Committees Reaffirm Collective Effort on SGR Reform Process

Last week, Chairman Dave Camp (R-MI) of the House Ways & Means Committee and Chairman Fred Upton (R-MI) of the Energy & Commerce Committee made joint statements that the two committees were still working together on a sustainable growth rate (SGR) reform proposal. Their statements are an attempt to quell previous reports that the two committees had parted ways from the discussions over alleged disagreements on identifying “pay-fors” to cover the cost of repealing the SGR.

Chairman Upton stood by his previous claim that his committee’s bill is on track to be marked-up and voted out of his committee by August. Both Chairmen indicated that they were optimistic about the process and said there was a good chance that legislation could pass out of the House later this year. Both Chairmen cited the Congressional Budget Offices’ (CBO) recent report to Congress that it will extend the “lowered” cost of repealing the SGR through November of this year as positive news for repeal. Currently, CBO projects the cost of repealing the SGR at $139 billion which is $100 billion less than previous scores. NASS recently submitted comments to the Energy and Commerce Committee on its draft SGR legislation and can be found here.

MedPAC Weighs “Premium Support” Payment Model in June Report

In its June report, the Medicare Payment Advisory Commission (MedPAC) put forth a set of discussion topics to reform Medicare’s payment system. One model that the commission examined in the report was “Competitively Determined Plan Contributions” (CPC). The CPC resembles previous proposals such as the “premium support” payment model that is widely supported by Republicans in Congress. The CPC model is based on two principles:

  • Medicare’s payment for a beneficiary’s care is set through a competitive process comparing the costs of available options for coverage, including private plans and traditional fee-for-service (FFS).
  • Beneficiaries’ individual premiums would vary depending on which coverage option they choose.

MedPAC also examined opportunities to better align Medicare’s payment for the same ambulatory services provided to similar patients in different settings, such as physicians’ offices or hospital outpatient departments (OPD). In the report, MedPAC  cited that because the provision of many services have migrated from physicians’ offices to the higher paid setting OPDs, that this has resulted in higher program spending and beneficiary cost sharing without significant changes in patient care.

A copy of the full report can be found here.

Senators Eye July for Floor Vote on Compounding Bill, House Releases Draft Legislation

The Chairman and Ranking Member of the Senate Health, Education, Labor & Pensions (HELP) Committee called on leaders of the Senate this week to quickly have a floor vote on a compounding bill that was passed out of the Committee last month. Sen.’s Tom Harkin (D-IA) and Alexander (R-TN) said that while some changes would need to be made to the legislation before coming to the floor, that it was crucial to pass a bill before another incident, such as the deadly meningitis outbreak, happened again. One section of the bill that has caused some concern among Senators is the provision to classify pharmacists filling “non-patient-specific” prescriptions as a manufacturer.  Some Senators argue that eliminating office use compounding may restrict patient access to compounded drugs.

Meanwhile, Rep. Morgan Griffith (R-VA) released a draft House compounding bill, which would continue to allow in-office use compounding and requires the Food and Drug Administration (FDA) to publish barred medications to the public. This draft bill does not contain the same enhanced oversight mechanisms for the FDA and does not impose annual fees on manufactures like the Senate bill.

A copy of the House draft legislation can be found here.