NCHC Pushes for Affordability Measures in 21st Century Cures Bill

WASHINGTON, DC – National Coalition on Health Care (NCHC) President and CEO John Rother urged the Energy and Commerce Committee to include measures to improve prescription drug affordability in 21st Century Cures legislation in a letter to Chairman Fred Upton (R-MI) yesterday.

“…the speedier introduction of treatments will mean nothing if patients and our health system cannot afford them. NCHC is gravely concerned that the discussion draft ignores the fundamental challenge of affordability,” said Rother in the letter. “Just nine months after its launch last June, the 21st Century Cures Initiative has helped bring the stakeholder community, lawmakers of both parties, executive branch agencies, and the White House together in a common effort to support innovation. But moving forward with legislation that fails to address affordability would not be reflective of the spirit of cooperation…”

The letter was sent in response to an open call for feedback from stakeholders on the 21st Century Cures Discussion Draft, released at the end of January.

See full press release:

NCHC Joins ACOs, Other Providers to Urge Improvements to Medicare Shared Savings Program

The National Coalition on Health Care (NCHC) joined with prominent organizations representing physicians, hospitals, and ACOs to push for reform to the Medicare Shared Savings Program (MSSP) in a comment letter submitted today.

“If we’re going to evolve beyond today’s costly, underperforming volume-based health care, Medicare must do more to expand the MSSP and help providers move to more advanced models,” said John Rother, NCHC’s President and CEO.

Along with NCHC, the letter’s signatories include American Academy of Family Physicians, American College of Physicians, American Medical Association, American Medical Group Association, Association of American Medical Colleges, Collaborative Health Systems, Medical Group Management Association, National Association of ACOs, Premier healthcare alliance, Trinity Health, and a subsidiary of Universal American. The letter was submitted in response to the Centers for Medicare and Medicaid Services (CMS)’s proposed rule on the MSSP, Medicare’s premier ACO initiative.

To ensure the MSSP delivers on its potential, the letter offers 35 pages of detailed recommendations aimed at five key priorities:

  • Strengthening the process of assigning Medicare beneficiaries;
  • Establishing a more appropriate balance between risk and reward;
  • Adopting payment waivers to eliminate barriers to care coordination;
  • Modifying the current benchmark methodology to promote ACO participation; and
  • Providing better and timelier data.

The proposals outlined in the letter would also allow beneficiaries to choose an ACO to be responsible for their care and, at the ACO’s prerogative, receive certain primary care services without cost-sharing.

According to Rother, much depends on CMS’ forthcoming ACO rule: “The signatories to this letter represent physicians, hospitals, and ACOs that are ready to deliver the better care at lower cost our nation needs. CMS must enable them to do so.”

See full press release:

American College of Physicians Joins Campaign for Sustainable Rx Pricing

The American College of Physicians, the largest medical-specialty organization and second-largest physician group in the United States, has joined the Campaign for Sustainable Rx Pricing (CSRxP), a broad-based coalition working for solutions to skyrocketing prescription medicine prices.

“ACP members work on the front lines of our health care delivery system and have witnessed firsthand the harm caused to patient health and personal finances by unsustainable pharmaceutical drug prices, especially those for new specialty drugs,” says John Rother, President and CEO of the National Coalition on Health Care, which leads CSRxP. “Exorbitant drug prices deny patients access to life-enhancing medicines and result in higher out-of-pocket costs, premiums, and taxes. To prevent our health care system from going bankrupt, we need to establish a drug pricing structure based on value and data-driven evidence and balance between the interests of innovative drug manufacturers and those of society and our health care system.”

“The pricing of specialty drugs increasingly lacks transparency and rationality,” says ACP President David A. Fleming. “We’re seeing the introduction of many patent-protected drugs with monopolistic pricing power that fail to demonstrate a relationship between their price and their value to the health care system. Though many of these medications offer great promise, the price tag for health care clinicians and patients is simply too much to bear. We look forward to working with the Campaign for Sustainable Rx Pricing to address these challenges.”

In 2013 specialty drugs accounted for less than 1 percent of U.S. prescriptions but for more than 25 percent of prescription spending. By the end of the decade, just 2 to 3 percent of all prescribed medications will be specialty drugs, but they will account for roughly 50 percent of the total drug spend, according to CVS Health.

See full press release:

Some Cause for Optimism in the President’s Budget

“While there is still plenty to argue about in the President’s proposal, the new budget does back several common-ground initiatives to curb health care costs that have been previously endorsed by key Republican lawmakers. Now the question is whether Congress can take yes for an answer and do something about the rising cost of health care.

SGR Reform and Physician Payment Reform: The President’s budget applauds last year’s bipartisan, bicameral legislation to repeal the SGR and promote new alternative payment models, and echoes calls from top Republican committee chairmen to finish the job this year.

Episodic bundling and PAC reforms:  The budget embraces episodic bundling initiatives similar to proposals advanced by Republican lawmakers that would encourage providers to deliver the right care at the most affordable cost.

Health Care Price and Quality Transparency:  The budget backs new data transparency reforms—similar to those championed by Representative Paul Ryan and Senator John Thune—that would enable consumer transparency tools to draw on Medicare’s storehouse of quality and cost data.

Sequester Relief:  The budget ends blunt-force sequestration cuts to tobacco prevention, diabetes prevention, and medical and nursing education—all programs that are vital to taming cost growth over the long-term. These cuts are replaced by hundreds of billions of savings through more targeted proposals.

The budget includes less helpful ideas as well. Administration proposals to dial up means testing and increase Medicare Part  B deductibles merely shift costs to beneficiaries. Such proposals may have some bipartisan support, but they do nothing to address the waste and inefficiency that are driving health care costs. When there are billions in real efficiencies to be found through constructive policy change, cost-shifting to seniors and the disabled is not the right way to achieve savings.

That said, we now know that SGR reform, improving value in Medicare, transparency, and sequester relief are on the to-do lists of both the Administration and key Republicans. Maybe, just maybe, that could mean a little relief from the rising burden of  health care costs is achievable this Congress.”

See full press release:

NCHC Joins Over 60 Health Care Stakeholders in a Letter Urging Congress to Repeal the SGR During the Lame Duck Session

WASHINGTON D.C.–This afternoon, the National Coalition on Health Care (NCHC) joined over 60 other leading health care stakeholders in a letter to Congressional leaders calling for the passage of legislation to repeal the Sustainable Growth Rate (SGR) formula, reform payment for physicians and other health professionals, and address crucial healthcare “extenders” during the lame duck session of Congress.

“Repeated temporary SGR patches have only put off the need for permanent reform and prolonged the threat of staggering reimbursement cuts that would threaten Medicare beneficiaries’ access to care,” said NCHC President and CEO John Rother. “Businesses, consumers, and health care providers agree that now is the time for Congress to act.”

See full press release:


SNHPA Joins Campaign for Sustainable Rx Pricing

Safety Net Hospitals for Pharmaceutical Access (SNHPA) has joined the Campaign for Sustainable Rx Pricing (CSRxP), a broad-based coalition concerned about the skyrocketing cost of prescription medicines.

“SNHPA will bring a much needed perspective and make a valuable contribution to the effort to find sensible solutions to irrational prescription drug prices, especially those for new specialty drugs,” says John Rother, president and CEO of the National Coalition on Health Care (NCHC), which heads up CSRxP. “We need to move to an approach where drug pricing is based on value to the health care system. New medicines offer extraordinary promise, but we are concerned that the system that has brought us these advances will become unsustainable if we can’t find a way to bring greater rationality to prices.”

SNHPA represents more than 1,000 hospitals that participate in the federal 340B drug discount program. The 340B program requires drug manufacturers to sell pharmaceuticals at a discount to public and private non-profit hospitals that serve high volumes of low-income patients. These hospitals provide over $28 billion in uncompensated care every year. The savings they realize from 340B drug discounts enable them to expand and improve care for their vulnerable patient populations.

“Hospitals and clinics in the 340B program must care for all patients whether they can pay or not,” says SNHPA President and Chief Executive Officer Ted Slafsky. “Today, on average, 340B hospitals are either squeaking by on historically slim operating margins – around 2 percent – or they are in the red. Major drug manufacturers’ profit margins average more than 20 percent.”

Mr. Slafsky noted the significant growth in the specialty drug market. “While many of these medications offer great promise, the price tag for health care providers and patients is simply unsustainable. Even at a discount, our hospitals and patients are struggling to afford medications that can cost hundreds of thousands of dollars. We look forward to working with the Campaign for Sustainable Rx Pricing to address these challenges.”

See full press release:

Gilead Rejects Reasonable Approach with $94,500 New Hepatitis C Drug

“By charging $94,500 for Harvoni, Gilead has made clear that it values Wall Street above the interests of patients, taxpayers, employers, and working families who must shoulder the burden of high health care costs. The company’s refusal to take a more reasonable and moderate approach to pricing cements its status as the poster child for everything that is wrong with pharmaceutical industry pricing.

Gilead’s escalator pricing could undermine the system of health care finance that has supported the biomedical innovation that we all want to continue. Unreasonable pricing not based on value threatens the sustainability of our entire health care system.”

Read John Rother’s blog post.

Read John Rother’s letter to lawmakers urging them to consider value transparency for pharmaceuticals.

See full press release:

After Bipartisan Push, President Signs Into Law a First Step Toward Post-Acute Care Reform

“Credit is due to the House Ways and Means and Senate Finance Committees for piloting this bill through today’s treacherous health care politics. Let’s hope yesterday’s signing of the IMPACT Act of 2014 is only the first, not the last, health policy win to emerge from bipartisan, bicameral efforts this year.

This new law will enable physicians, hospitals, and post-acute providers to better track and improve care for beneficiaries after a hospital stay by requiring providers to submit patient assessment data in a standardized format, and by developing systems of measurement for clinical quality, outcomes and resource use that can be applied across all post-acute settings. With this information, payers, providers, consumers, and family caregivers can work together to identify the best care setting for each individual. And policymakers can begin the challenging work of bringing broader reform to Medicare’s post-acute care systems.

We hope Congress will soon repeat this bipartisan, bicameral success in the areas of SGR reform, transparency, and care coordination. If they don’t, we will continue to see unchecked health costs erode the prosperity of American families and businesses.”

See full press release:

NCHC’s Inaugural Report Card Finds that 113th Congress Fails to Make the Grade on Health Care Costs

WASHINGTON D.C.–Today, the National Coalition on Health Care (NCHC) released “Health Costs and the American Family: A Report Card on the 113th Congress,” finding that despite strong bipartisan efforts, this Congress has yet to make the grade in curbing health care costs.

The seven-page report card grades actions taken by the 113 Congress in three areas of health policy where common-ground, bipartisan solutions were possible: modernizing physician payment and SGR repeal, price and quality transparency, and strengthening Medicare. The report card concludes that Congress has so far failed to make meaningful progress toward greater health care affordability.

“Families have seen a decade’s worth of income gains wiped out by rising health care costs. Our elected officials have to stop arguing and instead work on taking smart, bipartisan action on issues like physician payment reform, transparency, and Medicare,” said John Rother, NCHC’s President and CEO.

NCHC’s report card goes on to document the financial burdens imposed by unchecked health care costs, finding that, in 2013, the total cost of waste and inefficiency in the US care system amounted to $3,211 per person or $12,844 for a family of four.

“Workers and businesses alike are struggling to keep up with the cost of providing coverage to their families and employees, respectively. Providers, payers, and patients are engaged in new ways to keep the cost of care within reach, but they simply cannot do it alone. In payment reform, transparency, and Medicare, a few Congressional champions have put compromise ahead of partisanship to make progress toward a higher-performing health system. It’s time Congress as a whole does the same,” said Chris Dawe, a Senior Advisor to NCHC and former health policy advisor in the Obama White House.

The report card also urges Congress  to take action on these issues in the approaching lame duck session, while announcing NCHC’s plans to work with health care provider, payer, and consumer groups on an aggressive agenda for the next Congress. The document concludes by stating that health care stakeholders will soon be on Capitol Hill “demanding results, not more rhetoric.”

See full press release:

As Drug Costs Begin to Surge Again, Hatch-Waxman Offers Lessons on the Path Ahead

“Hatch-Waxman is one of the true success stories in health policy, saving trillions for consumers and taxpayers over the past thirty years. But with spiraling drug costs looming in the specialty pharmaceutical sector, it’s time we drew some lessons from that achievement.

Thirty years ago, Senator Orrin Hatch and Representative Henry Waxman refused to heed naysayers who claimed that you couldn’t have both affordability and innovation. Policymakers and stakeholders of very diverse interests and perspectives dialogued, debated, and ultimately settled on an approach that balanced the need to reward innovation with the need to maintain system-wide affordability. The results were trillions of dollars in savings from generic competition and three decades of continued breakthroughs in brand-name drugs.

As a new generation of exciting but expensive drugs emerges, we must acknowledge, as Hatch and Waxman did in the 1980s, that innovation has to come at a price our health system can afford.”

See full press release: