TRP Health Policy has complied all key developments in implementation of the Affordable Care Act (ACA) during the month of September. These updates are being posted to our online catalogue of ACA implementation here, which is indexed by title and section of the law. We hope you find this to be a helpful recap and reminder of the broad range of... Read More
WHG - 2016 Election Preview
This week at TRP Health Policy we have updated our analysis of the upcoming presidential and congressional elections, with analysis of their implications on Federal policy. In a concise slide deck, we present expectations for election outcomes, races to watch, and implications for Administration priorities under different scenarios... Read More
WHG - CMS' Exchange Rule: What You Need to Know
CCIIO recently announced new regulations intended to strengthen the health of the ACA marketplaces and improve the experience for insurers. The slate of technical tweaks announced by the agency — known as the draft 2018 Notice of Benefit and Payment Parameters — is the latest step in a range of actions the administration has taken this year to address complaints... Read More
WHG - MACRA: Initial Parameters and Future Directions
In a new slide presentation, TRP Health Policy provides a concise overview of MACRA's physician payment reforms, which consolidate the PQRS, Meaningful Use, and Value-based Payment Modifier programs into the Merit-based Incentive Program and offer further incentives to providers participating in Alternative Payment Models. The slides recap key considerations with the SGR repeal legislation, including patient care, administrative burden, small... Read More
WHG - EpiPen and the Pricing Debate - Congressional Oversight and Campaign Proposals
The chorus of disapproval about the cost of EpiPen prescriptions reached a crescendo last week after the maker of the drug, Mylan, was widely lambasted for drastic price increases in the product which is widely used to combat potentially life-threatening allergic reactions. Over the past decade, the list price for a package of two injectors has jumped from $94 to... Read More
WHG - Aetna and the Exchanges - What It Means for the ACA, Third-Party Payers, and the 'Public Option'
Last week, Aetna – one of the nation’s largest private insurers – announced that it would withdraw from 11 of the 15 Affordable Care Act (ACA) state exchanges where it sells health plans. Aetna, which had 838,000 exchange customers at the end of June, said its policyholders are turning out to be sicker and costlier than expected. In addition to... Read More
WHG - Quick Note re Fall Outlook & Cures/Innovations Package
Through some recent discussions with lead staff, we have gotten a clearer picture of the likely congressional activities during the September and post-election lame duck work periods that we wanted to pass along. According to Senate Republican leadership, the September work period is likely to focus on the “messes” left over from July: Puerto Rico pension issues, Zika, and the... Read More
WHG - Issue Brief: Clinton and Trump Health Policy Proposals
TRP Health Policy has prepared an issue brief outlining Hillary Clinton and Donald Trump’s stated healthcare priorities. While it emphasizes those impacting the pharmaceutical space, in light of the headline debates around drug pricing, the memo also explores other aspects of their healthcare agendas... Read More
WHG - 2016 Federal Election Outlook
TRP Health Policy has prepared a PowerPoint deck that examines the 2016 Federal elections and potential implications for healthcare. Here we walk through recent polling on the presidential and congressional races, consider the priorities of the key candidates and their parties, and look to areas of likely focus next year. In brief, no matter how you slice it, we will... Read More
WHG - Issue Brief: Child Nutrition and WIC Reauthorization
This memorandum provides an overview of the Child Nutrition and WIC Reauthorization Act (CNR), including background on the federal child nutrition programs it would address (section II) and details on the five-year reauthorization process (section III). Also provided below is background on the iteration of CNR currently in place, the Healthy, Hunger-Free Kids Act (HHFKA) (P.L. 111-296), which was signed into... Read More
WHG - Issue Brief: Part B Drug Pricing Levers - Least Costly Alternative and Inherent Reasonableness
With the increased politicization of drug pricing, the Administration is reportedly contemplating regulatory changes it might undertake to address the issue, such as deploying least costly alternative (LCA) or inherent reasonableness authority. However, both of these paths face considerable legal and political obstacles, and LCA policies likely would require legislation restoring HHS authority prior to implementation... Read More
WHG - Issue Brief: Telemedicine Coverage and Reimbursement
This memorandum explores the reimbursement and regulatory landscape for telemedicine services, particularly those relating to population health. The memo provides a brief definition of telemedicine, in contrast to broader telehealth services (sec. II), before outlining how government and private payers reimburse providers for certain telemedicine services (sec. III). Additionally, the memo identifies alternative sources of telemedicine funding via grant and... Read More
WHG - Issue Brief: Republican Alternatives to the ACA
This issue brief provides an overview of key 2016 GOP Presidential candidates’ healthcare reform-related proposals. It further outlines more comprehensive Affordable Care Act (ACA) alternative policies put forward by both lawmakers and conservative think tanks. In conclusion, we assess the likelihood of ACA repeal (or fundamental reform) and strategic and political considerations in that regard... Read More
WHG - Issue Brief: Biosimilars
This memorandum provides background on the Food and Drug Administration’s (FDA’s) implementation of the Biologics Price Competition and Innovation Act’s (BPCIA) abbreviated licensure pathway for products that are biosimilar to – or interchangeable with – a licensed biologic reference product. After a lengthy wait for implementing guidance, key pieces of which remain pending, biosimilars implementation has begun to accelerate. The FDA and Centers... Read More
WHG - Issue Brief: Outline of Likely 2017 CHIP and Medicare Extenders Package
This chart outlines the provisions that will potentially be included in the CHIP and Medicare extenders package Congress is likely to address next year. These items were most recently extended in MACRA 2015 (aka the permanent SGR repeal bill) and, for the most part, expire on September 30 or December 31 of next year. We have summarized each item and... Read More
WHG - Issue Brief: The 340B Program
This memorandum provides background on the 340B Drug Pricing Program to assist with review of the Health Resources and Services Administration (HRSA) omnibus guidance on key program parameters, released August 27, 2015. Congress has demonstrated sustained interest in the program, raising the possibility that HRSA’s highly anticipated guidance may not be the final word on these key issues. The Medicare Payment... Read More
WHG - Side by Side of CMMI & IPAB Authorities
This chart compares the constitution, authorities, and other parameters for the Center for Medicare and Medicaid Innovation (CMMI) and the Independent Payment Advisory Board (IPAB)... Read More
WHG - Issue Brief: Medicare Hospital Quality Reporting and Payment Programs
This memorandum provides an overview of key Medicare hospital quality reporting and payment programs, including their recent developments and significant upcoming changes. We begin with a brief outline of these programs, noting for example the Centers for Medicare and Medicaid Services’ (CMS) early experience with quality reporting-focused initiatives, such as the Hospital Inpatient Quality Reporting (IQR) Program. Building on the... Read More
WHG - Issue Brief: MACRA's Merit-Based Incentive Payment System
This Issue Brief provides an overview of key Medicare physician payment reforms to be implemented via the upcoming Merit-based Incentive Payment System (MIPS) pursuant to the latest “doc fix,” the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10). Although MIPS – which entails a consolidation of three Medicare physician quality reporting initiatives – is not set to... Read More
WHG - TRP Catalogue of Grant and Demonstration Opportunities
This is a catalogue of key select grant and demonstration opportunities in the healthcare space. The document features the open or imminent Federal offerings in this regard (as of the date of publication), with deadlines, summaries and links to additional details provided. We have labeled each opportunity based on the broad issue area(s) addressed. Please take a moment to review... Read More