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House vote puts GOP in tricky spot; baseball idea pitched to fix surprise costs


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House vote puts GOP in tricky spot; baseball idea pitched to fix surprise costs

The House adopted legislation last week intended to increase competition for lower-cost medicines in the U.S., while also shoring up the Affordable Care Act.

Only five Republicans, however, voted in favor of the bill, H.R. 987, despite the drug pricing provisions having broad bipartisan support.

The ACA measures would block the Trump administration's short-term health insurance plans — called "junk" policies by critics because they typically do not cover Americans with preexisting medical conditions — and would restore funds for outreach and enrollment efforts for insurance offered on the ACA marketplace.

Rep. Greg Walden, R-Ore., ranking member on the House Energy and Commerce Committee, said the move by Democrats to package the two ACA provisions with the three bipartisan drug pricing measures was "gotcha politics."

But Democrats said the vote on the legislation legitimately put Republicans on record for not standing by their claims that they support the pre-existing conditions protections.

Among the three drug pricing measures in H.R. 987 was the CREATES Act, which would make it easier and faster for generic drug companies to sue brand-name biopharmaceutical makers when those manufacturers withhold samples of their medicines needed by their competitors to conduct required studies for U.S. approval.

Another provision would end a gaming tactic known as exclusively parking, where the first generic company to file a U.S. application holds off on entering the market to delay the start of the 180-day exclusivity period it was granted in an attempt to block competitors.

The tactic is often used because the generic maker has entered into an agreement in which it is paid by the branded company to delay the market entrance of the lower-cost product.

H.R. 987 also included a provision to prohibit those pay-for-delay deals.

Senate bill includes baseball-style arbitration

Also last week, a bipartisan group of senators, led by Sens. Bill Cassidy, R-La., and Maggie Hassan, D-N.H., introduced legislation aimed at ending surprise medical bills — unexpected high out-of-pocket charges from hospitals and doctor offices that are increasingly catching Americans off guard.

The Senate legislation was unveiled two days after the details of a draft bipartisan House bill were revealed.

Like the House bill, the Senate's STOP Surprise Medical Bills Act would ban emergency room balance billing, in which hospitals and other healthcare providers try to force patients to pay the difference between what an out-of-network facility or doctor billed and what the health plan paid.

Unlike the House's No Surprises Act, though, the Senate legislation includes a measure that calls for "baseball-style" arbitration, meaning the insurer and the medical provider would each submit an offer and an independent dispute resolution entity certified by the federal government would choose which of those offers was more reasonable.

New York already has been running a similar process for resolving out-of-network billing, Hassan noted during a May 16 news conference.

"Increasingly, insurers and providers don't go to the baseball arbitration at all they just settle this between themselves because the arbitration system has set some standards that they now all abide by," Hassan said.

A senior Trump administration official, however, told reporters during a May 9 briefing that there was not "a lot of enthusiasm for arbitration" at the White House and said the administration viewed it as disruptive.

SNL Image

Sen. Lisa Murkowski, R-Alaska

Source: Associated Press

Sen. Lisa Murkowski, R-Alaska, acknowledged the Senate legislation does not address the high costs of air ambulances, or medevacs, a problem that hits residents in her mostly rural state particularly hard. The House's No Surprises Act also does not address those costs.

Murkowski noted some Alaskans carry special medevac insurance, but the coverage is pricey.

Since U.S. air ambulances are regulated by the Federal Aviation Administration, Cassidy said it is a transjurisdictional issue, which will involve the Senate Health, Education, Labor and Pensions, or HELP, Committee working with the chamber's Commerce Committee.

Sen. Lamar Alexander, R-Tenn., chairman of the Senate HELP Committee, said he hoped to get a bipartisan bill to the White House by July.

Alexander and Sen. Patty Murray, D-Wash., the HELP ranking member, are working on their own legislation. Rep. Lloyd Doggett, D-Texas, chairman of the House Ways and Means Health Subcommittee also has his own bill and is convening a hearing on May 21.

With the White House backing congressional activity on surprise medical bills, the issue is one of the few areas where legislative action on Capitol Hill in 2019 is possible, Cowen & Co. analyst Eric Assaraf said in a May 16 research note.

Bill aims to put Trump's TV ad drug pricing rule into law

A cadre of bipartisan senators are seeking to back up a new drug pricing rule from the Trump administration with the power of law.

Last week, Sens. Chuck Grassley, R-Iowa, Dick Durbin, D-Ill., Angus King, I-Maine, and Alexander introduced legislation intended to codify a rule finalized on May 8 by Health and Human Services requiring drugmakers starting in July to disclose their list prices television advertisements aimed at consumers.

Grassley and Durbin have tried before to legislate the requirement — getting as far as having the Senate adopt a bill last year as part of a funding package.

The measure called for $1 million for HHS to implement to implement such a rule.

But the drug pricing provision was ultimately stripped from the funding package.