Policy Updates: Hill Happenings and Administration Activities

By Garrett Eberhardt December 9, 2019

Hill Happenings

House and Senate Appropriators at Odds Over Process of Finalizing FY2020 Bills

House Democratic leaders are reportedly insisting that all 12 fiscal year (FY) 2020 appropriations bills be finalized before being presented to the floor in Congress. Democratic leadership sees the strategy as the best way to avoid a government shutdown rather than passing a series of minibus bills. Senate Appropriations Chair Sen. Richard Shelby (R-AL) has expressed doubt that all 12 bills could be finalized before the December 20 deadline and that if an agreement cannot be reached by the end of this week, another continuing resolution could be inevitable. While negotiations regarding smaller bills like Transportation-HUD, Energy & Water, Financial Services are making headway toward finalization, Senate Labor, Health & Human Services, Education, and Related Agencies subcommittee Chair Sen. Roy Blunt (R-MO) says that larger bills like his subcommittee’s become harder to finish the more time is taken on them. Committee members and their staff have been negotiating over the weekend with little news having come out about the progress they’ve made. There is also still the possibility that President Trump could refuse to sign any funding bills until funding for the southern border wall is secured.

House Schedules Vote for Drug Pricing Bill

It was announced on Thursday that the House of Representatives will be voting on H.R. 3, the Lower Drug Costs Now Act of 2019 this week. It remains unclear whether there will be a complete Congressional Budget Office score on the projected savings from the bill, as many lawmakers preferred before voting on the legislation. Speaker of the House Rep. Nancy Pelosi (D-CA), House Majority Leader Steny Hoyer (D-MD), and Reps. Frank Pallone (D-NJ), Richard Neal (D-MA) and Bobby Scott (D-VA) released a statement saying received enough guidance from CBO to bring the bill to the floor. One key provision in the bill that secured the support of progressive Democrats has been changed.  It would have directed the federal government to examine how to require drug makers to refund money to employer-sponsored health plans when the companies raised prices above the rate of inflation and issue regulations based on the findings. House Democratic leadership has instead dropped the mandate for regulations and only require the issue to be studied in the final bill. The move could threaten support from progressive members of the Democratic caucus.

The Senate is unlikely to take up the bill and an analysis from congressional legal advisers have warned that the legislation could also face challenges on its constitutionality due to its provisions limiting drug prices and the Eighth Amendment’s excessive fines clause. NASTAD has been actively advocating before Congress on this legislation, working to change a provision that would have negatively affected the 340B Drug Pricing Program discount and will continue to monitor its progress closely.

Administration Activities

HHS PrEP Donation Program Launches

The Department of Health and Human Services (HHS) launched its Ready, Set, PrEP program providing PrEP to 200,000 uninsured persons donated by Gilead Sciences. The deal for the donation of Truvada was announced in October and will continue annually through 2030. HHS will cover the dispensing costs through March with CVS, Rite Aid and Walgreens will donate pharmacy dispensing services thereafter. Qualified patients can receive PrEP at CVS Health, Walgreens, and Rite Aid locations, or through mail order, in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

CDC Analysis:  Majority of At-Risk Americans Not Receiving HIV Prevention Medication

An analysis by the Centers for Disease Control and Prevention (CDC) found that the majority of people at risk for HIV infection are not receiving prevention medication like PrEP to help them avoid transmission of the virus. The Vital Signs report states that of the 1.2 million people who could benefit from having access to PrEP, CDC found that only 18 percent are receiving the drug. Young people, African Americans, and Latinos were the most likely to not receive the medication. The analysis also found that two-thirds of those who are aware they have HIV are receiving treatment for the virus.

Hospital Organizations File Lawsuit Over Price Transparency Rule

Last week, multiple groups representing hospitals filed a lawsuit in federal court challenging the Trump administration’s price transparency rule requiring hospitals to disclose their negotiated rates with insurers. The American Hospital Association, Association of American Medical Colleges, National Association of Children’s Hospitals, and other groups argue in the suit that rule violates the First Amendment by provoking compelled speech and goes beyond the intent of “standard charges” transparency in the Affordable Care Act. It is also argued that the Department of Health and Human Services does not have the authority to enforce the rule. If the rule were to go into effect, it is estimated to cost hospitals between $38.7 million to $39.4 million.

Ending the Epidemic

HRSA Releases 2018 Ryan White Client Level Data Report

The Health Resources and Services Administration’s HIV/AIDS Bureau has released the Ryan White HIV/AIDS Program (RWHAP) Annual Client-Level Data Report for 2018. The report documents those served by the Ryan White program through data compiled on demographic and socioeconomic factors including age, race/ethnicity, transmission risk category, federal poverty level, health care coverage, and housing status. Retention in care and viral suppression data for the overall RWHAP client population receiving medical care are also included to better meet the needs for data-informed decision making. This year’s report highlights how the RWHAP plays a key role in providing care and treatment to people with new HIV diagnoses, people with HIV who are re-engaged in care, and people with HIV who are in care but not virally suppressed, which will contribute to the Ending the HIV Epidemic initiative’s treatment and prevention strategies.

Job Opportunities

Senior Director of Legal and Regulatory Affairs – Baltimore

The Baltimore City Health Department (BCHD) is seeking candidates for a Senior Director of Legal and Regulatory Affairs position. The position will serve as general counsel and principal legal advisor to BCHD's senior leadership team and will provide support throughout the agency on a wide range of legal matters including health law and regulatory compliance, health-related transactional matters, risk assessment, and affirmative litigation efforts with the City's Law Department.

Director of Policy – Illinois

The AIDS Foundation of Chicago (AFC) is seeking a Director of Policy with content expertise to stay abreast of critical healthcare delivery systems including Medicaid, Housing, Ryan White, and the Affordable Care Act (ACA) and influence health policy. The position will serve as the lead for policy development and work on identifying and resolving policy-related issues across the agency with other departments.

Director of Government Relations – Illinois

The AIDS Foundation of Chicago (AFC) is seeking a Director of Government Relations to develop and manage AFC’s federal, state and local government relations activities. The position will be the point person for HIV-related state legislative matters regarding appropriation, health care reform, and policy issues impacting the social determinants of health and health disparities.

HIV Transitional Specialist – Washington State

The Department of Corrections’ Health Services Division in Washington State is hiring an HIV Transitional Specialist. The position supports the department’s vision of maintaining safe communities by providing support for and developing comprehensive release plans for people living with HIV. The position will also provide technical assistance to correctional health care staff upon initial screening or admission and prior to the release of any patient living with HIV.

News Bulletin

ViiV Healthcare Submits NDA To FDA For Fostemsavir On HIV-1 Infection

“ViiV Healthcare, the global specialist HIV company majority owned by GSK, with Pfizer Inc. and Shionogi Limited as shareholders, completed submission of a New Drug Application to the US Food and Drug Administration seeking approval of fostemsavir, an investigational, first-in-class attachment inhibitor for the treatment of HIV-1 infection.”

 A Better Way for the Trump Administration to End HIV/AIDS
“The Trump administration announced last week a new program that will provide HIV prevention medications free of charge for uninsured patients. These pre-exposure prophylaxis (or PrEP) drugs are highly effective in preventing HIV, but with a cost of $2,000 a month, they are far too expensive for people without insurance. This new program will provide PrEP at no cost for up to 200,000 uninsured patients a year. Supporters have lauded this move as a major step toward President Trump’s plan to end HIV in the United States. Others have criticized it as not going nearly far enough: They would rather the government expedite generic drug production and lower the cost of PrEP.”