H.R.987: Strengthening Health Care and Lowering Prescription Drug Costs Act
The Strengthening Health Care and Lowering Prescription Drug Costs Act is a bipartisan omnibus bill that aims to increase access to quality, affordable healthcare and reduce the cost of prescription drugs. In total, the legislation combines seven bills.
H.R. 987 includes four bills for the purpose of protecting and strengthening access to affordable, quality health coverage:
1. A rollback of the administration’s rule that expanded junk insurance plans introduced by Kathy Castor (D-FL);
2. The State Allowance for a Variety of Exchanges Act (SAVE) Act (H.R. 1385) introduced by Rep. Andy Kim (D-NJ);
3. The Expand Navigators’ Resources for Outreach, Learning, and Longevity (ENROLL) Act of 2019 (H.R. 1386) introduced by Rep. Kathy Castor (D-FL) and;
4. The MORE Health Education Act, introduced by Rep. Lisa Blunt (D-NY). The Senate version of this bill is S. 455.
Junk Insurance Plans
In October 2018, the Short-Term, Limited-Duration Coverage Final Rule went into effect with significant implications for the American healthcare system. The rule undid an Obama-era regulation that restricted short term healthcare plans to three months and limited their renewability. Under the new rule, short term healthcare plans have a new, 12-month maximum with an option to renew up to three times, with a maximum length of 36 months. H.R. 987 would prohibit the enforcement of this rule and bar State Secretaries of the Treasury, Health and Human Services, and Labor from establishing “substantially similar rules”.
The SAVE Act would amend sections of the Affordable Care Act (ACA) to appropriate more funding for grants to promote state-level health insurance exchanges. The bill would provide funds to states that do not otherwise offer insurance exchanges. Additionally, it would allow for grants that last a maximum of two years and must be awarded before December 31st, 2022.
The ENROLL Act would appropriate funds to ensure that health insurance navigators, professionals who are trained to help consumers, small businesses, and their employees find insurance, have the resources necessary to continue assisting Americans in finding adequate and affordable coverage. The bill would reframe the definition of success for navigators to focus on education and assistance to those in need, regardless of burden, rather than focus specifically on application numbers. This would include redefining the responsibilities of navigators to include Medicaid and CHIP enrollment. Finally, the bill would require that each state has at least two navigator programs that are “physically present” in the state, with at least one being a community-based organization.
MORE Health Education Act
After taking office, the current administration cut financing for ACA education and outreach by 90%, reducing their funds from $100 million per year to $10 million per year. Reports by the Kaiser Family Foundation found that a quarter of participants were not aware of the December 15th deadline, while less than half of uninsured adults were aware of the ACA marketplaces. The MORE Health Education act would fully restore education and outreach funding to its previous levels. The bill would also add requirements that all information be provided in a culturally and linguistically appropriate way to ensure all Americans have access to quality health coverage.
Additionally, H.R. 987 includes three bills that aim to lower the cost of prescription drugs:
1. The Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2019 introduced by Rep. David Cicilline (D-RI), (Language taken from S. 340);
2. The Protecting Consumer Access to Generic Drugs Act (H.R. 1499) introduced by Rep. Bobby Rush (D-IL) and;
3. The BLOCKING Act (H.R. 938), Introduced by Kurt Schrader (D-OR).
The CREATES Act would apply strict rules requiring access to generic drugs for product developers, with some minor exceptions for Risk Evaluation and Management Strategies with Elements to Assure Safe Use (REMS w/ ETASU). Additionally, the bill would encourage the secretaries of Health and Human Services (HHS) and Education (ED) to take “every effort necessary” to increase education on generic drugs in pharmacy schools. Finally, the bill would mandate a report from the HHS Secretary, with assistance from the National Academy of Medicine, that includes: the number of drugs developed with federal assistance, the average cost incurred during development, the average revenue and profits of drug developers, the percentage of revenue and profits reinvested in drug research and development, and an appropriate percentage of reimbursement for the federal government.
Protecting Consumer Access to Generic Drugs Act
H.R. 987 also includes provisions to mediate the price of prescription drugs. The bill would make it unlawful for New Drug Application (NDA) and Biologic License Application (BLA) holders to enter into legal agreements in which they essentially buy out other producers and developers. This practice makes it significantly more difficult for companies to develop generic versions of expensive drugs, and subsequently bring those generics to market. Additionally, it would give the Food and Drug Administration (FDA) more power to enforce this regulation via legal and civil actions.
Current law states that the first applicant to the FDA for a generic drug patent is granted a 180-day exclusivity period, set to begin when the product is brought to market. However, companies can choose not to bring the generic to market and prevent other companies from submitting applications to the FDA, a practice known as “parking”. The BLOCKING Act would amend the applicable start date for the exclusivity period making the practice of “parking” almost impossible. This would likely allow generic, cheaper medications to make it to market quickly.
H.R. 987 has already passed the house and awaits consideration by the Senate.