Health Policy News – April 2021

This month’s edition of Health Policy News features a recent PCG white paper on Syndromic Surveillance—a tool that has been central to helping state and local health departments track the spread of COVID-19 and target testing, contact tracing, and other resource allocation.

Shortly before we published this newsletter today (Fri. 4/30), the Centers for Medicare and Medicaid Services (CMS) released the second final Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards, as well as an accompanying fact sheet. At first glance, the primary item of note for both issuers and consumers is the large reduction in the cost-sharing provisions from proposed to final, with the maximum out-of-pocket (MOOP) amount reduced by $400 for Plan Year 2022. The guidance also finalizes the following cost-sharing amounts:

  • The final 2022 reduced annual limitation on cost-sharing for eligible enrollees with incomes between 100% and 200% of the federal poverty level (FPL) is $2,900 for self-only coverage and $5,800 for other-than-self-only coverage.
  • The 2022 reduced annual limitation on cost-sharing for eligible enrollees with incomes above 200% and through 250% FPL is $6,950 for self-only coverage and $13,900 for other-than-self-only coverage.

We will be providing a more comprehensive update on the changes from proposed to final, as well as highlighting any new policies, so stay tuned to the blog for an update on the finalized Exchange Guidance for 2022.

Also, this month, we cover the latest federal health policy developments related to COVID-19. Implementation of the American Rescue Plan (signed into law last month) quickly began this month with the launch of extended premium tax credits and COBRA subsidies, as well as the provision of guidance on implementation of various provisions.

Beyond COVID-19-related topics, this month’s edition continues our series on state approaches to prescription drug cost control, highlighting efforts in Vermont as well as at the federal level to implement wholesale drug importation programs.

Health Information Exchanges (HIEs) and Syndromic Surveillance

Earlier this month, Health Policy News posted a white paper from PCG Health IT experts on Syndromic Surveillance. The COVID-19 pandemic has underscored the need to capture and securely share patient information via health information exchanges (HIEs). HIEs across the nation have been critically important in helping healthcare provider organizations, as well as state and local health departments, to report and track the spread of the virus, to analyze data for targeted testing and resource allocation planning, and to assist with contact tracing efforts.

While state and local health departments have collected and tracked syndromic surveillance data for years, the current pandemic has highlighted the urgent need to have a more robust, efficient, and well- funded ability to capture, standardize, and securely share this data across organizations, providers of care, and agency jurisdictions. To learn more about syndromic surveillance and possible new funding for these efforts under the American Rescue Plan Act of 2021—as well as why it is now more important than ever for states and territories to continue with this work—click here.

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Implementation of the American Rescue Plan Kicks off Quickly and the Federal Government Announces its Health Priorities for Discretionary Spending

With the COVID pandemic ongoing, the federal administration prioritized a quick kickoff to implementation of the American Rescue Plan Act of 2021 (ARP), which was signed into law on March 11, 2021 and seeks to broadly address the pandemic and its impacts. At the beginning of this month, the law’s expanded Premium Tax Credits and new COBRA subsidies went into effect. The administration also released guidance related to the halt to Advance Premium Tax Credit reconciliation for 2020, the COBRA subsidies, the continuing Special Enrollment Period, and ARP funding for community-based providers.

To learn more about all of those developments, as well as new Section 1135 Waiver approvals and the administration’s health priorities for discretionary spending, click here.

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Update on Vermont’s Efforts to Implement Wholesale Importation of Prescription Drugs from Canada

The COVID-19 pandemic has impacted many state policy efforts over the last year, with states across the U.S. re-deploying their staff towards tracing and vaccination work. This has undoubtedly contributed to less momentum on drug importation efforts at the state and federal level; however, with the new administration in office and new leadership in place at the Department of Health and Human Services, there will likely be efforts to move these policies forward soon.

This month, Health Policy News reviews and provides an update on the progress of a state drug importation initiative—Vermont’s Act 133, “An Act Relating to the Wholesale Importation of Prescription Drugs into Vermont” as part of our ongoing series highlighting state prescription drug cost control efforts. Legal challenges to the federal final rule that would allow for approval of state drug importation programs released in September 2020 are pending, and Canada has also issued orders to block drug importation efforts in certain instances. To read an overview of Vermont’s efforts to study, design, and receive federal approval for a drug importation program, click here.

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