Senate Finance Considers Key Amendments to Health Reform

With over 500 amendments for consideration by the Senate Finance Committee on Health Reform, progress was made to go through proposed changes and support was reached for some significant modifications or additions to the Chairman's Mark released last week by Max Baucus (D-MT). While the progress has been slow, it does feel like we are moving toward a Senate health reform bill that will have enough support to move forward. Key amendments passed by the Committee so far, include:

• Biosimilars Reimbursement. Offered by Senator Schumer (D-NY), an amendment that would reimburse biosimilars at the average sales price (ASP) plus the innovator/brand product's 6 percent add on, which is assumed to be greater than the biosimilar's own 6 percent. Senator Schumer had originally filed language that would have assigned the same billing codes to branded and biosimilar products but that language was removed in the modified proposal. PhRMA and BIO, reportedly, supported this amendment as modified. The amendment, as currently understood, contradicts some earlier press reports suggesting reimbursement for the innovator and biosimilar would be determined based on a volume-weighted average of the products. This one will be an important one to watch final bill language.
• PBM Transparency. Offered by Senator Cantwell (D-WA), an amendment that would require PBMs operating in the insurance exchanges to disclose to HHS information regarding: (1) the percent of all prescriptions provided through retail pharmacies compared to mail order pharmacies, and the generic dispensing and substitution rates in each location; (2) the aggregate amount and types of rebates, discounts, and price concessions that the PBM negotiates on behalf of the plan and the aggregate amount of these that are passed through to the plan sponsor; and (3) the average aggregate difference between the amount the plan pays the PBM and the amount that the PBM pays the retail and mail order pharmacy.
• Medicare Commission. Offered by Senator Rockefeller (D-WV), an amendment that would make binding the recommendations of a Medicare commission to lower spending growth unless the Senate voted by a two-thirds majority to reject them. The new commission's recommendations would have to be accepted by the president before being voted on by Congress.
• Patient-Centered Outcomes Research Institute. Offered by Senator Grassley (R-IA), an amendment which would remove cabinet secretaries and other high-ranking government officials from serving on the board of the Patient-Centered Outcomes Research Institute
  

Was anything key rejected? Yes and as is being widely reported, Baucus, voting along with Republicans, rejected an amendment that would have nullified the PhRMA accord reached earlier this year with Baucus and the White House. The amendment, offered by Senator Nelson (D-FL), would have scrapped the PhRMA agreement and would have made Medicaid-instead of Medicare- responsible for paying for low-income seniors' drugs; it would also eliminate the Part D coverage gap (or donut hole). The cost of the amendment would have been offset by requiring drug manufacturers to provide rebates to dual-eligible enrollees of Part D plans. It was estimated to produce $106 billion of revenue (after filling the doughnut hole, $50 billion would be left over).

Remember this is only what is included in the Senate side and we have not seen any legislative language yet and the Senate Finance Committee will resume its work on considering other amendments on Tuesday.