| | | |   | Hello and happy Thursday, D.C. Diagnosis readers! I have a quick behind-the-scenes tidbit this morning for seasoned drug pricing followers. Remember that old Trump-era executive order on international reference pricing that the White House refused to release for a while in summer 2020? I just got my FOIA response back… two years and two months after I initially filed it and well after the document was already made public. Send your timely news tips to rachel.cohrs@statnews.com. | | | Surprise billing lawsuits in chaos If you’re looking for some surprise billing drama, this week has already provided quite a bit, my colleague Bob Herman reports. First, on Tuesday, the American Hospital Association and the American Medical Association dismissed their claims in the surprise billing case against the federal government — a significant reversal from groups that argued vociferously against the law’s new process for settling out-of-network medical bills. But the groups hinted at different litigation in the future, telling reporters they are still unhappy with the final rules the Biden administration put out in August, and that “hospitals and doctors intend to make our voices heard in the courts very soon about these continued problems.” Most recently, during a hearing yesterday, the Association of Air Medical Services indicated it was following in the footsteps of AHA and AMA and would likewise dismiss its claims now that the final rules are out. But the AAMS also said it was deliberating whether it would file a different lawsuit in a different court, while attorneys for AMA and AHA backpedaled and said they have no intentions of filing any new lawsuits anywhere.
The AAMS, AHA, and AMA did not immediately respond to questions about the hearing on Wednesday. But a few things are clear: There are still plenty of other lawsuits that attack the surprise billing arbitration process and are stuck in limbo, especially the one in Texas that sits in front of a very provider-friendly judge; and the arbitration process remains an absolute mess. | The first baby steps implementing Democrats’ drug pricing plan The Inflation Reduction Act’s most impactful health provisions — giving the government the ability to negotiate drug prices and capping drug costs for Medicare patients — will take effect years from now, but the very first baby step in the law’s drug pricing policy implementation is about a week away. Oct. 1 marks the start of the look-back period that Medicare will use to demand refunds from drugmakers that raise prices faster than inflation. It’s unclear whether Medicare will be issuing any guidance beforehand, but West Health Policy Center health policy director Sean Dickson said it will be worth watching whether drugmakers change their pricing behavior significantly. Usually the times to watch for price hikes are January and July. The actual penalties will be charged to pharmaceutical companies for pharmacy drugs next year, from a baseline year of 2021. Kaiser Family Foundation’s deputy director of Medicare policy, Juliette Cubanski, said the law requires Medicare to calculate the penalties using average prices over the calendar quarters from October 2022 to September 2023. | Wake me up when October (?) ends Senate Majority Leader Chuck Schumer squeezed some more time for a potential vote on insulin legislation into the fall, as he announced this week that the Senate will be meeting in October this election year. Schumer has promised to hold another vote on a provision to lower insulin costs for patients with private insurance, but it’s unclear whether he will follow through. Measures from Sen. Raphael Warnock (D-Ga.) and Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) have been stalled for months (remember when we were supposed to vote shortly after Easter?), and there’s no sign of the logjam breaking anytime soon. When I asked Warnock earlier this month about whether there will be a vote soon, he just said, “I will keep pushing until we get a cap on insulin for folks on private insurance as well.” However, the House is still scheduled to leave town on Sept. 30, so it’s unlikely that even if the Senate votes on legislation by mid-October, that it would become law before the election — and the Senate already got a messaging vote to campaign on in August. | America's seniors deserve better: modernize Medicare coverage of innovative medical technologies America’s most vulnerable seniors are often forced to wait years for the Centers for Medicare & Medicaid Services (CMS) to cover and pay for innovative medical technology. Thankfully, CMS can significantly accelerate access to transformative medical technologies developed by America’s innovators by including a dedicated coverage pathway in the agency’s upcoming Transitional Coverage for Emerging Technologies (TCET) rule. Learn more about how Congress and CMS can accelerate coverage of innovative medical devices. | These diagrams on for-profit nursing homes will make your head hurt  Credit: Select Subcommittee on the Coronavirus Crisis The House oversight committee’s subcommittee on Covid-19 issued documents yesterday related to an investigation of for-profit nursing home chains, and the new documents disclosed included some mind-bogglingly complex org charts of how the companies are structured. The above photo is a depiction of Genesis Healthcare’s more than 700 discrete companies as of June 2020, and the 14 pages of charts provided by SavaSeniorCare are similarly convoluted. A sampling of Sava’s virtually indistinguishable parent company names: SSC Equity Holdings, LLC, SWC Equity Holdings, SSC Special Holdings, SSC Equity Holdings MT. In this general structure, each facility operates as its own company and leases the physical facilities from other companies in the network. That structure helps insulate the parent company from liability, and makes it difficult to tell from the outside which facilities are related to each other. | | | Thanks for reading! More next week,  | | | |
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