NHC Updates its Policy Recommendations for Lowering Health Care Costs

Monday, April 29, 2019

By: Eric Gascho, Vice President of Policy and Government Affairs

The National Health Council (NHC) endeavors to promote increased access to affordable, high-value, sustainable health care. In the fall of 2016, our Board of Directors began to analyze current policies and proposals designed to curb health care costs. We evaluated nearly 200 policy proposals that aim to reduce the cost of health care and found that the vast majority reduce costs at the expense of access to care for those who need it most.

We recently updated our health care cost policy recommendations to better reflect the current health care environment and help guide Congress and the Trump administration toward promoting lower health care costs and improving patient outcomes.

The NHC provided the following recommendations:

  • Reduce barriers for development of generic and biosimilar products.
    • Curb patent settlements or other strategies to delay patient access to lower cost medications.
    • Support FDA policies that implement a transparent, science based regulatory pathway for biosimilars.
    • Ensure safety provisions of Risk Evaluation and Mitigation Strategies while promoting access to samples for testing.
  • Promote meaningful transparency on price and cost sharing.
    • Establish standards for insurers to provide cost estimates, especially during plan selection.
    • Promote standards for providers to display billing information.
    • Protect patients from surprise medical bills.
    • Ensure rebates are passed through to the patient.
    • Require justification of significant drug price increases.
  • Encourage outcomes-based contracting (OBC).
    • Implement a voluntary demonstration project to test the impact of OBCs on outcomes, prescription drug costs, and total costs of care.
    • Include safe harbors to the Federal anti-kickback statute, Medicaid best-price requirement, and off-label communications.
  • Facilitate the implementation of value-based insurance design (VBID).
    • Expand Medicare Advantage (MA) VBID demonstrations within the Center for Medicare & Medicaid Innovation.
    • Allow plans the flexibility to provide coverage for additional services that manage chronic disease.
    • Support the development of outcome measures, especially those using patient-generated data, for use in new payment models.
    • Address barriers to value-based arrangements, including the Stark Law and Federal anti-kickback statute.

You can learn more about our initiative, including more detailed recommendations on the NHC’s Health Care Costs page.

Related Congressional and Administration Updates

General Health-Care Costs Initiative

Chairman Lamar Alexander (R-TN) of The Committee on Health, Education, Labor, and Pensions recently requested recommendations to help give Americans better health outcomes and experiences at lower costs. He received more than 400 specific recommendations. The committee intends to use these recommendations to guide their work on health care costs in the current Congress. The NHC submitted a letter outlining our recommendations. 

Generic Competition

Last month, NHC CEO Marc Boutin testified at a House Committee on Energy & Commerce Health Subcommittee that focused on lowering the cost of prescription drugs by reducing barriers to market competition. The hearing focused on seven bills designed to make it easier for generic drugs to reach the market, including the CREATES Act, FAST Generics Act, pay-for-delay ban, BLOCKING Act, the FAIR Generics Act, the Orange Book Transparency Act, and Purple Book Continuity Act.

Transparency

  • To create greater price transparency, the Trump administration has required all hospitals to provide cost information in a readable format. Although a step in the right direction, more action is needed to ensure billing information is displayed in a concise, accessible, and patient-friendly format.
  • The Department of Health and Human Services has proposed amending the Anti-kickback Statute to remove the safe harbor for manufacturer rebates to share the cost savings with patients. The NHC submitted comments in general support of the proposal and offered substantial recommendations to ensure it has the intended effect of reducing out-of-pocket costs without limiting access.
  • Several members of Congress have also proposed legislation to protect patients from surprise medical bills.

Outcomes-Based Contracts

Senators Bill Cassidy (R-LA) and Mark Warner (D-VA) have drafted bipartisan legislation that promotes the development of value-based and outcome-based contract agreements.