What We're Reading: Safety-Net Readmissions; Gag Clause Bill to Trump; CREATES Impact on Drug Spend

AJMC Staff

Easing Readmission Penalties at Safety-Net Hospitals

Penalties for hospitals with high 30-day readmission rates were part of the Affordable Care Act’s effort to encourage better care. Now, Medicare will ease up on annual readmission penalties for safety-net hospitals, reported Kaiser Health News. Safety-net hospitals have argued that their patients are more complex and likely to suffer complications because they cannot afford their medications or do not have regular doctors for check-ups. The safety-net hospitals have argued that many readmissions they see are through no fault of the institution but instead are a result of the poorer and more vulnerable populations they serve.

House Passes Gag Clause Bill

A week after the Senate, the House of Representatives also passed a bill that allows pharmacists to tell patients if their prescription drug would be cheaper off insurance. According to Bloomberg, the so-called gag clause bill has passed the House and will now head to President Donald Trump’s desk. The bill was in response to a practice where the co-payment for a drug is higher than the actual cost of the drug, allowing the pharmacy benefit manager (PBM) to pocket the difference. PBMs had barred pharmacists from telling patients that they could buy the drug for less.

CREATES Act Would Reduce Federal Spending on Drugs

The Creating and Restoring Equal Access to Equivalent Samples Act of 2018, known as the CREATES Act, would reduce federal spending on prescription drugs by $3.3 billion from 2019 to 2028, reported The Center for Biosimilars®, a sister site of The American Journal of Managed Care®. The Congressional Budget Office projects that the bill will allow generics, and biosimilars, to reach the market earlier than under current law. The CREATES Act creates a legal pathway for generic and biosimilar developers to bring civil lawsuits against the manufacturers of brand-name drugs if they don’t make enough reference samples of the branded product available for premarket testing.
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