CMS’ Blum Will Respond To Criticism Of Part D Proposed Rule At House Hearing
This article was originally published in The Pink Sheet Daily
Executive Summary
The Energy & Commerce Health Subcommittee plans a Feb. 26 hearing to air members’ opposition to CMS’ proposed rule on Medicare Part D, and Republicans warn that failure to “reject” the proposed rule “will force Congress to evaluate all legislative options necessary to ensure seniors are protected.”
CMS Deputy Administrator Jonathan Blum is scheduled to testify Feb. 26 at a House Energy & Commerce Health Subcommittee hearing about the agency’s recent Medicare Part D proposed rule.
Blum will take the hot seat in defense of the agency’s proposal to make controversial modifications to Medicare’s outpatient prescription drug program. CMS’ proposed rule, published Jan. 10, has generated a firestorm of opposition from a broad and diverse group of stakeholders, including drug manufacturers, insurers, pharmacy benefit managers, patient organizations and local business groups (Also see "CMS Part D Proposal Is “Solution In Search Of A Problem” – PhRMA’s Castellani" - Pink Sheet, 19 Feb, 2014.).
The hearing will provide a forum for members of the subcommittee to continue that opposition. It is entitled, “Messing with Success: How CMS’ Attack on the Part D Program Will Increase Costs and Reduce Choices for Seniors.”
In a hearing notice, the subcommittee says the proposed rule, which would narrow the scope of the Part D policy on protected drug classes, among a number of other changes, “would completely undermine the integrity and success of the Medicare Part D program.”
Part D “relies on competition, giving seniors more choices and driving down costs,” said Subcommittee Chairman Joe Pitts, R-Pa. “The proposed rule threatens to eliminate those choices and impose government mandates that would lead to limited provider networks, lost access to doctors for seniors, increased costs for care, and higher drug costs for both Medicare Part D beneficiaries as well as taxpayers.”
Stakeholders are united in the concern that the proposal would greatly increase CMS’ ability to intervene in the Part D marketplace. Provisions that have drawn the most opposition would remove mental health and immunosuppressant drugs from protected class status, limit sponsors to two prescription drug plans per PDP region and regulate plans’ pricing negotiations with pharmacies (Also see "Mental Health Drugs Face Contracting Challenges From Part D Formulary Proposal" - Pink Sheet, 20 Jan, 2014.).
Legality Questioned, Legislation Threatened
In a related initiative, Republican leaders in the House and Senate committees with jurisdiction over Medicare wrote to CMS Administrator Marilyn Tavenner and HHS Secretary Kathleen Sebelius on Feb. 19, questioning the legal basis for the proposed rule and threatening legislative remedies if the agency does not withdraw it.
The action follows similarly critical letters to CMS from the entire Senate Finance Committee and to President Obama from the top Republican leadership in the House (Also see "CMS Should Retain Existing Part D Protected Classes, Senate Finance Committee Urges" - Pink Sheet, 7 Feb, 2014.).
House Energy & Commerce Committee Chairman Fred Upton, R-Mich., Ways & Means Committee Chairman Dave Camp, R-Mich., and Senate Finance Committee Ranking Member Orrin Hatch, R-Utah, signed the Feb. 19 letter. Hatch had also signed the earlier Finance Committee letter to CMS, along with former Finance Committee Chairman Max Baucus, D-Mont. Upton and Camp also participated in the earlier letter from the House.
The latest letter asserts that in the proposed rule, “the agency interpreted Medicare Part D’s ‘non-interference’ provisions for the first time to allow the agency to interfere in negotiations between plans and pharmacies, a proposal that is inconsistent with both agency precedent and the plain letter of the law.”
In addition, more than eight million seniors may be forced out of their current plans and into more expensive ones if the proposal to limit the number of plans that may be offered by sponsors is finalized, the letter maintains. It also criticizes the proposal to remove some “formulary protections provided for vulnerable patients.”
“Washington should not be inserting itself between seniors and the prescription drug plans that they chose and depend on,” the letter argues. “Given the important legal questions and irreparable harm facing seniors across the country, we request that you reject these harmful changes to the Part D program and withdraw this proposed regulation.”
The letter warns that a “failure to reject this rule will force Congress to evaluate all legislative options necessary to ensure seniors are protected.”
In an email, a CMS spokesperson responded to criticism of the proposed rule by saying it “will ensure that Medicare beneficiaries have access to affordable health and prescription drug plans while making certain that plans provide value to Medicare and taxpayers. It would improve health care quality, reduce costs for Medicare beneficiaries … and give us new tools to combat fraud, waste and abuse.” Furthermore, the spokesperson said, “this is a proposed rule and we welcome comments from the public.” The comment deadline is March 7.