As Congress Works Toward Reducing Health Care Costs, ACP Continues to Provide Feedback, Suggestions

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The College responds to a discussion draft of the Lower Health Care Costs Act of 2019

June 21, 2019 (ACP) – Congress is poised to take significant action on a long list of policies regarding patient protections and health care costs. The American College of Physicians has offered guidance and perspective throughout the legislative process, and it continues to monitor the progress as the Lower Health Care Costs Act of 2019 moves forward.

“The legislation will help address many of the greatest concerns expressed by patients and clinicians over cost, affordability, and accessibility of care,” said Jared Frost, ACP's senior associate of legislative affairs. “However, ACP encourages Congress to explore additional important improvements.”

Earlier this year, the Senate Committee on Health, Education, Labor and Pensions asked members of the health community to submit their ideas on how to lower health care costs. ACP responded with an 18-page statement.

Now, a bipartisan discussion draft of the Lower Health Care Costs Act of 2019 has been released.

In a June 5 follow-up letter, ACP praised the draft as “a very positive step forward in addressing the challenges of lowering costs and improving patient outcomes in these policy areas.”

As Frost explained, “The College expressed support for several provisions, including those to promote bringing generic drugs to market, reducing administrative challenges to bringing biological products, such as insulin, to the market and transparency regarding biological products.”

In addition, he said, “ACP supported the provision to prohibit ‘gag clauses' and similar contractual arrangements that interfere in the transparency of relevant health care data and for health plans to have up-to-date directories for clinicians. The College also expressed support for public health provisions to address vaccine hesitancy and obesity.”

However, ACP reinforced the messages in its earlier letter about the need for legislation to go even further: “We encourage the Committee to explore additional improvements, including policies to support high-value primary care, expand access and coverage, support a well-trained physician workforce, reduce administrative burdens on clinicians and patients, reduce the cost of prescription drugs, and continue to improve the Quality Payment Program.”

Specifically, ACP called for several actions. For example, it urged the adoption of additional policies to address network adequacy as a possible contributing factor in the rise of “surprise” medical bills that have become a major burden for patients.

ACP also supports one of the proposed options to resolve disagreements between health insurers or plans and the “provider” or “practitioner” about reimbursement to prevent surprise medical bills to the patient. ACP prefers the option that supports independent dispute resolution. “While providing necessary relief for patients is necessary,” Frost said, “ensuring that physicians and clinicians receive appropriate and fair payment for services also must be considered.”

ACP also emphasized its support for prescription-drug legislation including the Preserve Access to Affordable Generics and Biosimilars Act, the Reforming Evergreening and Manipulation that Extends Drug Years (REMEDY) Act, the Creating and Restoring Equal Access to Equivalent Samples Act, the Prescription Drug STAR Act, and the Fair Accountability and Innovative Research (FAIR) Drug Pricing Act.

ACP is also pressing Congress on another important matter: Medicare Part D Drug Pricing legislation. In a June 6 letter, it urged the House Ways and Means and Energy and Commerce Committees to consider its concerns regarding the creation of an out-of-pocket maximum on prescription drug costs for Medicare beneficiaries in Part D “based on the current catastrophic threshold.”

The ACP states in the letter: “While ACP finds the intent of this proposal to be consistent with the College's goals of affordable prescription drug pricing and is pleased the committees have similar objectives for reform of Part D, we believe the full gamut of likely ramifications of such changes must also be carefully considered, particularly when programmatic changes of this magnitude are being put forward.”

What's next for the Lower Health Care Costs Act of 2019? The legislation will be revised in at least one more subsequent version and then has to be passed in both the Senate committee and the full Senate. “While there is optimism that this could be achieved,” Frost explained, “there are competing proposals regarding surprise billing in both the House and Senate as well as support for additional prescription drug proposals in both chambers. A lot of work needs to be done to get this to the finish line, and there's not a lot of time to do it before the August recess.”

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