Capitol Hill Report: Drug Pricing Reform: Congress, the AMA, and the AAN

November 23, 2015

By Mike Amery, Esq., Senior Legislative Counsel, Federal Affairs

Can Your Patients Afford Their Prescriptions?
The issue of drug prices has always been a concern of American Academy of Neurology members, especially those with patients who are affected by high costs, such as people living with MS. The AAN's Government Relations Committee (GRC) and Medical Economics and Management Committee (MEM) both had preliminary discussions on setting AAN policy regarding drug prices at meetings in August and September. 

The GRC and MEM will be holding a joint planning meeting in January where this topic is sure to be a top priority, and it couldn't be timelier as this issue continues to grow in Washington. 

Members of Congress on both sides of the aisle are becoming increasingly interested in this issue as costs for new blockbuster drugs like Sovaldi, along with price spikes in older drugs, have generated significant press coverage. Recent public opinion polls put drug pricing at the top of Americans interests regarding health care priorities.

Last week, the Senate Special Committee on Aging, led by Sens. Susan Collins (R-ME) and Claire McCaskill (D-MO), announced they had requested documents from Valeant Pharmaceuticals, Turing Pharmaceuticals, Retrophin, and Rodelis Tharaputics in an effort to investigate dramatic price increases after these companies acquired or merged with other companies. The prime example was Turing, which increased the cost of Daraprim from $13.50 to $750 per tablet. The committee will hold its first hearing on December 9. The House Oversight Committee plans to hold similar hearings early next year.

Meanwhile, drug pricing was a central topic at the American Medical Association interim meeting in Atlanta, attended by AAN member delegates and staff. The Academy co-sponsored a resolution authored by the American College of Rheumatology urging the AMA to advance legislation that would allow CMS to negotiate with pharmaceutical manufacturers on covered Part D drugs and seek greater price transparency overall. This resolution was considered by the House of Delegates in combination with two other resolutions and one report by the AMA's Council on Medical Service. Testimony was surprisingly positive. In the end, the amended Council report recommendations were accepted and we can expect the AMA to become much more involved in the debate over increasing drug costs. The AMA also called for a ban on pharmaceutical advertising directly to patients. Pharma advertising costs have increased by 30 percent in the past two years to reach $4.5 billion. The AMA cited concerns about public advertising steering consumers to more expensive drugs when cheaper and effective alternatives are available, and that consumers pick up the tab for these advertising dollars through higher drug prices. Learn more about the AMA positions.

FAST Act Moving Quickly on Co-sponsorships
The FAST Act (S. 1465/H.R. 2799) is legislation the AAN is working on with the American Heart/Stroke Association. Currently, Medicare will pay for a telemedicine consult for stroke if the hospital where the patient presents is in a designated rural area. The FAST Act would open up payments for these consultations in any area, resulting in greater patient access to neurologists. We predict this change will result in greater use of tPA, in turn reducing disability and producing savings $1.2 billion over 10 years due to less use of inpatient hospital rehabilitation and skilled nursing services.

Last week the AAN received some recognition for our efforts from Politico, a Capitol Hill newspaper:

TELE-STROKE BILL GAINS SUPPORT: The FAST Act, GOP Rep. Morgan Griffith's bill that would have Medicare pay for stroke treatment via telemedicine, now counts 38 co-sponsors, almost twice as many as it had two months ago. The American Academy of Neurology and the American Stroke Association have been pushing the bill of late. The stroke group says expanding tele-stroke coverage could save $1.2 billion over 10 years, despite the additional Medicare spending it entails.

We added a 39th co-sponsor this week when Rep. Jerry McNerney (D-CA) signed on.

Neurologist Runs for Governor of Virginia
There is big news in Virginia, as Lt. Gov. Ralph Northam, MD, (D), announced that he is running for governor in 2017. Northam is a practicing child neurologist, AAN member since 1990, and the highest elected neurologist in the US.

Current Gov. Terry McAuliffe (D) is term limited, so Northam looks to have the upper hand in becoming the Democratic nominee in what is sure to be a tough election in this swing state.

AAN Submits Comments on Medicare Payment Reform
By Daniel Spirn, Regulatory Counsel

On November 16, the AAN submitted comments to the Centers for Medicare & Medicaid Services (CMS) that will help shape the future of Medicare. Earlier this year, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The law repealed the Sustainable Growth Rate (SGR) formula, a mechanism created in 1997 designed to restrict growth in Medicare Part B spending. MACRA ushers in major changes to Medicare and starting on January 1, 2019, physician payments will be driven by either transitioning to alternative payment models (APMs) or participating in the Merit-based Incentive Payment System (MIPS), a consolidated pay-for-performance program. In October, CMS submitted a number of questions to stakeholders to help the agency develop the rules that will guide these new MACRA programs.

In our comments, the AAN stressed the need for CMS to consider the unique challenges facing neurologists serving the Medicare population. We called upon the agency to place a special emphasis on small and rural practices when considering new rules. Additionally, the AAN noted its desire to work with CMS on the development of APM policies and inclusion of options for neurologists to join APMs that will provide a bonus on Medicare payments. We will continue to work closely with CMS to minimize any potential burden on neurologists. Please take a few minutes to learn more about MACRA and Medicare payment reform on the AAN's website.


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