On November 19, 2021, the Build Back Better Act passed the U.S. House of Representatives with a vote of 220–213. The legislation contains significant health-care provisions, some of which are outlined below.
Drug Pricing—The legislation contains prescription drug pricing reforms designed to address high costs under Medicare Part B and Part D. The bill would direct the Secretary of the Department of Health and Human Services to negotiate prices for a selection of high-cost drugs that are no longer subject to market exclusivity. The bill would also require drug manufacturers to provide rebates to Medicare if certain drug price increases outpace inflation. ASCO has concerns about the changes to Part B reimbursement that would result from drug price negotiation and will work with Congress and the administration on implementing policies that better address high drug costs without compromising patient access to cancer care.
Affordable Care Act (ACA)—The bill would extend ACA subsidies established by the American Rescue Plan through 2025. These reforms reduce premiums for people below 400% of the federal poverty line and extend premium reductions to people of all incomes so that no one pays more than 8.5% of income for health insurance premiums through the ACA marketplaces.
The legislation would also address the coverage gap in the 12 states that have not expanded Medicaid so that their residents below 138% of the poverty line can gain coverage through no-premium ACA health plans through 2025. It also maintains a continuous open enrollment period during this time to help ensure they receive coverage.
Pharmacy Benefit Managers (PBMs)—Starting January 1, 2023, PBMs offered as part of ACA Marketplace plans must provide a report to employers and plan sponsors every 6 months that details how much copayment assistance was funded by drug makers. PBMs will also have to disclose extensive information on the prices they paid for specific drugs, the rebates for specific drugs, and the rationale for placing drugs on certain tiers within their formulary.
Medicaid—The bill would provide a 3% increase in Federal Medical Assistance Percentages for states that newly expand Medicaid for 2023, 2024, and 2025.
Medicaid Home and Community Based Services—The bill would provide approximately $150 billion in new Medicaid funding for Home and Community Based Services to states. This is designed to enable older people and people with disabilities to remain in their communities.
Health-Care Workforce—The legislation makes a number of health-care workforce investments, including funding for medical and nursing schools, Health Professions Opportunity Grants, graduate medical education, the National Health Service Corps and the Nurse Corps, maternal health support, and nursing home worker training grants.
Public Health Infrastructure—The bill would make public health infrastructure improvements, through investments in community health centers; pandemic preparedness; and state, local, and tribal public health infrastructure grants.
The Build Back Better Act now moves to the U.S. Senate for consideration. ASCO will continue to closely monitor the bill’s progress and weigh in on issues related to patients with cancer and the oncology care community.
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