RNS Advocacy: Capitol Update – October 2023

The most widely reported story out of D.C. in October was the three-week vacancy of the House Speakership, but that was far from the only activity on Capitol Hill.

Looking ahead, the government is currently funded through November 17. To avoid a shutdown, Congress will have to enact its appropriations bills before then, or provide another short-term extension. The newly minted House Speaker has outlined an aggressive timeline to get through this process but has stated that, if another short-term extension is needed, that would extend into the new year, with the goal of avoiding a pre-holiday “omnibus” spending bill.

In the health policy sphere, the House Energy & Commerce Committee’s Health Subcommittee held a hearing on October 19 to discuss a list of over twenty bills related to Medicare reimbursement, quality measurement, and administrative burdens on providers. The hearing, entitled “What’s the Prognosis? Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors,” featured two panels of witnesses, including the Centers for Medicare and Medicaid Services, the Government Accountability Office, and the Medicare Payment Advisory Commission, as well as two physician groups and two think tanks. Although bipartisan agreement can be rare to come by, there was clear consensus from both sides of the aisle that the Medicare Physician Fee Schedule fails to keep pace with inflation and under-reimburses providers and that administrative burdens on providers, including utilization management, have reached crisis levels. There are several pieces of legislation that take steps to reform the Fee Schedule, but – as is usually the case – the main obstacle to enactment will be that these bills are “scored” by the Congressional Budget Office as raising federal government spending.

For our part, RNS continues to advocate reform of utilization management, including step therapy. To that end, we joined a Safe Step Act Coalition letter calling on congressional leadership to include the Safe Step Act in the final pharmacy benefit manager reform bill that will hopefully come together before the end of this Congress.

We’ve also pursued legislative reforms to the use of copay accumulator programs by insurance companies and their pharmacy benefit managers, because these programs prevent patients from accessing the full value of cost-sharing assistance. Earlier this year, RNS joined a judicial challenge to the use of these programs in the Affordable Care Act exchanges by signing onto an amicus brief. Recently, there was an exciting development in that litigation: the court struck down the regulation allowing the blanket use of copay accumulators in the exchanges, leaving in place a previous regulation allowing use of these programs only for branded drugs that have low-cost therapeutic alternatives. Notably, the court ruling allows the agency to revisit this issue in the future, so we quickly joined a letter by the All Copays Count Coalition to the Administration, urging them not to appeal the ruling. In the meantime, RNS will continue its advocacy for the HELP Copays Act, bipartisan legislation that would codify protection for patients against the use of accumulators. In the House, the bill recently reached the 100-mark for cosponsors, which is an encouraging indicator of Congress’ interest in reform.