) along with more than two dozen of their colleagues in the House and Senate introduced sweeping reforms Thursday that would dramatically reduce prescription drug prices in the United States. The plan to reduce the skyrocketing cost of prescription drugs includes three bills:

  • The Prescription Drug Price Relief Act, which would peg the price of prescription drugs in the United States to the median price in five major countries: Canada, the United Kingdom, France, Germany and Japan;

  • The Medicare Drug Price Negotiation Act, which would direct the Secretary of Health and Human Services (HHS) to negotiate lower prices for prescription drugs under Medicare Part D;

  • The Affordable and Safe Prescription Drug Importation Act, which would allow patients, pharmacists and wholesalers to import safe, affordable medicine from Canada and other major countries. (Sanders.Senate.gov)

  • House and Senate Democratic health leaders sent a letter to Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma on Thursday requesting detailed information on the Trump Administration’s spending of user fees generated by the Affordable Care Act (ACA) Marketplace exchanges, including HealthCare.gov. The letter was signed by Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ), Ways and Means Chairman Richard Neal (D-MA), Education and Labor Chairman Bobby Scott (D-VA), Senate Finance Ranking Member Ron Wyden (D-OR), and Senate HELP Ranking Member Patty Murray (D-WA). “The Administration’s record of undermining enrollment in the Marketplaces, including by cutting funding for vital functions such as marketing and outreach, as well as spending agency funds on ‘repeal and replace’ propaganda, raises questions about whether the dedicated funding is being spent effectively, legally, and appropriately to enhance Americans’ access to comprehensive health insurance,” the Democrats wrote. Last year, CMS made the decision to gut funding for consumer outreach and assistance for enrolling in the Marketplaces, reducing funding from $100 million to just $10 million — a 90% cut. The agency also slashed funding for navigator programs by 40%. (EnergyCommerce.House.gov)

  • New York City Mayor Bill de Blasio announced on Tuesday that his administration will launch "the largest, most comprehensive plan in the nation" to guarantee health care for every New Yorker. The plan will serve the 600,000 New Yorkers without insurance by strengthening NYC’s public health insurance option, MetroPlus, and guaranteeing anyone ineligible for insurance – including undocumented New Yorkers – has direct access to NYC Health + Hospitals’ physicians, pharmacies and mental health and substance abuse services through a new program called NYC Care. All services will be affordable on a sliding scale. The programs will include customer-friendly call lines to help New Yorkers – regardless of their insurance – make appointments with general practitioners, cardiologists, pediatricians, gynecologists and a full spectrum of health care services. “Health care is a right, not a privilege reserved for those who can afford it,” said Mayor de Blasio. “While the federal government works to gut health care for millions of Americans, New York City is leading the way by guaranteeing that every New Yorker has access to quality, comprehensive access to care, regardless of immigration status or their ability to pay.” (NYC.gov)

  • On Thursday, the Louisiana Department of Health released a solicitation for offers (SFO) to identify a pharmaceutical partner to negotiate unrestricted access to curative treatment for hepatitis C for Medicaid and incarcerated patients in Louisiana. The SFO will allow the Department to develop an arrangement through a public/private partnership with a hepatitis C drug manufacturer that will bring the goal of ending the hepatitis C epidemic within reach for the people of the state of Louisiana. “Our Department is pursuing a subscription model for hepatitis C treatment that will give us the opportunity to solve a major public health challenge and put a cure within reach for our most vulnerable populations while keeping health care costs stable,” said Dr. Rebekah Gee, secretary, Louisiana Department of Health. The Department of Health’s goal is to treat over 10,000 Medicaid-enrolled and incarcerated individuals by the end of 2020 through the subscription model, with the ultimate goal of eliminating this disease. The state is gaining national attention for being the first to utilize "the Netflix model" in this context. (LDH.LA.gov, WashingtonPost.com)


  • Illinois Attorney General Lisa Madigan announced she has recovered $135 million for the state in a settlement with Teva Pharmaceuticals USA Inc. that resolves allegations the drug company inflated the wholesale prices used in setting the rates for Medicaid reimbursements. The settlement stems from a 2005 lawsuit filed by Madigan against 47 drug makers, including Teva Pharmaceuticals, for deceptive practices related to the Average Wholesale Price (AWP) of numerous prescription drugs. Madigan’s lawsuit alleged the drug makers fraudulently published inflated Average Wholesale Prices, which Medicaid programs used to determine the reimbursement amounts for drugs prescribed to Medicaid patients. Madigan alleged the inflated prices have resulted in the overpayment of drug costs by the state. (IllinoisAttorneyGeneral.gov)

Medicare & Medicaid

  • In a guidance published Monday, the CMS laid out requirements for Shared Savings Program ACOs that apply for a waiver of the three-day stay rule. Only ACOs currently participating in or applying to certain Shared Savings Program performance-based risk tracks can apply for waivers, which will take effect July 1, 2019. To apply, an ACO must provide the CMS with a list of skilled-nursing facilities with which the ACO will partner, along with a SNF affiliate agreement for each facility. Partnering SNFs must have an overall CMS quality rating of three stars or higher. For the first time, critical-access hospitals and other small rural hospitals operating under swing bed arrangements are eligible to be SNF affiliates. They are not required to have a CMS quality rating, which recognizes that in many rural communities, hospitals are the sole SNF provider. (ModernHealthcare.com)

  • CMS issued an Informational Bulletin last Friday, January 4, that provides another strategy for states to better support timely access to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for people dually eligible for Medicaid and Medicare. Both Medicare and Medicaid cover DMEPOS, which can be essential to dually eligible individuals’ mobility, health status, independence in the community, and overall quality of life. This Informational Bulletin provides an additional strategy to those included in the Informational Bulletin released in January 2017 in which we described several strategies to increase access to DMEPOS for dually eligible individuals. Specifically, in this Informational Bulletin, CMS advises that states need not obtain a Medicare denial for DMEPOS that Medicare routinely denies as noncovered under the Medicare DME benefit (e.g., incontinence supplies). (Medicaid.gov)

Private Sector

  • During a presentation at the J.P. Morgan Healthcare Conference in San Francisco this week, CVS Health CEO Larry Merlo laid out his high-level strategy to improve consumer healthcare and assuaged some concerns over the last minute stumbling block to the CVS- Aetna deal posed by Judge Richard Leon. “I want to unequivocally state CVS Health and Aetna are one company and our transformation work is already underway,” Merlo said. “We’re already rolling out products and services that benefit clients by helping their members achieve their best health at a lower cost.”He added that the additional court review will not impact the timeline for integration and roll-out of consumer health services. Part of that integration includes pharmacy dispensing at Aetna being consolidated within the CVS Caremark PBM. Of note, Merlo announced the first retail health “concept store” focused on chronic disease opening up in the Houston, Texas market next month. Some of the characteristics of these concept stores include care concierge centers, enhanced screening for chronic disease, phlebotomy services and personalized prescription support. (MedCityNews.com)

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