Congress

Alexander, Murray outline plan to lower health costs

Alexander he hopes it will get a committee mark up next month and the Senate will debate a bill in July

Chairman Lamar Alexander, R-Tenn., and ranking member Sen. Patty Murray, D-Wash., conduct a Senate Health, Education, Labor and Pensions Committee hearing in Dirksen Building titled "Vaccines Save Lives: What Is Driving Preventable Disease Outbreaks?" on March 5, 2019. (Tom Williams/CQ Roll Call file photo)

Two influential senators released draft health care legislation Thursday, a package of narrowly tailored proposals that will likely be part of a measure to lower health care costs that lawmakers hope to pass this year.

The draft bill, from Health, Education, Labor and Pensions Chairman Lamar Alexander, R-Tenn., and ranking member Patty Murray, D-Wash., targets five areas: banning surprise medical bills; speeding low-cost generic drugs to market; increasing transparency; improving public health; and enhancing health information technology, according to a summary.

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“These are common sense steps we can take, and every single one of them has the objective of reducing the health care costs that you pay for out of your own pocket,” Alexander said in a statement.

Although health care is one of the most partisan issues on Capitol Hill in the current divided Congress, lawmakers are still optimistic legislation to prohibit surprise medical bills and lower prescription drug prices could pass this year, even after President Donald Trump declared this week that he would not work with Democrats as they investigate the administration.

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“I’m sure the president is going to support [it] in the end,” said Senate Finance Chairman Charles E. Grassley, R-Iowa. “I would be surprised if he didn’t. I think that there’s not much that the president talking to [Speaker Nancy] Pelosi could do about what we’re doing here already.”

Alexander said this week he hopes the HELP Committee will mark up legislation next month and the Senate will debate a bill in July.

The Finance Committee will offer its own drug pricing bill by June 17, Grassley told reporters Wednesday. That bill is expected to address aspects of Medicare reimbursement for prescription drugs and also likely impose an out-of-pocket maximum spending limit for participants in Medicare’s prescription drug benefit, Part D.

Senators have been careful to keep the package bipartisan and to include lawmakers’ priorities while avoiding any major changes to the 2010 health care law. Last week, House Democrats packaged several bipartisan drug pricing bills, including one that is part of the Senate measure, with several bills meant to bolster the 2010 law, drawing the ire of House Republicans.

“I appreciate the work Democrats and Republicans on our committee are doing and encourage Republicans to continue working with us on the many other health care challenges families face today — including threats to protections for pre-existing conditions as a result of President Trump’s health care sabotage,” Murray said in a statement.

Health committee proposal

The bill includes several provisions meant to ensure drugmakers don’t abuse Food and Drug Administration incentives to encourage new drug development. Drugs that involve the creation of a new chemical molecule are eligible for a five-year exclusive sales period after they are approved. But some drugmakers have claimed this reward by getting approval for new uses or changing how a drug is administered. The bill would clarify that the exclusivity only applies for new drugs.

The bill would also codify an FDA policy meant to ensure insulin manufacturers can’t claim new exclusivity periods for existing products as the FDA transitions from regulating insulin as a traditional drug to a biologic drug.

The legislation also includes several House-passed measures. Two (HR 1503, HR 1520) would require more timely updates of the FDA databases that say when a drug’s monopoly protection expires, and another (HR 938) would start the clock more quickly on a 180-day exclusivity period granted to generic drugmakers if it looks like they are dragging their feet on a product’s launch. The Senate bill also contains a section meant to deter drugmakers from abusing the FDA’s “citizen petition” process in order to delay approval of competing products, an idea shared in a measure the House Judiciary Committee approved in April.

On surprise medical bills, the two propose three options to protect patients from facing unexpected bills and for insurers and providers to negotiate payment. Lawmakers want to prohibit the surprise bills for patients receiving emergency services or inadvertently receiving out-of-network care.

The first option would require an in-network facility to guarantee to patients and health plans that all individual providers there be considered in network. Another option is arbitration, so that for all surprise bills over $750, the payer and provider could give their best offers to an independent judge for dispute resolution. Under the third, the payer would reimburse the provider or facility at the median rate for a service in a certain geographic area.

Lawmakers in both chambers have offered a variety of ways to address surprise medical bills and could face pressure to reach an agreement soon if Alexander wants to pass legislation this summer.

The measure would also authorize grants for high-profile public health issues, including for education about vaccines and for maternal mortality.

The bill would also set up a non-profit entity to establish an all-payer claims database, which would group unidentified claims from self-insured plans, Medicare and participating states.

The proposal would require health plans to disclose claims data, their in-network physicians and patients’ expected out-of-pocket costs. The legislation also seeks to ensure patients get timely information about costs from providers and insurers about their out-of-pocket costs, including requiring that patients receive bills for any treatments within 30 days of the service.

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