This Week in Healthcare Reform: May 21st, 2021

Thousands of Health Action Network members take action on the “Rebate Rule”; stakeholders support audio-only telehealth; specialty drugs make up half of all pharmacy spending; and, one of the country’s largest hospital systems sues thousands of patients.

We encourage you to stay involved as implementation efforts surrounding healthcare reform progress.  Visit the Health Action Network and be sure to let us know what’s on your mind.

Week in Review

Rebate Rule: Opposition to the “Rebate Rule” continues to grow, with advocates voicing their concern about how the misguided attempt to rein-in rising prescription drug prices in the Medicare Part D program will only drive up costs for seniors while burdening taxpayers with billions of dollars in new taxes.  Last week, we asked you, our Health Action Network members, to add your voice to that growing chorus and thousands of you responded, sending letters to lawmakers urging them to eliminate the Rebate Rule and protect vulnerable seniors from the threat of rising prescription drug costs.  For those of you who haven’t yet taken action, there’s still time to reach out to your elected officials to tell them the Rebate Rule is the wrong prescription for out-of-control drug prices.  Take action today!

Audio-Only Telehealth: Earlier this year, a bipartisan bill was introduced in the U.S. House of Representatives aimed at protecting Medicare Advantage beneficiaries’ ability to access audio-only telehealth services.  The proposal looks to build on flexibilities that were made available by the Centers for Medicare & Medicaid Services (CMS) in response to the ongoing coronavirus pandemic.  Currently, CMS only allows providers to offer telehealth services through the Medicare Advantage program if a video component is included.  However, that may not always be an option for low-income or rural enrollees.  By loosening those restrictions, patients from all walks of life will be able to benefit from the increased access to care made possible by telehealth.  Stakeholders have already thrown their support behind the proposed bill, including health plans, the business community, and advocacy groups.

Specialty Rx: According to a new report, specialty drugs now make up more than half of the total pharmacy spend in this country – all the more alarming, given that this category of drugs only accounts for 2.2 percent of total drug volume.  Drilling further, the report also found that just five therapeutic categories drove 90 percent of that spend.  In looking to help mitigate these rising costs, the authors pointed to the importance of eliminating waste in specialty drugs.  By harnessing technology to stay more closely connected to patients, providers and pharmacy benefit managers (PBMs) can better avoid unnecessary spending and ensure alignment on care treatment adherence.  This focus on reducing waste, specifically in the specialty pharmaceuticals category, is of growing importance as net spending on these drugs is surging.

Hospitals Suing Patients: Last summer, at the height of the coronavirus pandemic, it was reported that hospitals in some of the states with the worst outbreaks were quietly getting back to the business of suing patients.  Many of these hospitals had paused or slowed down the rate at which they took people to court in the immediate wake of the public health crisis, but as the weather got warmer – and, as cases of the coronavirus were raging – systems in Florida, Texas, and Arizona brought hundreds of lawsuits against patients as they sought to collect unpaid medical bills.  This aggressive practice was already deeply controversial prior to the pandemic.  Now, new reports have surfaced that one of the largest hospital chains in the country has been suing thousands of patients.  That hospital chain, Community Health Systems, Inc., has filed at least 19,000 lawsuits since March of 2020.  According to the reports, the company’s 84 hospitals, largely concentrated in the South, but stretching across the country, have taken their patients to court for as little as $201.  While they argue that litigation is their last resort in seeking to extract payment for unpaid medical bills, advocates say those tactics are financially ruinous for low-income patients, made all the more so amid a pandemic-fueled economic collapse.


With the Memorial Day holiday around the corner, there will not be a newsletter next week.  But, look for us again in your inbox the following week. 

Until then, you can keep up with the latest by following the Health Action Network on Twitter and by liking us on Facebook.  And, be sure to check us out on LinkedIn, too.  As always, let us know if there’s something you’d like to see covered in a future newsletter.