With midterm elections resulting in a divided Congress, the U.S. Department of Health and Human Services will be free to focus on longstanding priorities for the agency, such as implementing drug negotiation policy within Medicare, its top official said.
“In a way, we’re now going to be able to concentrate on the work we have to still execute on,” HHS Secretary Xavier Becerra said at the HLTH conference in Las Vegas on Tuesday.
Under the Inflation Reduction Act passed earlier this year, Congress granted Medicare the power to negotiate how much it pays for certain prescription drugs starting in 2026, and to receive rebates from pharmaceutical manufacturers that hike drug costs in the program above the rate of inflation starting in 2023.
“We’re going to have to rapidly move forward to make sure that we’re ready next year to begin the process to begin the negotiation, where we start to select the drugs, the first drugs that will be part of that negotiation, sitting down with the different companies and manufacturers so by 2026 the new negotiated prices will start to kick in,” Becerra said.
Initially, the IRA was written to allow the government to negotiate drug prices for all Americans, but Congress later restricted the policy only to the 65 million Americans on Medicare amid fierce opposition from the powerful pharmaceutical industry. The law is still expected to save the government a significant amount of money. The Congressional Budget Office estimates almost $99 billion in Medicare savings over a decade from the IRA’s drug negotiation provisions.
Drugmakers are continuing to work behind the scenes to chip away at Medicare’s ability to negotiate medicine prices as regulators begin to hash out the details of implementing the IRA.
According to The Wall Street Journal, companies are lobbying for additional legislation to counter some measures of the law, and are working to shape upcoming rules around implementation. Ideas include extending the time frame after which pills become eligible for price negotiations, or exempting drugs that treat more than one rare disease, according to the Journal.
“We get a lot of pushback,” Becerra said. “We think we’re being aggressive. But so are those who aren’t necessarily happy with what we’re planning — they get very aggressive.”
Becerra also called out implementing surprise billing policies enacted in the No Surprises Act as an ongoing priority, though it’s “taking a while to implement because we keep being taken to court,” the secretary said.
The No Surprises ACT, which was signed into law in 2020, established new federal protections around surprise bills. Those include requiring private health plans to cover the out-of-network claims and apply in-network cost sharing, and prohibiting providers from billing patients more than the in-network amount.
The Biden administration was hit by a number of lawsuits over the policies, though some parties retracted their suits as the HHS released rules more favorable to their interests. But the HHS still faces litigation, including from the Texas Medical Association.
Becerra said that HHS will also focus on addressing the U.S. mental health crisis and the ongoing COVID-19 pandemic, including research on long COVID, and will continue to work to ensure insurance coverage gains.
The number of uninsured Americans has plummeted, partially due to pandemic-era coverage gains in public programs like the Affordable Care Act exchanges and Medicaid. The uninsured rate dropped to a record low of 8% in the first quarter of 2022, according to HHS data.
“We’re going to continue to make progress,” Becerra said.
Congress returned to work on Monday to start the lame duck session. In the session that begins in early January, Democrats will retain control of the Senate, while Republicans will take control of the House of Representatives. Based on the latest House race tallies, Republicans have secured 218 seats, the minimum for a majority, while Democrats have 209. Another seven seats remain uncalled.