Week in Washington

CMS Regulation Releases

CMS released a series of proposed payment regulations this week.

• For the FY 2025 physician fee schedule CMS proposed a 2.8% cut.
• For the FY 2025 outpatient payments, CMS proposed a 2.6% increase.
• As part of the outpatient rule CMS also proposed a requirement that hospitals and critical access hospitals that participate in Medicare and Medicaid for obstetrical services have certain basic equipment to reduce maternal mortality rates.

Congress is considering increasing Medicare payment rates however no legislation is expected to pass until after the election.

FTC to Sue PBMs

The Federal Trade Commission is expected to sue the three biggest pharmacy benefit managers (CVS Caremark, Express Scripts, Optimum Rx) over allegations that they used their dominant position to illegally increase prescription prices and their profits.

 Odds and Ends

• CMS released 2024 Marketplace effectuation data. Effectuated enrollment as of February 2024 stands at 20.8 million. This is a 33% increase relative to effectuated enrollment as of February 2023.  An additional note that the difference between plan selections (initial data from Open Enrollment) and effectuated enrollment (data on enrollees that have had their first month enrollment paid for) has shrunk in recent years.
• Inflation cooled in June according to new CPI data. In fact, the monthly inflation rate was -0.1%, driven by lower gas prices. Medical service costs increase also were lower than prior months. The lower inflation rate could encourage the Federal Reserve to lower interest rates.
• Boehringer Ingelheim lost its District Case against CMS over its implementation of the Inflation Reduction Act drug negotiation provisions. To date CMS has been successful in its cases but there are several other cases that will be having hearings in July on this topic. Georgetown’s tracker on litigation on this topic is very useful to keep updated on the latest cases.