Two items of note (courtesy of the Pink Sheet) that are urgently important, but getting little attention.
1. Non-Interference
The House health care reform bill passed by the Energy and Commerce Committee directs HHS to negotiate drug prices directly with manufacturers for the Medicare Part D program, but it does not authorize HHS to establish a national formulary.
That leaves the provision vulnerable to being stripped out as the bill proceeds through Congress -on the basis that it may not reduce costs.
The Congressional Budget Office, in past estimates, has consistently concluded that savings generated from direct government price negotiation under Part D would be negligible unless HHS could bring some bargaining leverage to the table.
In a 2007 analysis, then CBO Director (now OMB Director) Peter Orszag wrote: "Negotiation is likely to be effective only if it is accompanied by some sort of pressure on drug manufacturers to secure price concessions."
Specifically, "the authority to establish a formulary, set prices administratively, or take regulatory actions against firms failing to offer price reductions could give the [HHS secretary] the ability to obtain significant discounts."
He added that "in the absence of such authority, the Secretary's ability to issue credible threats or take other actions in an effort to obtain significant discounts would be limited."
2. Comparative Effectiveness
Although it was not introduced during the House Energy and Commerce Committee's markup of the health care reform bill, an amendment prepared by Rep. Donna Christensen, D-V.I., that would create a public-private institute to oversee comparative effectiveness research activities remains in play and could be a part of the final package that is voted on by the House.
Christensen was given the go-ahead to introduce the amendment during the markup, but time constraints kept the amendment, which was filed with the committee, from being introduced for consideration. A staffer for Christensen said the representative has a commitment from Energy and Commerce Chairman Henry Waxman, D-Calif., to work on adding the amendment to the final House bill. The amendment would replace the current language in H.R. 3200 that places coordination of comparative effectiveness research activities within the Agency for Healthcare Research and Quality. The current language creates an independent CER commission to oversee the center, recommend research priorities and conduct stakeholder outreach.
According to a fact sheet on Christensen's amendment, it would create an independent public-private institute governed by a board of directors consisting of the HHS secretary, the directors of AHRQ and the National Institutes of Health, and 20 additional members appointed by GAO representing a broad range of stakeholders, including patients and consumers, physicians, public agencies (CMS and state and federal health programs), private payers, drug and device manufacturers, non-profit health research organizations, quality measurement/decision support organizations and organizations conducting minority health research.
The amendment, co-sponsored by fellow committee Democrat Jay Inslee,
