Legislative Update
Important Information for Employers:
Biden's Budget and Changes to Oversight Rule
by Alex Jung, Alex Jung Consulting & MBGH Board Member
Legislation and litigation around healthcare is heating up. Congress is holding hearings with federal agency leaders like CMS as well as demanding healthcare CEOs come to Washington to explain their business practices in the face of ever growing public demand for accountability around skyrocketing healthcare prices.  

President Biden recently released his new budget which is focused on "Reducing Drug and Other Healthcare Costs for All Americans."
The Budget builds upon the Inflation Reduction Act to continue lowering the cost of prescription drugs. For Medicare, this includes further strengthening its newly established negotiation power by negotiating more drugs and bringing drugs into negotiation sooner after they launch. The Budget also proposes to limit Medicare Part D cost-sharing for high-value generic drugs, Department of Health and Human Services such as those used to treat chronic diseases like hypertension and high cholesterol, to no more than $2. 

For Medicaid, the Budget includes proposals to ensure Medicaid and the Children’s Health Insurance Program (CHIP) are prudent purchasers of prescription drugs, such as authorizing HHS to negotiate supplemental drug rebates on behalf of interested States in order to pool purchasing power. 

For the commercial market, the Budget includes proposals to curb inflation in prescription drug prices and cap the prices of insulin products at $35 for a monthly prescription. Eli Lilly just announced they would be lowering the price of their insulin to $35 a month. Coincidence?

And then there's the Consolidated Appropriations Act (CAA). 

MBGH is offering a series of employer-only roundtables (via webinar) to deep dive into employer responsibilities. Why? Well, as Bloomberg's recent article explains (link above), employers can no longer hide behind the excuse that someone else is managing prices for them. There is absolute legal jeopardy to employers who don't act on protecting their employees from fraud, waste and abuse in their plan. It's called fiduciary duty.

Think your vendors are going to take on these fiduciary duties when they are not legally required to at all? Think again. You are the responsible party and the likely defendant as employee and union lawsuits are gaining traction nationally. 

The healthcare industry is undergoing a long overdue reckoning and the largest risks sit with employers. It's time to get serious about taking control of where your employee pre-tax premium deductions are being spent. It's your job to ensure you are protecting them. The law now requires it.
MBGH will keep you informed as these issues progress!