Complications: Health Policy Unraveled

Understanding Medicare’s Negotiated Drug Prices: What Are The Real Savings?

In mid-August, the Biden administration announced it had completed negotiations for the first 10 drugs in Medicare’s price program and that the new prices will be implemented in 2026. The achievement marks decades of effort and is a stellar achievement for the Democrats and the administration. But Medicare already receives discounts and rebates on drugs, so it’s unclear what the savings will really be off the list price. And, as Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan] points out, it is also unclear how much of any savings will filter through to patients because their costs will be determined by their insurance plans. Nor is it clear whether patients’ formularies will include the drugs whose prices were negotiated. Finally, Stephanie also describes how the Inflation Reduction Act fits into this landscape. MEET YOUR HOST Name: Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan]  Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting [http://mwcllc.com/] Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement. Connect: LinkedIn [https://www.linkedin.com/in/stephanie-kennan-174050b] EPISODE HIGHLIGHTS [00:47] The administration claims the prices for the first 10 drugs negotiated under the Inflation Reduction Act will save taxpayers $6 billion and another $1.5 billion to seniors in out-of-pocket costs. [01:54] The Centers for Medicare & Medicaid Services based its savings figures off the list priced for drugs, but many of the drugs are currently available to Medicare plans for discounts and rebates. [02:18] Medicare recipients don’t usually pay the list price for drugs; they pay the price dictated by their insurance plans. [02:44] Some members of Congress and patient advocacy groups worry there aren’t enough rules to guarantee that insurance plans will include the first 10 drugs, with newly negotiated prices, in patient formularies. CONTACT Connect with us on Facebook [https://www.facebook.com/McGuireWoodsConsulting], X [https://x.com/MWConsulting], LinkedIn [https://www.linkedin.com/company/mcguirewoods-consulting/], YouTube [https://www.youtube.com/@mcguirewoodsconsulting]. Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com [http://www.mwcllc.com]

How the Inflation Reduction Act Is Affecting Medicare Part D Drug Costs

In an ironic move, it’s likely that Medicare Part D insurance premiums will rise next year even as a 2022 law sought to lower costs for patients,  but the administration is planning on implementing a program to stabilize the market. Under the 2022 law, insurers must now make up the difference between costs formerly covered by patients and are raising drug premiums to compensate, explains host Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan]. Join her as she explains the changes facing insurers and the efforts the government is making to stabilize the market during the transition brought about by the 2022 Inflation Reduction Act. MEET YOUR HOST Name: Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan]  Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting [http://mwcllc.com/] Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement. Connect: LinkedIn [https://www.linkedin.com/in/stephanie-kennan-174050b] EPISODE HIGHLIGHTS [00:47] Insurers will be expected to make up the difference between what Medicare Part D patients used to pay and what they will pay beginning next year. The government will help defray the cost. [01:22] The administration’s program designed to help defray costs is expected to cost $5 billion if all Medicare Part D plans participate, but enrollment is not yet certain. [03:11] Under the Inflation Reduction Act, when patients meet a spending cap, plans will pay a higher percentage than before, and drug manufacturers will be required to provide a discount. [05:01] A new Part D stabilization demonstration has three components for prescription drug plans that participate: lowering the base cost of the beneficiary premium; limiting Part D premium increases, and narrowing the upper threshold of risk corridors while increasing government risk-sharing.  CONTACT Connect with us on Facebook [https://www.facebook.com/McGuireWoodsConsulting], X [https://x.com/MWConsulting], LinkedIn [https://www.linkedin.com/company/mcguirewoods-consulting/], YouTube [https://www.youtube.com/@mcguirewoodsconsulting]. Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com [http://www.mwcllc.com]

Rejecting a Psychedelic Drug for PTSD Treatment: Why and What’s Next

A revolution in the use of psychedelic drugs to treat mental health issues experienced a setback in early August when the FDA declined to approve MMDA as a treatment for post-traumatic stress disorder.   Host Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan] provides important context to the FDA’s decision, which came as the agency has faced criticism for approving therapies without convincing evidence. She outlines the fallout, including a peer-reviewed journal’s decision to retract three papers about MMDA-assisted psychotherapy. She also looks ahead, explaining that, while this first attempt for MMDA stalled, other companies are working on their own applications. MEET YOUR HOST Name: Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan]  Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting [http://mwcllc.com/] Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement. Connect: LinkedIn [https://www.linkedin.com/in/stephanie-kennan-174050b] EPISODE HIGHLIGHTS [00:40] On August 9, the FDA announced it would not approve an application for MMDA-assisted psychotherapy to treat post-traumatic stress disorder. [01:18] MMDA would have been the first psychedelic drug approved by the FDA, but the government’s rejection was not unexpected, as an advisory panel had voted not to approve earlier this summer. [01:50] In addition to denying approval, the FDA also said it would withdraw a planned study on people who buy psychedelic drugs. [02:16] The FDA’s decision comes at a time when it has been criticized for approving therapies without convincing evidence. [02:25] Fallout from the FDA’s decision includes the “Journal of Psychopharmacology’s” retraction of three papers about MMDA-assisted psychotherapy due to violations of protocol. [02:47] Meanwhile, the company that sought approval is raising concerns about the composition and conduct of the FDA’s advisory committee meeting. CONTACT Connect with us on Facebook [https://www.facebook.com/McGuireWoodsConsulting], X [https://x.com/MWConsulting], LinkedIn [https://www.linkedin.com/company/mcguirewoods-consulting/], YouTube [https://www.youtube.com/@mcguirewoodsconsulting]. Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com [http://www.mwcllc.com]

Reforming the Medicare Physician Fee Schedule: Controversy and Urgency

Congress is teeing up discussions on a controversial issue that strikes at the heart of the Medicare system: how physicians are paid. Lawmakers are weighing changes to the Medicare Physician Fee Schedule for the first time since 2015, and host Stephanie Kennan lays out the landscape. She provides background on the pay schedule, describes reforms under consideration, and explains why physicians and other stakeholders are warning about a gap between rising costs and physician payments – which could impact care. MEET YOUR HOST Name: Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan]  Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting [http://mwcllc.com/] Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers, and associations concerned about Medicare and Medicaid reimbursement. Connect: LinkedIn [https://www.linkedin.com/in/stephanie-kennan-174050b] EPISODE HIGHLIGHTS [00:51] For the first time since 2015, Congress is weighing potential changes to the Medicare Physician Fee Schedule. [01:03] Reform is driven by the proposed 2025 Medicare Physician Fee Schedule, which would cut physicians’ pay rate by 2.8 percent. [01:50] Doctors aren’t the only ones concerned about the projected payment schedule; Medicare trustees have issued warnings of their own. [02:34] How the physician fee schedule works. [03:16] The Medicare Economic Index, or MEI, figures prominently in payment reform discussions. Here’s what to know about it. [05:17] An overview of the white paper, released in May by the Senate Finance Committee, proposing that Medicare adjust payments to account for inflation. [05:38] The white paper outlines opportunities for reform, among them: creating sustainable payment updates to ensure clinicians can own and operate their practices and incentivizing alternative payment models that reward providing better care at lower cost. [07:16] A bipartisan duo of lawmakers has proposed legislation that, they say, would better support and improve pay for high-quality primary care providers. [08:05] Their proposal represents a marker for discussions on primary care, and lawmakers have teed up this difficult and controversial issue. CONTACT Connect with us on Facebook [https://www.facebook.com/McGuireWoodsConsulting], Twitter [https://twitter.com/MWConsulting], LinkedIn [https://www.linkedin.com/company/mcguirewoods-consulting/], YouTube [https://www.youtube.com/@mcguirewoodsconsulting]. Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com [http://www.mwcllc.com]

How Site-Neutral Payment Reform Divides Policymakers and Hospitals

“Site-neutral” is a short name for a proposal that has bipartisan interest in Congress, but is being fiercely fought by hospitals.  Host Stephanie Kennan explores the divisive issue of site-neutral payment reform, an approach to healthcare spending that would align Medicare payments for outpatient services across care settings. Amid growing bipartisan interest and pressure to rein in healthcare costs, Congress has proposed reforms such as the Medicare Patient Access to Cancer Treatment Act. But hospitals are fighting it because of the potential to reduce revenue and, they worry, decrease healthcare access in rural and low-income communities.  Tune in as Stephanie outlines arguments on both sides of the debate and updates listeners on the status of this controversial approach. MEET YOUR HOST Name: Stephanie Kennan [https://www.mwcllc.com/our-people/k/Stephanie-A-Kennan]  Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting [http://mwcllc.com/] Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement. Connect: LinkedIn [https://www.linkedin.com/in/stephanie-kennan-174050b] EPISODE HIGHLIGHTS [00:32] “Site-neutral payments” is shorthand for a reform that would align Medicare payments for outpatient services across settings. Hospitals are anything but neutral about this approach – they’re fighting it fiercely. [00:59] The goal of this approach is for Medicare to pay the same rate for the same service, regardless of what type of facility – outpatient department, surgical center, or freestanding physician’s office – provides it. [01:37] Last year, a congressional advisory committee on Medicare payments called MedPAC identified potential services that could be appropriate for site-neutral payments. [02:34] Congress has been focusing on site-neutral payment reform because of concerns about healthcare costs and the rapid pace of consolidation. [03:56] Opponents argue that this approach would adversely affect patient access to services by reducing hospital venues, particularly in rural and low-income communities. [05:07] An overview of the various proposals in Congress related to site-neutral payment reform and how hospitals could be affected. [06:15] Is the fight only about the money? Hospitals point to other concerns, including that this reform could potentially decrease overall healthcare spending. CONTACT Connect with us on Facebook [https://www.facebook.com/McGuireWoodsConsulting], X [https://x.com/MWConsulting], LinkedIn [https://www.linkedin.com/company/mcguirewoods-consulting/], YouTube [https://www.youtube.com/@mcguirewoodsconsulting]. Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com [http://www.mwcllc.com]