RISE summarizes the latest headlines that impact the Department of Health & Human Services, Medicare, and Medicare Advantage.

HHS to fund $150M to support community-based health care providers with COVID-19 response and vaccinations

The Department of Health & Human Services (HHS) on Monday announced it will make nearly $150 million available to 100 “health center program look-alikes” to help their response to COVID-19. HHS describe health center look-alikes as community-based health care providers that provide essential primary care services to underserved communities and vulnerable populations but are not Health Center Program grantees.

The funding will be made available through the Health Resources and Services Administration (HRSA) and is part of President Joe Biden's commitment to ensuring equity in the nation's COVID-19 response and vaccination efforts. The funds will be used to advance equitable access to COVID-19 vaccinations, testing, treatment, and other essential health center services for underserved and vulnerable populations.

“Thanks to the American Rescue Plan, needed aid is coming to vulnerable communities—to help them respond to the pandemic, to increase testing and vaccinations, and to provide critical health services," said HHS Secretary Xavier Becerra in the announcement.

Providers must apply for the grants by May 14. Click here for more information.

Medical associations to CMS: Suspend prior authorization requirements

Forty medical groups urged the Centers for Medicare & Medicaid Services (CMS) to delay new prior authorization requirements which are scheduled to go into effect in July. In an April 7 letter to CMS Acting Administrator Elizabeth Richter, the groups opposed the expansion of prior authorization to certain procedures. The requirements would have an “adverse impact on timely access for beneficiaries to medically necessary care and the administrative burden imposed on providers,” the groups wrote. The letter was signed by 40 organizations, including the American Medical Association (AMA), Healthcare Financial Management Association, American College of Surgeons, and American Academy of Family Physicians.

The organization asked CMS to delay implementation of the new requirements until the agency conducts a thorough analysis of the impact for the five outpatient services that were implemented in July 2020, including the extent to which Medicare Administrative Contractors have met the deadlines for processing the requests as well as the costs and other burdens imposed upon providers and beneficiaries. In addition, it asked the agency to establish transparent and specific criteria to guide decision-making related to the use of prior authorization.

In the most recent 2020 AMA prior authorization survey, which was conducted in December 2020 and released this month 90 percent of the 1,000 physicians surveyed reported that prior authorization requirements have a negative effect on patient clinical outcomes, with 30 percent saying the requirements have led to a serious adverse event for a patient in their care. 

KFF report: Small number of drugs make up the majority of Medicare prescription drug spending

A new analysis from the Kaiser Family Foundation (KFF) finds that relatively few drugs account for a large share of Medicare prescription drug spending. The finding suggests that recent proposals that focus on prices for a limited number of high-cost drugs could achieve significant savings.

Researchers looked at the top drugs for Medicare Part D and B. They found:

  • The 250 top-selling drugs in Medicare Part D with one manufacturer and no generic competition (roughly 7 percent of the 3,500 Part D covered drugs) accounted for 60 percent of the net total Part D spending of $145 billion in 2019
  • The top 50 covered drugs in Medicare Part B (or 8.5 percent of all Part B covered drugs) accounted for 80 percent of the total Part B drug spending of $37 billion in 2019

In the study announcement, KFF said the findings can be used to inform ongoing policy debates about policies to rein in prescription drug prices, such as proposals to allow the government to negotiate drug prices (Part D) or peg payments to international prices (Part B), if such changes were applied to a limited number of drugs.

“Focusing drug price negotiation or reference pricing on a subset of high-priced drugs could leave some savings on the table but might also be a more efficient use of administrative resources,” KFF said in the announcement.