Weekly Update for Week Ending November 20, 2021

Weekly Update for Week Ending November 20, 2021

Congress Takes a Break – Again!

Even though they have such important issues they must deal with before the end of the year, Congress is in recess this week because of the Thanksgiving holiday. It is hard to believe they can finish all their work in time for Christmas so expect to see them take a short Christmas break and then be working right up until the new year.

Already, it is expected that they will pass another short-term funding extension to get them into next year and they will finish funding the government for fiscal year 2022 sometime in January or even February.

How they will handle the other legislation, like the debt ceiling, that they have to deal with is anyone’s guess at this point.

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One Down - One to Go

Finally-- last week the House of Representatives passed the legislation containing measures to lower prescription drug prices and cover hearing services under Medicare. The vote was close, with one Democrat and all Republicans voting against the legislation, siding with the drug companies in arguing that the bill would result in fewer new medications being developed.

The plan would allow Medicare to negotiate some drug prices, penalize drug makers that hike prices faster than inflation, and cap drug costs for seniors and patients who use insulin.

Specifically, it would place a $35-per-month limit on the cost of insulin under Medicare and a cap on out-of-pocket prescription drug costs at $2,000 per year.

The bill would also require drugmakers to pay back profits from raising the cost of medicines above inflation.

However, the bill is not as sweeping as earlier versions and it will be a while before its provisions would go into effect if it passes the Senate.

The details of the bill are important because although it would eventually lead to lower prices on some drugs, the number of drugs affect is limited, and it would take a few years to fully implement the new law.

Here is some of what the legislation that passed the House last week would cover.

It would direct the Health and Human Services Department (HHS) to establish a “Drug Price Negotiation Program” to negotiate a maximum price of high-cost prescription drugs for Medicare Parts D and B beginning 2025.

The measure would require HHS to identify 100 drugs without competition that have been on the market for seven years and biologics that have been on the market for 11 years, and that have the highest spending under Medicare. HHS would select as many as 10 drugs from that list for negotiation in 2025 and as many as 20 drugs by 2028, plus insulin.

There are other more complicated restrictions on what drugs would be affected and when the law would take effect, but the above information probably is enough to know for now.

Although this legislation is far less than what TSCL wanted, it is a major step forward because it’s the first time legislation to try and bring the prices of prescription drugs down has been able to pass either house of Congress.

PhRMA, the brand-drug lobby, claimed the package “threatens innovation and makes a broken health care system even worse,” but the Congressional Budget Office (CBO) estimated that Democrats’ drug pricing reforms would result in ten fewer drugs entering the market over the next three decades — and only one fewer drug in the first ten years — out of an expected 1,300 new drugs.___

Boost for Home Health Care

The House bill would provide $150 billion under Medicaid to enable states to give more elderly and disabled Americans the opportunity to get long-term care at home as well as to boost pay for home care workers.


Hearing Services Covered Under Medicare

If the bill passes the Senate, for the first time Medicare would cover hearing services for seniors, including coverage for a new hearing aid every five years. Coverage for dental and vision services had to be removed from the bill in order for it to pass the House. However, Senator Bernie Sanders (I-Vt) has said he still wants dental and vision benefits to be added back.

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On to the Senate

The legislation dealing with prescription drug prices now moves to the Senate for action. Everyone expects there will be changes to it. The real questions are how many changes will be made, what kinds of changes will the Senate make, and will they be able to pass it at all.

If the Senate is able to pass it, it must go to a conference committee where the differences between the House and Senate bills must be worked out and if they can reach agreement on one bill, it must go back to each body for a final vote. If all of that can be accomplished, then it will go to the President for his signature.

As we have reported before, all Republicans have said they will vote against the bill, regardless of what’s in it. So, the Democrats have to get all 50 of their Senators to agree to the bill. That’s why Senators Manchin and Sinema has been in the news so much and why what they will support is so important.

However, there are other Democratic Senators who don’t like some of the provisions regarding lowering prescription drug prices in the House bill so there will be a struggle to get them on board as well.

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Bill to Stop Cuts in Medicare Payments to Doctors is Introduced

Last week there was some refreshing proof that Congress can still, on occasion, work together in a bi-partisan manner.

Representatives Larry Bucshon, M.D. (R-Ind.) and Ami Bera, M.D. (D-Calif.)  announced the introduction of bipartisan legislation to provide critical relief to physicians responding to the COVID-19 pandemic who are currently scheduled to receive Medicare payment cuts next year. The Supporting Medicare Providers Act of 2021 (H.R. 6020) would extend the 2021 Medicare physician payment adjustment of 3.75% for an additional year.

“Beginning on January 1, 2022, many specialists, therapists, and other physicians will be faced with substantial reimbursement cuts – up to 9 percent for many providers, if Congress does not act. These cuts would make our nation’s doctors work longer hours for less pay during the worst global health crisis of our generation,” said Dr. Bucshon. “I want to thank my friend and fellow doctor, Congressman Ami Bera (D-Calif.) for his partnership in leading the bipartisan Supporting Medicare Providers Act of 2021, which will ensure Americans continue to have access to quality care in their communities. I look forward to continuing to work with congressional leaders to find practical ways to pay for this proposal and advance this important bill into law before January 1, 2022.”

“As an internal medicine doctor by training, I know that cutting payments for physicians during the middle of a global pandemic will only further strain our health care system and the ability for health care professionals to serve their patients,” said Representative Bera, who previously served as Chief Medical Officer for Sacramento County. “That’s why I’m introducing the bipartisan Supporting Medicare Providers Act of 2021 with my good friend and fellow doctor Representative Bucshon, M.D. to prevent these harmful cuts from occurring. Our frontline health care workers are heroes keeping our communities safe and healthy during this pandemic, and they deserve our full and unwavering support.”

Reps. Bucshon and Bera led over 245 Members of Congress in an October 2021 letter urging House Leadership to address the looming Medicare payment cuts to health care providers that will further strain patient access to care.

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More Proof Congressional Action is Needed to Lower Drug Prices

According to a report in Stat News last week, during 2020, drug makers raised prices on seven widely used medicines by substantial amounts without any new clinical evidence to justify the increases, forcing patients and health insurers in the U.S. to spend an additional $1.67 billion last year, according to a new analysis.

Much of the added spending was attributed to just one drug – AbbVie’s Humira treatment for rheumatoid arthritis and other ailments. The price rose by 9.6%, after rebates and discounts, which led to an extra $1.4 billion in spending had the price not been raised, according to the analysis by the Institute for Clinical and Economic Review, a nonprofit that mostly assesses the cost effectiveness of new medicines.

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As we continue dealing with the Covid 19 pandemic, TSCL remains constant in our fight for you to protect your Social Security, Medicare, and Medicaid benefits. We’ve had to make some adjustments in the way we carry on our work, but we have not, and will not stop our work on your behalf.

For progress updates or for more information about these and other bills that would strengthen Social Security and Medicare programs, visit the our website at www.SeniorsLeague.orgfollow TSCL on Twitter or Facebook.