A group of health care industry experts recently shared legislative updates from Washington, DC, impacting oncology at the 2024 Community Oncology Conference. The panel of speakers included Christian G. Downs, JD, MHHA, Association of Community Cancer Centers; Ben Jones, McKesson, The US Oncology Network; Jerrica Mathis, Cardinal Health; Shelly Mui-Lipnik, Cencora; Kristine Rufener, Association for Clinical Oncology; and moderator Ted Okon, MBA, Community Oncology Alliance (COA).

Cybersecurity and Health Care

One of the main topics discussed during the panel was the recent cyberattack on Change Healthcare. Each participant shared how their organization is dealing with the ramifications of the attack. Jerrica Mathis stated that the Senate finance committee has announced a hearing at the end of April 2024 to meet with UnitedHealthcare’s CEO and legislation has been introduced to the committee to accelerate payments if something like this were to happen again. However, she hopes Congress will not overcorrect in one direction to prevent necessary stakeholders from accessing health care data. “This issue is not going anywhere anytime soon. It will be in the spotlight until we come to some resolution,” she said.

Ben Jones was critical of the US government’s response to the attack. For instance, he noted that the government viewed the problem through the lens of COVID and did not see the disruption to patient care. Because the disruption did not reach the levels that occurred during COVID, the government did not provide enough support and advanced payments. Also, they first started only assisting hospitals before it was “pushed upon them” to include physician practices. Practices and providers were exhausting efforts to complete manual processes to ensure that patients weren’t impacted. Jones emphasized that there needs to be a thorough analysis of what went wrong, what went right during this crisis, and what should happen now. There are practices that are experiencing prolonged distress, even resulting in some providers selling their practices, said Jones.

Kristine Rufener agrees that the attack has been disruptive to practices and their ability to make claims and receive payments. She stated that her organization has been holding conversations on the topic with the Centers for Medicare & Medicare Services and UnitedHealthcare to ensure that providers, not just hospitals, are included in the wider discussion. She noted that discussions around AI and technology and where that fits into health care will likely be merged with cybersecurity talks. She also predicts that “there will be more activity on the hill” around these topics in 2025.

Christian Downs further discussed the challenges that practices are facing due to the attack. First, they have an operational challenge of keeping their practice/business running. Second, cybersecurity systems are expensive, and small practices and small hospitals may not be able to cover the cost of such systems and might even need to close their practices as a result. There is also the issue of consolidation, which is a legislative and legal issue, according to Downs. “When the physicians, insurance, the distribution model, the technology is all in one place—you are not going to be able to control that going forward,” said Downs.

To address these challenges, Shelly Mui-Lipnik shared an update on potential legislation for a federal law that the Department of Health & Human Services aims to give guidance on cyberattacks when it comes to health care. She encourages health care stakeholders to reach out to congressional committee members to “ask the hard questions” to policymakers so they can appropriately address the issue.

PBMs

The next topic on the agenda was pharmacy benefit managers (PBMs). Ted Okon prompted the panelists to share what their organizations consider to be the most pressing issues when it comes to PBMs. Ben Jones began the discussion by focusing on “white bagging” mandates. “That tells a very clear story on the disruption to access to seamless, timely care that is formulated around a patient at the point of care,” he said. His team, along with COA, led efforts for a white bagging mandate prohibition in Texas and were also able to get this prohibition passed in Oregon. They plan to continue these efforts in other states, and Jones hopes it’s the next surprise billing initiative.

In terms of addressing the PBM issue at the federal level, Kristine Rufener said there has been a lot of movement in this area. It’s more of a bipartisan issue now, and she’s optimistic that committees have been working on different aspects of PBM reform. Shelly Mui-Lipnik also noted there will likely be legislative progress toward the end of the year with the Medicare Telehealth expiring provisions. She added that the education around PBMs has increased over the past couple of years. Jerrica Mathis furthered this point by discussing several opportunities to pass legislation on PBMs: (1) Congress will have to pass a budget again in September, (2) the lame duck period offers lawmakers the opportunity to resolve urgent matters before the new Congress’ term begins, and (3) there are many members of Congress leaving office and they often like to pass “legacy bills” before the end of their term.

Drug Shortages

The issue of drug shortages was also discussed among the panel members. Kristine Rufener shared some of the latest developments from Capitol Hill. For instance, the Homeland Security committee is interested in looking at drug shortages from a national security perspective. They’ve started working on bills dealing with the supply chain and they’ve held some hearings on the topic. The House Committee on Energy and Commerce have also held hearings on the issue. Rufener’s organization is working with any stakeholders that have ideas to tackle the issue. However, Jerrica Mathis noted there will likely not be a “huge legislative change” on drug shortages this year, as Congress is “still very much wrapping their heads around what this all means and the complexity of it all.”

In the meantime, Ben Jones suggested that the health care industry should focus on supply chain resiliency and practice and provider mitigation strategies.

Source: Downs CG, Jones B, Mathis J, Mui-Lipnik S, Okon T, Rufener K. The politics of oncology: legislative updates & predictions from Capitol Hill. Presented at the 2024 Community Oncology Conference; April 4-5, 2024. Orlando, Florida.