The Centers for Medicare and Medicaid Services (CMS) released a list of 27 drugs under the Medicare Part B program that may be cheaper for beneficiaries between April 1-June 30, 2023. The Inflation Reduction Act (IRA) requires drug companies to pay rebates to Medicare when prescription drug prices rise faster than the rate of inflation, for certain drugs. For the time period of April through June, 27 drugs have an adjusted coinsurance rate based on the inflation-adjusted payment amount.

CMS also released initial guidance for the Medicare Drug Price Negotiation Program.  The guidance gives an overview of how CMS intends to implement the Negotiation Program and specifies the requirements and procedures that may be applicable to manufacturers.

The Medicaid and CHIP Payment and Access Commission (MACPAC) submitted the March 2023 Report to Congress on Medicaid and CHIP. The report includes four chapters and focuses on improving race and ethnicity data collection in the Medicaid program; increasing the transparency of nursing facility payment data; providing state Medicaid programs increased flexibility in following Medicare drug coverage decisions; and examining payment policy for America’s safety net hospitals.

The Medicare Payment Advisory Commission (MedPAC) also issued its yearly report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). The full report can be found here.

The Senate Health, Education, Labor, and Pensions (HELP) Committee issued a request for information (RFI), seeking stakeholder input on policies the Committee should consider in reauthorizing the Pandemic and All Hazards Preparedness Act (PAHPA). All comments must be submitted to the Committee by close of business on Wednesday, March 29, 2023.

Additionally, Senate HELP Committee leaders, Chairman Sanders and Ranking Member Cassidy, have agreed to hold a markup on prescription drug pricing, with a focus on bipartisan policies related to generic drugs and pharmacy benefit managers (PBMs). The Committee is still working to lock down a date for the markup. We will send out an alert when the Committee releases the date and time.

The Department of Health and Human Services (HHS) will make $25 million in funding available to expand primary health care and mental health services in schools. Applicants, for the first time, must add or expand mental health services to receive school-based funding. To receive a share of the funding, health centers must submit applications in Grants.gov by 11:59 p.m. ET on March 31, 2023. 

On Wednesday, the Centers for Medicare and Medicaid Services (CMS) released a list of 27 drugs under the Medicare Part B program that may be cheaper for beneficiaries between April 1-June 30, 2023. The Inflation Reduction Act (IRA) requires drug companies to pay rebates to Medicare when prescription drug prices rise faster than the rate of inflation, for certain drugs. For the time period of April through June, 27 drugs have an adjusted coinsurance rate based on the inflation-adjusted payment amount. This means that Traditional Medicare and Medicare Advantage beneficiaries may pay less for their prescription drugs during this period, with savings ranging from $2 to $390 per average dose. The top three insulin manufacturers have reduced their listing prices, likely averting rebate payments. The press release can be found here, and the fact sheet can be found here.

CMS released initial guidance for the Medicare Drug Price Negotiation Program. The guidance gives an overview of how CMS intends to implement the Negotiation Program for “initial price applicability year 2026” (January 1, 2026 to December 31, 2026) and specifies the requirements and procedures that may be applicable to manufacturers. The full guidance can be found here, and the fact sheet can be found here.

The Department of Health and Human Services (HHS) will make $25 million in funding available to expand primary health care and mental health services in schools. Applicants, for the first time, must add or expand mental health services to receive school-based funding. Health Resources and Services Administration (HRSA) funded health centers operate more than 3,000 school-based service sites across the U.S. To receive a share of the funding, health centers must submit applications in Grants.gov by 11:59 p.m. ET on March 31, 2023 and in HRSA Electronic Handbooks by 5:00 p.m. ET on May 1, 2023. More can be found here.

The Medicaid and CHIP Payment and Access Commission (MACPAC) submitted the March 2023 Report to Congress on Medicaid and CHIP. The report includes four chapters and focuses on improving race and ethnicity data collection in the Medicaid program; increasing the transparency of nursing facility payment data; providing state Medicaid programs increased flexibility in following Medicare drug coverage decisions; and examining payment policy for America’s safety net hospitals. Additional information can be found here.

The Medicare Payment Advisory Commission (MedPAC) issued its yearly report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). MedPAC’s recommendations to Congress include a “higher-than-current-law FFS payment update for acute care hospitals [for 2024], positive payment updates for two other sectors (physician and other health professional services and outpatient dialysis), and negative updates for three post-acute care sectors (skilled nursing facility, home health, and inpatient rehabilitation facility).” The full report can be found here.

On Wednesday, Senate Finance Committee Republicans, led by Ranking Member Mike Crapo (R-ID), sent a letter to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure, urging them to take steps to prevent adverse outcomes for Medicare Advantage (MA) beneficiaries, following an Advance Notice released by CMS in February 2023. The Senators wrote that, “Some of the proposal’s modifications to risk adjustment, for example, could trigger severe and unintended consequences for seniors. Given the complexity of the policy changes in question, the swift enactment of these reforms could spur confusion and uncertainty among health care providers and plans.” The full letter can be found here.

The Senate Health, Education, Labor, and Pensions (HELP) Committee issued a request for information (RFI), seeking stakeholder input on policies the Committee should consider in reauthorizing the Pandemic and All Hazards Preparedness Act (PAHPA). In 2006, PAHPA was signed into law to “improve the Nation’s public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural.” All comments must be submitted to the Committee by close of business on Wednesday, March 29, 2023. The RFI can be found here.

Senator Marsha Blackburn (R-TN), co-chair of the Senate Rural Health Caucus, will introduce her Rural Health Agenda for the 118th Congress. The Senator asserts that her agenda is aimed at “addressing health care challenges in rural America to maintain quality care close to home.” The Agenda is centered around three bipartisan bills: the Rural Health Innovation Act, the Rural America Health Corps Act, and the Save Rural Hospitals Act. The press release can be found here.

Senate Finance Committee - Hearing

Full Committee Hearing: "The President’s Fiscal Year 2024 Health and Human Services Budget."

Wednesday, March 22 at 10:00 AM EST

Senate Homeland Security and Governmental Affairs Committee - Hearing

Senate Homeland Security and Governmental Affairs Committee Hearing: "Drug Shortage Health and National Security Risks: Underlying Causes and Needed Reforms."

Wednesday, March 22 at 10:00 AM EST

House Committee on Appropriations - Hearing

Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies (Committee on Appropriations) Hearing: Member Day - Agriculture, Rural Development, Food and Drug Administration, and Related Agencies

Thursday, March 23 at 10:00 AM EST

House Ways and Means Health Subcommittee – Hearing

“Why Health Care is Unaffordable: The Fallout of Democrats’ Inflation on Patients and Small Businesses.”

Thursday, March 23 at 2:00 PM EST

House Committee on Appropriations - Hearing

Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (Committee on Appropriations) Hearing: Public Witness Day - Labor, Health and Human Services, Education, and Related Agencies

Thursday, March 23 at 10:00 AM EST