FEHBlog

The President held his bipartisan healthcare summit at the Blair House today. The Politico reflects the general consensus as far as I can tell that there was no clear winner from the lengthy meeting. It further reports that “After a brief period of consultation following the White House health reform summit, congressional Democrats plan to begin making the case next week for a massive, Democrats-only health care plan, party strategists told POLITICO.”

“In attempting to solve a problem that doesn’t exist, this legislation is the triumph of sound bites over substance. The Congressional Budget Office has said that passage of this legislation will do nothing to reduce health care costs. Moreover, according to the National Association of Insurance Commissioners, anti-competitive ‘activities are not permitted under the McCarran-Ferguson Act and are not tolerated under state law.’ Real reform means containing costs to ensure that health care is affordable for working families and small businesses. It’s time to clear the political hurdles that stand in the way of real cost containment.”

The House Federal Workforce Committee held a hearing today on the Chairman’s bill (HR 4489) to regulate prescription drug pricing in the FEHB Program. The testimony is available here. Preceding the hearing, the Office of Personnel Management issued a letter “to provide fee-for-service carriers with new FEHB pharmacy benefit management (PBM) transparency principles.”  

Govexec.com, Joe Davidson of the Washington Post, and Federal News Radio have reported on the hearing.

The President released a summary of his health care reform proposal yesterday. The proposal drives off of the bill that the Senate passed on Christmas Eve. It does not include a public option, but it does include a new federal commission to keep health insurance premiums “affordable.”  Interestingly, the Washington Post joined the Wall Street Journal in editorializing against this commission.

Modern Healthcare reports that “At a news briefing [today], House Speaker Nancy Pelosi (D-Calif.) said the White House’s new reform blueprint was “getting a good reception” among members of the House Democratic Caucus. “We have a lot more work to do” to get all Democrats onboard with the legislation, she acknowledged.

The Politico has posted the agenda for Thursday’s healthcare reform summit.

The Republican proposal is posted here.

Well this week will feature several big events — The President is expected to release his proposal to merge the Senate and House healthcare reform bills tomorrow according to the New York Times; the House Federal Workforce Subcommittee will hold a hearing Tuesday afternoon about its Chairman’s bill (HR 4489) to regulate prescription drug pricing in the FEHBP, and the President’s healthcare reform summit will take place on Thursday.

As prescription benefit managers (“PBMs”) will be under scrutiny at Tuesday’s hearing, let me point out a worthy endeavor of those companies — promoting personalized medicine.  Business Insurance reports about Medco’s effort to use genetic testing to accurately dose the blood thinner wayfarin and tamoxifin, a drug used to treat cancer. What’s more

Woonsocket, R.I.-based CVS Caremark Corp. is preparing to introduce a similar program in May after acquiring a majority stake in Generation Health Inc., a genetic benefit management company in Upper Saddle River, N.J. The companies last fall formed a strategic partnership to expand pharmacogenomic clinical and testing services for CVS Caremark PBM clients to improve care for patients who either don’t respond to their medications or have adverse reactions.

It’s also worth noting a Federal Times column by Reg Jones which discusses how different types of federal annuities affect eligibility for annuitant coverage under the FEHBP.

Last month, OPM announced a reorganization, and this month the Centers for Medicare and Medicaid Services is doing the same. The Hill has an interesting report about the changes, which were announced on Wednesday by internal CMS email, a copy of which is included in the Hill article. The article points out that CMS has not had a Senate confirmed Administrator since October 2006 when Mark McClellan left that post.  President Obama has not nominated an Administrator. Since he took office, CMS’s chief operating officer Charlene M. Frizzera has been acting administrator.

Today is the first birthday of the HITECH Act. President Obama signed this bill into law on February 17, 2009, as part of the Recovery Act. This first birthday is significant because the HITECH Act’s business associate provisions took effect today. Business associates are billing services, claims administrators, and other parties who handle protected health information for HIPAA covered entities, such as health plans, health claims clearinghouses, and health care providers who use electronic claim transactions. The business associate concept which the Department of Health and Human Services (“HHS”) created in the HIPAA Privacy and Security Rules is now enshrined in statute, and business associates are now subject to HIPAA’s enhanced civil and criminal penalties. AIS Health Business Daily recently offered a useful perspective on these new liabilities.

BNA is reporting that HHS is developing regulations to provide guidance on the changes that the HITECH Act made to the HIPAA Privacy and Security Rules. HHS has not indicated when the regulations will be published.

Finally, Government HIT News reports that HHS “named Joy Pritts, an assistant research professor at Georgetown University’s Health Policy Institute, as chief privacy officer in the Office of the National Coordinator for Health IT.”

Happy President’s Day.  President Obama’s health care reform summit is ten days away. Here’s a link to the invitation (not mine). The invitation explains that

The President will offer opening remarks at the beginning of the meeting, followed by remarks from a Republican leader chosen by the Republican leadership and a Democratic leader chosen by the Democratic leadership. The President will then open and moderate discussion on four critical topics: insurance reforms, cost containment, expanding coverage, and the impact health reform legislation will have on deficit reduction.

There are rumblings that Speaker Pelosi is contemplating the use of the budget reconciliation process to ram through the Senate bill with the House modifications as the reconciliation “sidecar.”  However, the unexpected resignation of former Congressman W.J. “Billy” Tauzin as CEO of the prescription drug manufacturer association, PhRMA,  late last week “presents another complication for Democratic leaders as they struggle to keep the effort from falling apart amid a tide of political setbacks” according to the Washington Post.

AHIP and the Blue Cross Blue Shield Association announced late last week that a large group of health insurers and health care provider organizations have teamed up in New Jersey (similar to the ongoing project in Ohio) that creates

opportunities to simplify the work associated with patient visits and achieve savings, including providing physicians and hospitals with information in “real-time” that:

• Allows office staff to quickly determine key eligibility and benefit information (e.g., co-pays, co-insurance, and deductibles, and differences in coverage for services provided in- versus out-of-network), minimizing time and expense needed for such purposes;
• Gives physicians access to current and accurate information on the status of claims submitted by physician offices for payment by insurers.  This will minimize the need for follow up steps by office staff or submission of duplicate claims that delay rather than expedite payment in most systems;
• Tests real-time referrals and timely pre-authorization of services; and
• Provides for the online submission of healthcare claims.

Very cool. It’s nice to see the industry cooperating to create uniform technology standards.

Meanwhile, on Friday, HHS Secretary Sibelius announced that the federal government is doling out about one billion Recovery Act dollars to health care providers in order to allow them to adopt and make meaningful use of electronic health records. 

Modern Healthcare reports that the narrowly focused Senate jobs bill that the Majority Leader unveiled today does not include the Medicare Part B doctor pay fix or the COBRA / TCC subsidy extension discussed in previous FEHBlog entries. Politico portrayed this move as a rebuke at Senate Finance Committee Chairman Max Baucus who had negotiated a broader bill with Republican Senator Chuck Grassley. Instead these two time sensitive provisions will be included in a tax extenders bill which also will be considered during the week of February 21 after the Senate returns from its recess.

Govexec.com reports that the House Federal Workforce subcommittee hearing on its Chairman’s bill (HR 4489) regulating FEHBP prescription drug pricing has been rescheduled for Tuesday February 23. According to the Committee’s website, the hearing will be held in Room 2154 of the Rayburn House Office Building beginning at 2 pm. Roll Call published an opinion piece by Mark Merritt, the Pharmaceutical Care Management Association‘s CEO, criticizing the bill as unnecessary.

Due to the continuing winter weather problems here in DC (or South Buffalo), the House Federal Workforce Subcommittee has postponed tomorrow’s scheduled hearing on the Chairman’s bill, H.R. 4489, “The Federal Employees Health Benefits Program (FEHBP) Prescription Drug Integrity, Transparency, and Cost Savings Act.” According to the Politico, the House will be out of session until February 22.

The Politico reports that Senate Majority Leader Harry Reid (D Nev) is planning to keep the Senate in session in order to consider President Obama’s top priority a jobs bill.   Business Insurance reports that the COBRA / TCC subsidy extension in the bill will cover people who lose their employer sponsored coverage due to involuntary termination or reduction of hours (NEW) over the next three months. 


The Washington Post reports that the “President Obama and congressional leaders emerged from a rare bipartisan meeting on Tuesday pledging to work together on a range of issues, including a job-creation bill that lawmakers hope to pass this month, along with longer-term goals related to health care, trade and energy.” CNN Politics and the AP offer their perspectives on the political dance leading up to the President’s February 25 health care summit.

Happy Super Sunday!

The House Oversight & Government Reform Committee’s federal workforce committee will be holding a hearing Wednesday February 10 about its Chairman Stephen Lynch’s bill, HR 4489, The FEHBP Prescription Drug Integrity, Transparency and Cost Savings Act.  The hearing will begin at 10 am assuming that we are dug out from the snowcopalypse before then. The witness list has not been posted yet. The National Community Pharmacists Association recently sent Chairman Lynch a letter suuporting the bill but cautioning that

“There are several areas of the bill which we would encourage be modified. The current language establishes that the amount that the carrier plan may pay a PBM for a prescription drug may not exceed the drug’s average manufacturer price (AMP). The use of AMP as a pricing benchmark for the carrier, and in turn the pharmacy provider, is problematic unless AMP were to be significantly redefined or increased in such a way that truly reflects the retail pharmacy acquisition cost of a prescription drug, which is higher than a drug’s current AMP. Moreover, use of AMP would be inappropriate to pay for generic drugs because of the need for reimbursement policies to encourage the use of generics.

“In addition, the definition of AMP in the legislation is not appropriate because it includes mail order sales. It should only reflect sales to retail pharmacies. Without modification of these provisions, community pharmacy participation in the program would be threatened, reducing patients’ access to prescription medications.”

PCMA, the PBM trade association, has expressed its opposition to the bill.

The U.S. Office of Personnel Management has posted its 2009 health information technology and transparency report. The web page lists

The health plans [which] met OPM’s HIT, quality and price/cost transparency standards at the time this Guide went to press. As other plans bring these tools on line, we will add them to the list on our website. So, please check the updated information at www.opm.gov/insure before you make your healthcare decisions.

Congratulations to those FEHB plans.

The New York Times reports that

Democrats were also pushing to include [in the jobs bill that is the President’s current top legislative priority] an extension of unemployment benefits and of health care coverage for those out of work [which refers to the 65% COBRA / TCC subsidy program]. Discussions were also under way about potentially attaching other initiatives, including a provision to prevent a steep [21%] cut in Medicare payment rates for doctors.

As noted here last week, Congress needs to act on extending the COBRA / TCC subsidy program and avoiding the Medicare cut this month.

The Wall Street Journal yesterday featured an interesting interview with Wellpoint’s CEO Angela Braly. “‘It’s just not clear where we go from here,’ says the highest ranking woman in the Fortune 500, sounding as astonished as anyone about Scott Brown’s victory.”