ASCO Legislative Update: 2017 Outlook Shelagh Foster, JD Division - - PowerPoint PPT Presentation

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

• ncology 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)

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0% 10% 20% 30% 40% 50% 60% Staffing Issues Payer Pressures Electronic Health Records Drug Pricing Increasing Practice/Facility Expenses

2015 (n=177) 2016 (n=123)

WHAT’S HAPPENING??

Your New Healthcare Team

President Donald Trump Tom Price Secretary of HHS Seema Verma CMS Administrator Francis Collins Director of NIH Scott Gottlieb FDA Commissioner 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)

• Repeals Prevention Fund
• 1-year freeze Planned Parenthood $
• Repeal of Medicaid expansion

(grandfathers current enrollees)

• Tighter Medicaid eligibility criteria
• Safety net $, non-expansion states
• 30% surcharge lapsed coverage
• Higher premiums for older Americans
• Per capita allotment for Medicaid
• Repeals “essential health benefits”
• Changes HSA contributions
• Tax credits low and middle-income

Some Highlights:

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

• A March 2016 HHS report estimates

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

AHCA

• TBA

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

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What’s Next? Three Phases of Reform

Legislation for everything else Administrative Actions Budget Reconciliation (American 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

• Removing FDA review of safety

and efficacy

• No provision for IRB, associated

patient protections

• No systematic data collection on

safety and efficacy, which could help all patients

What ASCO is Doing

• Working with trial sponsors and FDA

to relax the eligibility criteria for clinical trials to enable more patients to participate

• Launched TAPUR and CancerLinQ

to learn from individual patients, help build evidence base for delivery of high-quality cancer care.

• 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

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MACRA: Influencing Implementation

Ensuring a smooth transition

• Numerous training webinars
• State presentations
• Train the trainer
• Testimony to Congress
• Comments to CMS
• Agency and Hill meetings

On October 14 CMS released its Final Rule, which allows practices to ‘pick their pace,’ accepts a number of 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
• Medicaid
• MACRA Implementation
• HIT/EHRs
• Chronic Care
• Access: Clinical Trials
• Access: Affordable Drugs
• Drug Pricing
• Laboratory Developed

Tests

• Safe Handling
• 340B
• Site Neutral Payment
• User Fee Acts
• Opioid Abuse Epidemic
• Improved Care for

Children

• Improved Care for Older

Americans

• Palliative Care
• Treatment Planning
• Budget/Appropriations

Funding

• Tobacco
• 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

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Electronic Health Records

• Implementation of 21st

Century Cures provisions to:

–Achieve interoperable EHRs –Prevent information blocking –Harness the full potential of big-data

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PARTNERING WITH STATE AFFILIATES

Action Increasingly at the State Level

ASCO’s 2017 State Advocacy Priorities Priority Issues

• 1. Opioid Therapy
• 2. Safe Handling of Hazardous Drugs
• 3. Oral Chemotherapy Parity
• 4. Clinical Pathways
• 5. Medicaid Coverage of Clinical

Trials Participation

Other State Advocacy Issues

Biosimilars Brown Bagging HPV Vaccination Indoor Tanning Medicaid Reform Prior Authorization Specialty Tiers Step Therapy/Fail First 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

Safe Handling of Hazardous Drugs

• ASCO Task Force working
• n updated safety

standards

• Supporting State Affiliates
• n state regulatory activity
• Submitted comments on

USP <800>

• Supported AMA Resolution
• Reaching out to

CDC/NIOSH

Pathways

• Policy statement defining

high quality pathways published January 2016

• ASCO criteria published

February 2017

• Helping states with

legislative language

• ASCO.org State Advocacy page

– State legislative calendar – ASCO’s state policy priorities – Infographics and state cancer fact sheets

• State ACT Network

– Focus solely on state legislative action – Includes CQ clickable map by state

• Policy Toolkits

– On opioids, pathways, oral parity and the safe handling of hazardous drugs – Toolkits may include policy statements and briefs, model legislation and FAQ’s

State Advocacy Resources

….STAY TUNED!

Questions??