Health Policy Changes on the Horizon in an Election Year

A variety of health policy proposals have been rolled out in the face of an election year where health care is a top priority for voters. During a presentation at AMCP eLearning Days, John Michael O’Brien, PharmD, MPH, managing partner of JMOB & Associates, discussed potential changes to the health policy and commercial landscape.

Dr. O’Brien started by discussing the COVID-19 pandemic in relation to pharmacist care. On April 8, the Department of Health and Human Services issued new guidance under the Public Readiness and Emergency Preparedness Act authorizing licensed pharmacists to order and administer FDA-authorized COVID-19 tests.

However, there is still confusion related to pharmacists’ role in COVID-19 testing, as states, not the federal government, regulate pharmacy practice. The relevant Federal Register notice states “licensed health professional or other individual authorized to prescribe, administer, or dispense Covered Countermeasures under the law of the state in which the Covered Countermeasure was prescribed, administered, or dispensed; or a person within a category of persons identified as qualified in the Secretary’s Declaration.”

Next, he discussed drug pricing, which has bipartisan poll appeal. According to a Kaiser Permanente Foundation health tracking poll, 81% of Democrats and 62% of Republicans say lowering prescription drug costs should be a top priority for Congress. Lowering what people pay for health care is supported by 72% and 51%, respectively. And 87% of Democrats and 51% of Republicans support maintaining the Affordable Care Act’s preexisting condition protections.

He noted that list price growth is frequently cited as a reason to lower drug prices, and aggregate drug spending growth is equally important to public and private payers and consumers.

Dr. O’Brien then discussed presumptive Democratic presidential nominee Joe Biden’s prescription drug proposals:

  • Repeal non-interference provision of the Social Security Act
  • Establish an independent board to evaluate prices of new drugs, using either external reference pricing or board-generated recommendations
  • Inflation cap on annual price increases
  • Importation of prescription drugs on an individual basis
  • Accelerate review and approval of generics and biosimilars

In the absence of federal legislation, states and employers will act. Last year, 33 states enacted more than 50 laws to address drug pricing, access, and affordability, with legislation including price commissions, price controls, transparency, intellectual property and patent settlements, and importation. Some of these represent models for the federal legislation, such as transparency and prohibition of gag rules for pharmacists.

Presentation: Health Policy Trends Impacting Managed Care Pharmacy: Are You Ready? AMCP eLearning Days, April 20-24.