Payer Roundup—PBM executives set to testify before Senate Finance Committee

Drug prices
Executives at five pharmacy benefit managers are confirmed for an April hearing on drug prices, plus more insurance headlines. (Getty/Charles Wollertz)

PBM executives set to testify on Capitol Hill

Executives at five major pharmacy benefit managers (PBMs) are confirmed to testify before the Senate Finance Committee on drug prices next month.

Leaders at Cigna, the parent company of Express Scripts, CVS, Humana, Optum and Prime Therapeutics are slated to testify at a hearing on April 9. The hearing will be the latest in a series before the Finance Committee on drug prices. Last month, executives at major pharmaceutical companies were grilled by senators.

Finance Committee Chairman Chuck Grassley, R-Iowa, and Ranking Member Ron Wyden, D-Ore., said in a joint statement that it's "only fair" for PBMs to address rising prices.

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“Middlemen in the healthcare industry owe patients and taxpayers an explanation of their role," the senators said. "There’s far too much bureaucracy and too little transparency getting in the way of affordable, quality healthcare." (The Hill)

Lobbying group behind thousands of comments on HHS drug rebate rule 

Though the Department of Health and Human Services’ plan to eliminate legal protections for drug rebates is plenty controversial, it’s garnered far more comments than a rule would reasonably expect—and many big-name industry players have yet to weigh in. 

More than 5,000 of the some-18,000 comments posted on the rule so far match a form letter from RetireSafe, a Washington-based advocacy group that is connected to the pharmaceutical industry. 

Mark Gibbons, the group’s CEO, said RetireSafe has been collecting signatures through multiple challenges, including social media and newspaper ads. The group received a $50,000 donation from the Pharmaceutical Research and Manufacturers of America and a $5,000 payment from the Biotechnology Innovation Organization. 

A PhRMA spokeswoman said the company works with a variety of groups that both agree and disagree with its policy positions, while a spokesperson with BIO said it was not involved in the comment blitz. (STAT

Tennessee House committee OKs Medicaid block grant plan 

A key Tennessee House committee has advanced a proposal to transform the state’s Medicaid program into block grants. 

The House Finance, Ways and Means Subcommittee approved a Republican-led bill to establish the block grants on Wednesday. Should the bill be signed by the governor, it would require approval from the Centers of Medicare & Medicaid Services before becoming official. 

One day before the committee’s vote, a group of 30 state organizations, including the YWCA and United Way, sent a letter to state officials expressing concern about the plan. 

Supporters of the plan say it would allow for greater flexibility in how to allocate federal Medicaid funds. (Tennessean)

Air ambulances come with a hefty price tag, even for the insured: GAO

A new report from the Government Accountability Office highlights the big bills that can come after a patient has been transported via air ambulance, even for those with insurance.

GAO studied close to 21,000 air ambulance trips from 2017 and found that 70% were out of network for the patient. By contrast, about half of ground ambulance trips are out of network. Out-of-network care is the source of surprise bills that can catch patients off guard with large payments.

In tandem, prices for air ambulance trips have increased, according to the study. GAO found that the median price for a helicopter transport in 2017 was about $36,400, a 60% increased from a 2012 median price of $22,100. (FierceHealthcare)

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