6. The rising cost of insulin
Sami Inkinen, CEO and founder of Virta Health, a San Francisco-based health tech company specializing in type 2 diabetes reversal through nutritional intervention, believes in 2020, there will be policy changes roll out to help address the rising cost of insulin, which the FDA Commissioner Scott Gottlieb, MD, has called unacceptably high for a decades-old drug.
“Insulins are biologic drugs, and they will be regulated as such for the first time in 2020. The transition will spur generic competition in the insulin market and impact costs,” Inkinen says. “The shift has been long planned, but it comes amid growing public outrage and media stories focused on patients having to ration their insulin, travel abroad to buy cheaper insulin, and make choices between buying insulin or putting food on the table.”
HHS is aggressively pushing forward with new requirements to hasten the adoption of interoperable electronic health records and utilizing brand new legal authorities to do so. In its February 2019 Interoperability and Patient Access proposed rule, CMS requires all Medicare, Medicaid, and federal exchange plans to share claims data information electronically with enrollees.
“While this is an important policy objective to further the administration’s goal of giving patients access and control over their own data, it could create a burden for plans to operationalize this new rule and ensure it complies with data safety standards,” Felder says. “This rule is set to be finalized by the end of the year, and plans will be charged with implementing it in 2020.”
8. Lowering drug prices
Lee Barrett, executive director and CEO of Electronic Healthcare Network Accreditation Commission, the nonprofit standards development and healthcare accreditation company, says to the extent to which managed care companies manage drugs, as well as other healthcare service delivery, the current focus on bringing drug costs under control is relevant.
House Speaker Nancy Pelosi’s bill to lower prescription drug prices would save Medicare $345 billion over 10 years, according to a preliminary analysis from the nonpartisan Congressional Budget Office.
The main thrust of the plan would allow Medicare to negotiate lower prices on up to 250 of the most expensive drugs—including insulin—per year and apply those discounts to private health plans.
“If Medicare were to move in the direction of the Pelosi proposal, in which drug prices would be indexed against foreign prices and the government would negotiate prices downward, we would expect that drug prices in the commercial market would fall as well,” Barrett says. “While a political agreement on an approach to lowering drug prices will be difficult, we think there is a reasonable chance that drug manufacturers and PBMs [pharmacy benefit managers] will be squeezed considerably in 2020, and managed care organizations, like other payers/controllers of care, should benefit.”
This past summer, the Trump administration dropped the proposed drug rebate rule aimed at PBMs, then introduced a plan to import drugs from Canada. As the public is still searching for a solution, 2020 will undoubtedly see more discussions about how to reel in drug prices.
Keith Loria is an award-winning journalist who has been writing for major newspapers and magazines for close to 20 years.