Affordable Care Act

Upheld By

US Supreme Court
June 28, 2012
(PDF, 777 KB)

Wither the Affordable Care Act?
With all the focus on the individual mandate and Medicaid expansion provisions of the Affordable Care Act, relatively little attention has been paid to the multitude of provisions in the Act that affect pharmaceutical policies including pricing, reimbursement, benefit management and marketing. Yet there is a lot there, and there are potentially opportunities for legislators to expand some existing state programs and look for alternative ways to implement other policies such as PBM transparency, disclosure of gifts and payments to physicians, datamining, academic detailing and more. NLARx Executive Director Sharon Treat presented briefly on many of these provisions, and the legislators and legislative staff present agreed that a future NLARx meeting should be devoted to exploring the ACA and the opportunities for state legislators to expand on policies in the Act, such as marketing disclosure, and potentially to use the rules of the Exchanges to promote greater transparency in PBMs as well as to fine-tune data and electronic record privacy provisions.

Implementation of Sunshine Act Disclosures Delayed
CMS-OMB Delaying Physician Disclosure Rule
October 4, 2011

Report Medicare & Medicaid
NCSL Overview of Medicaid Drug Pricing Changes Under the ACA

October 7, 2011 - States are considering or have enacted a variety of changes in their Medicaid programs to respond to the challenges arising from increased demand for and higher costs of prescription drugs. Recent state legislation related to Medicaid prescription drugs generally is designed around new or expanded applications of management tools already available to states through federal law. Among the strategies receiving legislative attention are use of:

  • preferred drug lists (PDL) or formularies,
  • generic substitution,
  • cost-sharing or copayments,
  • multi-state purchasing,
  • pharmacy benefit managers (PBMs)
  • prior authorization,
  • drug utilization review (DUR),
  • dispensing fees,
  • ingredient reimbursements (AWP, AMP, ASP),
  • supplemental rebates from manufacturers.
  • disease management [NCSL report]
  • carve-outs from managed care plans

Click here to go to the NCSL Website and read more

Consequences of Repeal: Donuts, Not Cheap Drugs, for Seniors
January 3, 2011

By GoozNews
Business is flush with cash and getting ready to hire. Or at least, so said this morning?s Wall Street Journal, the bible of the business class.
But one group of firms is hunkering down for a tough year. Pharmaceutical companies face a sluggish environment because of the new health care law, the paper?s industry roundup said. Why? The Affordable Care Act, slated for repeal before the president gives his state of the union address, forces companies to offer senior citizens who fall into the donut hole of non-coverage half-price name brand drugs. Said the Journal:

Dave Holveck, CEO of Endo Pharmaceutical Holdings Inc., estimated that closing the Medicare hole will cost his company between $20 million and $30 million in annual revenue.

Repeal the law and that?s $20 to $30 million that will come straight out of senior citizens? pockets. I suspect most senior voters, who disproportionately supported Republicans and their call to repeal health care reform, were not aware they were voting for higher drug prices. Democrats in the coming weeks will undoubtedly be telling them about that consequence of reform?s repeal. on the web

Prescription requests may rise under new OTC drug payment provision A health reform law requirement taking effect Jan. 1, 2011, forbids using flexible spending accounts and other tax-exempt funds to buy medication without a prescription.
http://www.ama-assn.org/amednews/2010/12/13/gvl21213.htm

Special Report: Medicaid Rebate Changes

Text of Patient Protection and Affordable Care Act (??PPACA??; Public Law 111?148) consolidating the amendments made by title X of the Act and the Health Care and Education
Reconciliation Act of 2010 (??HCERA??; Public Law 111?152)

The $250 Doughnut Hole Rebate (AARP Fact Sheet)

Federal Officials Confirm A Shift In Medicaid Drug Rebates
Link to federal guidance: http://www.cms.gov/smdl/smd/itemdetail.asp?itemid=CMS1234846

Letter from U.S. Senator Byron Dorgan (D-N.D.) and Montana Governor Brian Schweitzer to the Secretary of Health and Human Services requesting the Secretary Sebelius approve a pilot project allowing North Dakota and Montana to import lower-priced prescription drugs from Canada.

Centers for Medicare and Medicaid Guidance on increased Medicaid Prescription Drug Rebate Percentages in the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA).

SIDE-BY-SIDE COMPARISON OF MAJOR HEALTH CARE REFORM PROPOSALS (House, Senate, Obama)
The Henry J Kaiser Foundation

NLARx, Consumers Union, Consumer Federation of America, and the U.S. Public Interest Research Group. Letter to President Obama on Healthcare Reform and Affordable Generics. March 10, 2010.

Side-by-Side Comparison of Health Care Reform Legislation Featuring the President?s Proposals. Ernst & Young. February 23, 2010.

Letter from Consumer Groups to Congressional Leadership on PBM Transparency

Tri-Committee House Majority Staff Side-by-Side

Kaiser Side-By-Side Comparing Senate and House Versions

NLARx Joins with Consumer Groups to Support Comprehensive Sunshine Provisions

Manager's Amendment #3276 to Reid Substitute amendment #2786

33 Consumer and Labor Organizations' Letter to All members of the US Sentate In Support of Ban on Pay-for-Delay Settlements. December 7, 2009.

NLARx to Majority Leader Reid: Fix the Donut Hole, Speed Up Generic Pathway, Bring Down Drug Costs in Health Reform Legislation. Press Release, November 2009.

NLARx Letter to Sen. Reid on the Drug Prices and Generic Pathways Provisions of the Senate Legislation. November 20, 2009.

Summary of Senate (Reid) Bill Provisions on Prescription Drugs. November 19, 2009.

Pew Prescription Project Comparison of the Sunshine provisions in the House and Senate Reform Bills. November 19, 2009.

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