ASCO Legislative Update: 2017 Outlook Shelagh Foster, JD Division Director, Advocacy ASCO
What We’ll Talk About Today How ASCO Sets Priorities What’s Happened/ing in DC 2017 Forecast – Administration/Congressional Priorities – ASCO Priorities – Other issues that matter ASCO/State Affiliate Collaboration
ASCO PRIORITIES
ASCO PRIORITIES: 2017-18 GOAL 1 : Pursue access to high quality, affordable care for every patient with cancer Examples: Drug Price, Access to Care GOAL 2 : Advance policies and delivery system reform that supports oncology providers in their delivery of high quality, high value cancer care Examples: MACRA, Payment Reform GOAL 3 : Advocate for policies that support a robust federally funded cancer research, prevention, drug development and clinical trials system Examples: Right to Try, Clinical Trials Coverage, NIH Funding
Top 3 Practice Pressures, ASCO Oncology Practice Trends Survey (2015-2016) Increasing Practice/Facility Expenses Drug Pricing Electronic Health Records Payer Pressures Staffing Issues 0% 10% 20% 30% 40% 50% 60% 2015 (n=177) 2016 (n=123) 5
WHAT’S HAPPENING??
Your New Healthcare Team Tom Price President Donald Trump Secretary of HHS Francis Collins Scott Gottlieb Seema Verma Director of NIH FDA Commissioner CMS Administrator Nominee
Right off the bat…. • January 20: ACA Roll Back – Agencies to use all discretion to remove financial burdens on states, individuals, families, providers and insurers • January 30: Regulatory Relief – Includes requirement involving cost analyses that could fundamentally alter the process and content of regulations
American Health Care Act (AHCA) Some Highlights: • Repeals Prevention Fund • 30% surcharge lapsed coverage • 1-year freeze Planned Parenthood $ • Higher premiums for older Americans • Repeal of Medicaid expansion • Per capita allotment for Medicaid (grandfathers current enrollees) • Repeals “essential health benefits” • Tighter Medicaid eligibility criteria • Changes HSA contributions • Safety net $, non-expansion states • Tax credits low and middle-income
The American Health Care Act (AHCA) • Energy & Commerce (27 hours) • Ways & Means (18 hours) • Budget Committee • House Vote • Senate Action Soon?
What the AHCA Keeps from the ACA • Pre-existing conditions • Lifetime caps • Coverage on family policy to age 26
What the AHCA Changes • Repeals Individual Mandate – Reduces penalty to zero … BUT , Must Maintain Continuous Coverage – Break in Coverage? • 63 Days can still purchase insurance w/out regard to preexisting conditions. Beyond that premiums would be 30% higher for 12 months. • Tax Credits – ACA: Tied to Income – AHCA: Tied to Age, but insurers can charge more as you get older • Help for High Income Earners – Repeal of Certain Taxes – Health Savings Account Deposits – Restores Some Flexible Savings Account Benefits
Continued… • Changes to Medicaid –2020 Rollback Federal Funding for Expansion States Coverage of People Under 138% of Poverty Level –Used to Be Specific Categories (children, pregnant women, elderly, disabled) –31 States Expanded –If Part of Current Expansion, Will Remain Covered, unless you lose eligibility –States Would No Longer Able to Enroll According to ACA Criteria
The Future of Medicaid • ACA established a new “expansion” population providing coverage to childless adults • State governments controlled by both parties are invested in protecting coverage for this population • Block Grants may cause significant numbers to lose coverage Parity with Medicare requirements (e.g., clinical trials coverage)
CBO Score on AHCA • TBA
Coverage Data ACA AHCA • A March 2016 HHS report estimates • TBA that 20.0 million adults gained health insurance coverage due to the ACA – 17.7 million nonelderly adults gained insurance through exchanges – 2.3 million young adults (18 to 25) gained health insurance through the age 26 provision • Medicaid and CHIP enrollment grew by 12 million among states that implemented Medicaid expansion Source: HHS Health Insurance Coverage and the Affordable Care Act, 2010-2016
ASCO’s Position: Ensure Access to Insurance Coverage • Coverage for those with pre-existing conditions • Coverage for all cancer patients regardless of income and health • No lifetime coverage caps • Guaranteed renewability • Coverage of cancer screenings 17
What’s Next? Three Phases of Reform Budget Legislation for Reconciliation Administrative everything (American Actions else Healthcare Act)
OTHER ADMINISTRATION/CONGRESSIONAL HEALTHCARE PRIORITIES
As we know them… • Budget • Drug Pricing • Right to Try • MACRA Implementation • Medicare Reform? • Others?
“Skinny” President’s Budget • HHS: Cut $15.1B – 17.9% • 21st Century CURES: Funds for program integrity and implementation. • FDA: Doubles user fees to $2B; administrative changes to speed drug approvals. • NIH: Cut $5.8B – 18.3%; structural/administrative changes to reduce cost. • AHRQ: Consolidated with other programs Source: Washington Post, March 16, 2017
Drug Pricing • President, bipartisan promising action – Medicare negotiation for drug price? – Re-importation of drugs? – Performance based pricing? – No more Part B demo… • Hold physicians accountable for utilization…not market entry pricing Oncology must not be used to claim the high cost of drugs has been addressed.
What’s Next? “I am working on a new system where there will be competition in the Drug Industry. Pricing for the American people will come way down!” “Phase 2 or 3” of repeal and replace Medicare negotiation…importation…faster generics?
Right to Try 33 States have passed legislation allowing Concerns About Bills What ASCO is Doing • Removing FDA review of safety • Working with trial sponsors and FDA to relax the eligibility criteria for and efficacy clinical trials to enable more patients to participate • No provision for IRB, associated patient protections • Launched TAPUR and CancerLinQ to learn from individual patients, help build evidence base for delivery of • No systematic data collection on high-quality cancer care. safety and efficacy, which could help all patients • Developing Position Statement
Trickett Wendler Right to Try Act of 2017 Senator Ron Johnson (R) Wisconsin
Oversight of MACRA Implementation • Monitor implementation of MACRA to ensure the intent of the law is followed; including: – Test multiple innovative alternative payment models – Ensure providers MIPS scores are not negatively impacted by the cost of drugs 26
MACRA: Influencing Implementation Ensuring a smooth transition On October 14 CMS • Numerous training webinars released its Final Rule, • State presentations which allows practices • Train the trainer to ‘pick their pace,’ • Testimony to Congress accepts a number of • Comments to CMS • Agency and Hill meetings ASCO recommendations
Are You Prepared?
Payment Reform and Practice Transformation are Key ASCO will Submit to Physician Technical Advisory Committee by August
Congressional Legislative Overview • ACA Repeal/Replace • Site Neutral Payment • Medicaid • User Fee Acts • MACRA Implementation • Opioid Abuse Epidemic • HIT/EHRs • Improved Care for Children • Chronic Care • Improved Care for Older • Access: Clinical Trials Americans • Access: Affordable Drugs • Palliative Care • Drug Pricing • Treatment Planning • Laboratory Developed • Budget/Appropriations Tests Funding • Safe Handling • Tobacco • 340B • Prevention
ASCO WILL CONTINUE TO PUSH
Reducing Administrative Burden Congress, Administration and payers need to streamline regulations to ease burdens on physicians and allow for more time with the patient. Appropriate use of clinical pathways Interoperable EHRs Prior Authorization/Payer requirements Streamline quality reporting 32
Electronic Health Records • Implementation of 21 st Century Cures provisions to: –Achieve interoperable EHRs –Prevent information blocking –Harness the full potential of big-data 33
PARTNERING WITH STATE AFFILIATES
Action Increasingly at the State Level ASCO’s 2017 State Advocacy Priorities Priority Issues Other State Advocacy Issues 1. Opioid Therapy Biosimilars 2. Safe Handling of Hazardous Drugs Brown Bagging HPV Vaccination 3. Oral Chemotherapy Parity Indoor Tanning Medicaid Reform 4. Clinical Pathways Prior Authorization Specialty Tiers 5. Medicaid Coverage of Clinical Step Therapy/Fail First Trials Participation Tobacco (Smoke free workplaces)
Prescription Opioids • States alarmed at epidemic - 100+ state bills in 2017 so far on prescription opioids • Balancing support for state action with appropriate care • Top concerns: - Limits on prescriptions (dose/days) - PDMP prescriber query requirements Working with SAC leaders to share strategies
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