Activity at the state and federal level this week is heating up in the fight against higher drug and healthcare costs. PBMs testified before federal lawmakers, who seemed uncertain of their role in the industry. The Montana Senate delayed the Medicaid bill, and Pennsylvania’s Attorney General filed a petition to attempt to force UPMC to sign a continuation of their temporary agreement with Highmark. This and more in this week’s Innovation Partners BioBlog.


Drug Pricing Hearing May Show A ‘Disconnect’ Between PBMs and Senators

Five executives from the nation’s largest PBMs testified before federal lawmakers this week. PBMs attempted to justify their role while lawmakers pushed for greater transparency. The senators appeared less anxious to pound on the PBMs’ which signals they may not fully understand the business model. The industry continued to watch the unfolding story.
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Payer Roundup—Senate delays Montana Medicaid bill

The Montana state Senate has delayed a bill to extend Medicaid. A vote of 25-25 stalled the House bill; Republican lawmakers are trying to use this to their advantage for new laws. The current bill expires over the summer. According to Montana law, the Senate bill needs to pass the chamber by Tuesday because of a transmittal deadline.
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MACPAC calls for Congress to eliminate the drug rebate cap

MACPAC called for Congress to eliminate the drug rebate cap in an effort to address growing drug prices. The savings from higher rebates would allow states to provide the same level of drug coverage at lower costs and continue to exert downward pressure on price increases, they said. The change could potentially save the federal government between $15 billion and $20 billion over 10 years according to estimates from the Congressional Budget Office (CBO).
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Medicare Aims to Expand Coverage of Cancer Care. But Is It Enough

Cancer patients, doctors and drug companies are urging the Trump Administration to extend Medicare coverage to CAR-T cell therapy. Because the treatment is uniquely made for each patient, it can be quite costly. Medicare will determine over the next few weeks if and how it may cover these and other groundbreaking personalized treatments. Most are very expensive, but the benefits last for years.
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Maryland, Massachusetts statehouses press drug-pricing bills as feds founder

Although the federal government is fighting its own drug pricing battles, states aren’t standing idly by but are also taking action. Massachusetts’ Joint Committee on Health Care Financing heard testimony on the rising cost of drugs as it reviewed 21 bills targeting drug pricing and transparency. Maryland backed a state drug affordability board that would take effect in 2022.The bill, which cleared conference committee Monday, would allow the newly formed commission to cap prices on certain drugs it determines are unreasonably costly for consumers. The governor may still veto the bill.
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Pennsylvania AG, UPMC take spat to state’s highest court

The Pennsylvania Attorney General, Josh Shapiro, filed a petition against the University of Pittsburgh Medical Center (UPMC), stating that it is in violation of its charitable obligations by refusing to sign on to a modified version of the agreement with Highmark. UPMC says Shapiro lacks the authority to force the agreement. UPMC and Highmark Health have been fighting for the better part of a decade over market share in both the greater Pittsburgh payer and provider markets. Pennsylvania issued a multi-year consent decree that mandates each offer coverage for services provided at the other’s facilities. That deal is set to expire this summer.
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