Employment. Health Care employment accelerated in March from 4.28% to 4.47% with each of the major sectors experiencing increases. As we examine the push-me-pull-you debate between MCOs and the government over increased utilization/cost, this round is going to the high cost bucket.
CONGRESS.
Advancing Telehealth. The House Energy and Commerce Committee will hold a hearing next week on making telehealth flexibilities created during the Public Health Emergency and then codified on a temporary basis.
While the hearing is not considering specific legislation, the aim is to permanently permit audio only telehealth, expand the types of providers that can conduct telehealth visits and reduce geographical restrictions.
A Change Will Do You Good. UNH (-) On the other side of the Hill, the Senate is planning hearings on the Change/UNH cyber attack. The focus is on how widespread the impact was as much as it is to prevent similar future events.
Sen. Mark Warner has introduced a bill to provide accelerated and advanced Medicare payments to providers affected by a cyber attack but only if they have installed modern preventive measures.
No date has been set for the hearing.
Physicians Pay. Senate Finance will convene the first of what promises to be many hearings on the Physicians Fee Schedule. The current governing statute – MACA was born in an era where value-based purchasing was considered a thing. It is getting increasingly unworkable in a higher cost of capital environment with temporary patches creating annual uncertainty.
Change probably needs to come sooner rather than later as quitting the Medicare program is now on the table for most multispecialty practices. We would anticipate that some of the deregulation work conducted by the House Energy and Commerce Committee will find an opening for things like site neutral payments
WHITE HOUSE.
Biosimilars. Following hints from the White House, CMS has sent guidance to Part D plans telling them they can offer biosimilars – interchangeable or not – through “formulary maintenance” process intra-plan year.
It is not sure how this move might disrupt the current paradigm in which plan sponsors favor reference biologics with fat rebates over lower cost biosimilars. The administration has to get and keep drug prices down and appear to be up for anything.
Dental Services. The 2025 final ACA Exchange rule was released. It includes a provision that would allow states to include adult dental services in the Essential Health Benefits package required for marketplace plans.
The provision reverses a prohibition adopted during the Obama administration and would be effective in 2027.
OTHER STUFF.
Paxlovid Bust. In the least surprising news of the year, a PFE sponsored study, published in the New England Journal of Medicine, concludes that Paxlovid is no better than a placebo in vaccinated individuals with average risk of serious disease.
The prescribing history suggests doctors figured this out a while a go and only governments have been fool enough to buy it in large quantities. Antivirals have always been difficult to develop and their record remains intact.
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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