Payer Roundup—Senate Finance Committee invites PBMs to drug hearing

Marriott International CEO Arne Sorenson has been called to testify at a March 7 Senate hearing regarding data breaches in the private sector.
The Senate Finance Committee invited executives from five PBMs to testify before a committee on drug pricing, plus more payer news. (Getty Images/lucky-photographer)

Senate Finance Committee invites PBMs to drug hearing

The U.S. Senate Finance Committee, led by Chairman Chuck Grassley and Ranking Member Ron Wyden, invited executives from five pharmacy benefit managers (PBMs) to testify before a committee on drug pricing.

The hearing, set for April 3, will be the third in a series of hearings looking at the costs of prescription drugs. Cigna, now the parent company of Express Scripts, CVS, Humana, OptumRx and Prime Therapeutics have been invited to the hearing. As pharmaceutical companies testified on the issue, the committee feels it is only fair to let PBMs talk about their role in lowering prescription drug prices. Grassley and Wyden ask that these companies come prepared to discuss real solutions.

“We welcome the opportunity to share with the committee the role of PBMs in advocating on behalf of consumers and plan sponsors to make prescription drugs accessible and affordable,” a spokesperson from the Pharmaceutical Care Management Association (PCMA) told FierceHealthcare.


2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

To further reduce prescription drug costs, PCMA sent Congress this year a number of legislative and regulatory policies to increase competition, reduce and build on market-based tools in public programs and private health insurance. (Announcement)

One-tenth of proposed Medicare cuts would affect seniors

Medicare cuts suggested by President Donald Trump in his 2020 budget proposals would impact a fraction of seniors in the program, according to a new report.

Most of the budget cuts would actually affect hospital payments, according to a study from the Committee for a Responsible Federal Budget. The actual amount of Medicare cuts proposed in the budget is about $500 billion, not the $845 billion that has been citied in other sources, CRFB says.

The changes that could affect seniors are in Medicare Part D, which would raise out-of-pocket costs for drugs for some seniors, but lower costs for others. But the analysis finds no changes in premiums, deductibles, copays or co-insurance. (Analysis)

Discovery Health Partners signs 20 health plans for its ESRD solution

Discovery Health Partners has signed on 20 health plans to date for its ESRD Premium Restoration solution, which launched in late 2018. The ESRD Premium solutions helps Medicare Advantage plans restore underpaid premiums from Centers for Medicare & Medicaid Services (CMS) for members with end-stage renal disease.

The treatments for renal disease are expensive and require lifelong care, so CMS pays Medicare Advantage plans a higher premium for each member with ESRD to help cover the costs of treatment.

“Discovery is adept at navigating these complex processes, and this expertise fills a real need for clients. We are pleased to support large and small health plans through this complex process of restoring underpaid premiums and ensuring accurate premiums are received going forward,” Kevin McDonald, VP of eligibility operations at Discovery Health Partners, said in a statement.(Announcement)

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