• Congress Still Mulling Drug Cost Solution – House Bill Includes New Medicare Vision Benefits


    Congress continues to seek solutions to rising drug costs, with competing bills in the Senate and House of Representatives offering wildly different paths toward an otherwise shared goal.

    • In the Senate, Finance Committee leaders Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore., have made changes to their already bipartisan drug cost proposal with an eye on gaining the support of more of their Senate colleagues. The authors remain open to additional changes which could include a positive 2020 Medicare physician pay update. In an effort to advance one of President Trump’s top priorities, the White House has thrown its support behind the updated Senate Finance Committee bill.
    • In the House, legislation from Speaker Nancy Pelosi, D-Calif., was passed today, but has few prospects of adoption by the Senate. HR 3 includes two provisions of particular importance to ophthalmologists: a two-year, 0.5% Medicare physician pay increase and a new vision benefit in original Medicare. 

    The varying proposals face long odds of securing the necessary consensus to pass in today’s polarized political climate, where impeachment proceedings are the focus of Congress’ attention.

    Senate legislation rolls in important Medicare provisions

    The current Grassley-Wyden bill, updated from its initial iteration, includes new provisions that would lower seniors' out-of-pocket payments. It would also provide multiyear funding for numerous health programs that will expire unless Congress gives them new funding before the end of the year. Committee leaders included these health “extenders” — which include the physician geographic practice cost index (GPCI) floor and funding for community health centers — as a way to gain greater broader support for their drug pricing package. The Academy is arguing that a Medicare physician pay update should be considered among those programs that Congress must address before the end of the year. 

    White House bolsters support for Senate proposal

    While the bill is bipartisan, there are still very few Republicans in the Senate who support the updated proposal, in part because it still includes an annual drug price-cap provision. Senate Majority Leader Mitch McConnell, R-Ky., has been reluctant to authorize a vote, though the White House’s recent endorsement of the bill will increase pressure to act. 

    House bill faces long odds, but pushes new vision benefit under Medicare

    Pelosi’s bill, in which the government would determine drug prices for the entire country, is considered dead-on-arrival to the Senate. HR 3 gives the U.S. Secretary of Health and Human Services the authority to directly negotiate with drug companies for up to 250 of the highest-priced drugs each year based on an International Pricing Index, which is similar to a Trump administration proposal. The Congressional Budget Office recently determined that the bill would result in $500 billion in annual savings.

    What HR 3 lacks is Republican support.

    Among those new programs to improve Medicare is a new “routine eye exam” vision benefit — which include refraction — starting in 2024. Under this provision, subsidies will be provided to beneficiaries for either one pair of eyeglasses every two years or a two-year supply of contact lenses. In the first year of the new benefit, Medicare will cover up to $85 for eyeglass lenses and up to $85 for frames. This is increased from what was initially proposed after the Academy voiced concerns that previously proposed subsidy amounts might not be sufficient for the needs of seniors.

    As the new vision benefit was being developed, lawmakers also addressed another Academy concern by incorporating changes to ensure that beneficiaries would still have access to coverage of a new pair of glasses after cataract surgery, even if they already received new glasses within the bill’s two-year limit. 

    Savings from H.R. 3 would also be used to: 

    • Expand Medicare coverage for hearing and dental services
    • Invest $10 billion in biomedical research funding at the National Institutes of Health
    • Increase Food and Drug Administration funding by $2 billion
    • Provide $10 billion in funding for Community Health Centers 

    Physician pay update makes its way into Pelosi bill

    Under the Medicare Access and CHIP Reauthorization Act, physicians are scheduled for a zero-percent payment updates for years 2020-2025. To stop the pay freeze, Congress must be convinced to make changes to MACRA. Join us today by sending a letter urging action from your elected lawmaker. The Pelosi proposal takes on this issue, providing a two-year, 0.5% Medicare physician pay increase. The possibility of a pay increase remains in play for the Senate bill but has yet to be put to paper by its authors.