America's Health Insurance Plans is "hopeful" that the Biden administration could pull the industry's hated rebate rule, which was finalized by the Department of Health and Human Services late last year.
Under the rule, pharmacy benefit managers will no longer enjoy anti-kickback safe harbors for drug rebates in Part D and instead will be pushed to offer discounts at the point of sale. Insurers and PBMs have slammed the rule as a gift to the pharmaceutical industry and warn it could lead to higher premiums for Part D beneficiaries.
The Pharmaceutical Care Management Association, which represents PBMs, has filed suit against HHS in an effort to block the rule.
AHIP CEO Matt Eyles said during a "state of the industry" briefing Tuesday that the organization has been in contact with the Biden administration about the potential impacts of the rule.
"We're hopeful that the rule will not be put into effect," Eyles said. "There's so much uncertainty around that. We have been communicating some of those challenges to the new administration."
Another headwind insurers are bracing for this year is around price transparency regulations, which went into effect this month. Hospitals are now required to post their payer-negotiated payment rates for services online.
Their approach to the requirement so far has been scattershot, with some simply posting the data while others are launching or enhancing price estimator tools for patients. A similar rule, which will force health insurers to post negotiated rates and cost-sharing data online, will go into effect on 2023 for 500 shoppable services.
Eyles said the rule's approach fails to provide data to customers in an actionable manner and will serve to undercut competition and negotiation on pricing. He said providers that are aware of who their competition is and what they've bid are less likely to bid aggressively and lower costs.
Insurers offer cost estimators to members, he said, as a way to provide data about costs in a more personalized, and thus usable, way.
"That’s why health insurance providers are constantly developing resources to help people understand what their costs will be," he said
Eyles said that while AHIP has been in contact with regulators about concerns like the rebate rule and Medicare Advantage, the administration's immediate focus is on the COVID-19 pandemic response.
He said that as such he expects critical flexibilities for telehealth to continue in the near term, as HHS' public health emergency will likely be in place through the end of the year.
"I think there's a recognition that telehealth flexibilities need to be extended," Eyles said.