Thursday, January 21, 2010

Another lively day

House Federal Workforce Committee Chairman Stephen Lynch (D Mass.) has introduced a bill, H.R. 4489, to regulate the prescription drug pricing and use of prescription benefit managers in the FEHB Program. According to his press release,
Specifically, the FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act provides the Office of Personnel Management (OPM) greater oversight authority of the FEHBP’s prescription drug contracting and pricing methods in order to better ensure that federal workers are receiving the best benefits at the best price. Among the strong oversight provisions included in the legislation is a requirement that Pharmacy Benefit Managers (PBMs), who currently contract with individual insurance plans to provide FEHBP prescription drug benefits, return 99% of all rebates, market share incentives, and other monies received from pharmaceutical manufacturers for FEHBP business. In addition, the legislation would prohibit “drug switching” without prior physican approval, impose new disclosure and transparency requirements on PBMs in line with industry trends, and cap prescription drug prices paid by the FEHBP at the amount of the Average Manufacturer Price (AMP).
PCMA, the PBM trade association, was not pleased with the new bill. Its press release states in pertinent part
Congress has enough on its plate without also trying new experiments on the successful Federal Employees Health Benefits Program (FEHBP), one of our nation’s most proven health benefit programs. FEHBP is one of the best-functioning, well-regarded health programs in America and should not be subject to wholesale political changes.
The Subcommittee will hold a hearing on the bill next month.

Last week's general health care reform compromise would postpone application of the Senate bill's 40% excise tax on high cost plans from 2013 to 2018 for collectively bargained plans and state and local government employee plans. Joe Davidson of the Washington Post and report today that Majority Leader Steny Hoyer has announced that the compromise also will be extended to rank and file federal employees participating in FEHB plans.

IFAwebnews reports on a Heritage Foundation conference at which three former OPM directors questioned the Senate healthcare reform bill discussed the Senate bil provision that would authorize the OPM Director to contract for at least two multi-state health plans that would participate in the Senate bill's state health insurance exchanges. The related Heritage Foundation analysis of the provision is here.

However, other press reports indicate that Mr. Hoyer's announcement, while welcome, and the Heritage Foundation discussion assume a fact not in evidence -- that the Senate bill in in play. The Washington Post reports tonight that
As Democrats continued to grapple with the consequences of their loss in Massachusetts, House Speaker Nancy Pelosi on Thursday eliminated the most obvious avenue for completing health-care reform, saying the House will not embrace the version of the legislation already approved by the Senate.
The Politico further reports that on the majority side of the aisle
Health care reform teetered on the brink of collapse Thursday as House and Senate leaders struggled to coalesce around a strategy to rescue the plan, in the face of growing pessimism among lawmakers that the president’s top priority can survive.

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