Advocacy in Action: EDCs, Physician Payment, and More

What’s Happening in Washington

SOTU & Trump Health Priorities – President Donald Trump gave his annual State of the Union (SOTU) address February 5 and shared his top health policy proposals, including a plan to reduce HIV, a plea to address the cost of prescription drugs and a call for health care price transparency. President Trump also said his budget would ask Congress for $500 million for childhood cancer research. (Cheat sheet on the Trump health priorities courtesy of the Coalition for Health Funding is available here.)

Administration and Congress Offer Different Proposals to Address Increasing Drug Prices – The Trump administration proposed a new rule that would eliminate rebates between prescription drug manufacturers and pharmacy benefit managers in federal health programs like Medicare and Medicaid, but it’s unclear whether officials have the necessary authority to do that or the impact the proposal would have.

The goal is to create greater transparency in the arrangements between drug manufacturers and insurance companies, or their PBMs, which trade favorable formulary placement in exchange for rebates on brand-name drugs. HHS Secretary Alex Azar and others contend that rebates, which are often a percentage of a drug’s list price, incentivize manufacturers to push prices higher and encourage insurers to favor more expensive products.  However, HHS projects that the proposal would result in increasing monthly Medicare premiums increase anywhere from $3.20 to $5.64 per patient. Federal spending would range anywhere from decreasing by $99.6 billion to increasing by $196.1 billion over 10 years.

Endocrine Society Government and Public Affairs (GPA) staff have begun analyzing the proposed rule and working with member experts on a response due April 8.

Meanwhile, members of Congress are forging their own path on drug pricing issues through legislation that differs from President Trump’s efforts through regulation.  Congress was already poised to take on prescription drug prices before the State of the Union speech, with two congressional panels conducting hearings on the topic last week and at least one slated for next week. Three modest but bipartisan bills backed by Senate Finance Committee Chairman Charles E. Grassley (R-IA) have support from top Democrats, making it likely that they will see action and be part of an eventual drug pricing deal:

• S 974, which would make it easier for generic drug companies to access the samples they need to create new copycat products.
• S 64 to ban legal settlements over patent disputes that delay the entry of generic drugs to market.
• S 205 would prevent drug makers from over-charging the Medicaid program for discounts they provide in exchange for coverage.

In addition, Democrats also expect to push their own plan to allow Medicare to negotiate drug prices, which Senate Republicans aren’t expected to take up.

Endocrine Society GPA staff are monitoring all these developments and encouraging lawmakers to address the need to make insulin affordable.

House Hearings Preview Democrats Next Steps on Health Care Law – House Democrats and Republicans sparred over the 2010 health care law during a trio of hearings February 6 agreeing on guaranteed coverage of pre-existing conditions, but not on much else.  The hearings provided a view into how House Democrats may try to strengthen the health care law now that they control the House floor and the appropriations process. They want to reverse Trump administration actions expanding health plans that don’t comply with the law’s rules and cutting funding for enrollment activities. But lawmakers offered few, if any, policy proposals affecting the law that could earn bipartisan support. (See our web page on the Endocrine Society’s position and resources on access to affordable health care.)

What We Are Working On:

EDC Congressional Briefing – We co-sponsored with the Environmental Working Group an educational briefing for congressional staff on the impact of chemicals in cosmetics and personal care products on human health.  Endocrine Society member Dr. Leo Trasande explained what endocrine-disrupting chemicals (EDCs) are, how they are used in personal care products, including cosmetics, and how they affect the endocrine system. Senator Diane Feinstein (D-CA) plans to reintroduce legislation, the Personal Care Products Act, in the next several weeks that would give the Food and Drug Administration authority to review the safety of personal care products.  The briefing gave us the opportunity to provide educational background on the issue so other Senators will understand and support the legislation when it is introduced.  It also gave us an opportunity to share our fact sheet on EDCs and our web page resources.

Physician Payment – Endocrine Society member Ilona Lorincz represented the Society at the AMA Current Procedural Terminology (CPT) meeting this week to discuss revisions to evaluation and management codes that are currently being proposed. We plan to survey our membership in the coming weeks to help determine the value of these codes, which will be considered by Medicare for the 2021 fee schedule. Medicare has proposed its own revisions to the codes, which collapse levels 2-4 and remove some documentation requirements. We continue to advocate our opposition to this proposal and for revisions to prevent payment cuts to endocrinologists.  See our resources for endocrinologists about the coding changes:

• Webinar: Evaluations and Management Coding Revisions – What You Need to Know 
• 2019 Medicare Physician Fee Schedule Final Rule Summary
• Final Medicare Physician Fee Schedule Codes 

Letter Sharing Concerns about “Plan S” Impact on Science and Scholarly Publishing

The Endocrine Society joined a coalition of prominent research organizations to address serious concerns about a proposal to require that all scientific reports funded by members of the Coalition S be published in compliant open access journals or platforms.

Letter Urging Congress to Reauthorize the Pediatric Subspecialty Loan Repayment Program
The Endocrine Society joined a coalition of organizations to urge Congress to reauthorize the Pediatric Subspecialty Loan Repayment Program and help provide children with timely access to vital health services.