Bipartisan Opioids, Pharmacy 'Gag Clause' Bills Advancing in Congress 

The inauguration of President Barack Obama, January 20th 2009. Dan Moore
Sep 20 2018

The Senate on Monday overwhelmingly passed a bipartisan bill (HR 6) to address the opioid crisis, increasing odds that final legislation may reach the president’s desk before the midterm elections. While many similarities exist between the Senate bill and the version passed by the House (HR 6) in June, the two chambers must now work out the differences in conference negotiations — a process that began even before the Senate vote.

Employer groups are urging lawmakers to reject a revenue-raising provision in the House measure that would increase the number of months that employer-sponsored health plans must cover end-stage renal disease (ESRD) services before Medicare kicks in from 30 to 33 months. While this provision is projected to save the government $344 million, the actual overall additional cost to employers would be much higher.

Employers are also pushing back on a House-bill provision that would require employer health plans to report prescription drug coverage to determine primary payer status in Medicare.

The Senate’s lack of interest in these provisions so far bodes well for employers, but the shape of final legislation remains to be seen and advocacy efforts continue apace. Final votes could happen as early as next week.

Nixing drug price ‘gag’ clauses

It’s also increasingly likely that Congress will act before the elections to make it easier for patients in private health plans to get the lowest possible price on prescription drugs. Just before passing its opioids bill on Monday, the Senate approved, 98-2, the “Patient Right to Know Drug Prices Act,” (S 2554) which prohibits “gag clauses” in commercial health plan contracts that prevent pharmacists from telling customers they could save money on drugs by paying out of pocket rather using their insurance benefit.

A House committee recently passed its own “gag clause” bill (HR 6733), and the House may soon vote on the measure. A House-passed bill would need to be reconciled with the Senate legislation, which also includes new reporting requirements intended to prevent “pay for delay” deals in which brand-name biologic companies pay a biosimilar maker to stay off the market for a number of years.

House and Senate lawmakers negotiating a massive government spending bill recently dropped language approved unanimously by the Senate that would have required drug-makers to disclose prices in advertisements. The Trump administration is readying regulations that are expected to include the requirement.

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