POLICY BRIEFINGS


OIG Estimates EpiPen Overpayments


The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) estimates that the Medicaid program could have overpaid as much as $1.27 billion for EpiPen because the product was misclassified as a generic rather than a brand name drug. The OIG examined program spending between 2006 and 2016. e estimate was in response to an inquiry from Sen. Chuck Grassley (R-Iowa). The OIG’s findings greatly exceed the $465 million in overpayments that was previously reported by Mylan, the manufacturer of EpiPen. The company has not responded to requests for information from Sen. Grassley about why the product was misclassified, and why Mylan failed to correct the situation when it was brought to their attention.


Senate Considers Employee Health Plan Tax


The Wall Street Journal has reported that Republicans are considering including a tax on employer health plans as a part of the Senate GOP’s health care legislation. The tax would generate billions of dollars in revenue and could help create incentives to reign in health care spending growth. The idea was considered by Speaker of the House Paul Ryan (R-Wis.), but ultimately not included in the House-passed American Health Care Act (AHCA).


GAO: CMS Should Track MA Dropouts


The Government Accountability Office (GAO) has recommended that the Centers for Medicare and Medicaid Services (CMS) should track whether the Medicare Advantage enrollees who drop out of managed care plans are getting adequate care. The GAO report found that beneficiaries in poorer health are more likely than others enrolled in Medicare Advantage to voluntarily leave their health plans. These plans tended to have lower quality scores, with enrollees more likely to face difficulty in accessing care. The plans were also more likely to be restricted provider network health maintenance organizations. The GAO suggests that CMS take advantage of the opportunity to use disenrollment data to better target oversight and identify problems within the Medicare Advantage program. The GAO study was requested by Sen. Sherrod Brown (D-Ohio) and Rep. Rosa DeLauro (D-Conn.) in 2015.


Lawmakers Request 340B Audit Information


Energy and Commerce Committee Chairman Greg Walden (R-Ore.), Oversight and Investigations Subcommittee Chairman Tim Murphy (R-Pa.) and Health Subcommittee Chairman Michael Burgess (R-Texas) have written to the Health Resources and Services Administration (HRSA) requesting the last two years of audit documents for the 340B drug pricing program. “The Committee is concerned about the 340B program’s rapid growth without additional and proportional oversight,” the lawmakers write. They outline a number of concerns with the drug pricing program, including entities billing for duplicate discounts on the same medication, and uninsured or underinsured patients paying the full list price despite the 340B hospital receiving the discounted price. They also note that HRSA doesn’t always follow up on audits when program violations are found. The lawmakers express support for the tracking of 340B program savings, and how the savings are spent by covered entities. The lawmakers request that the audit documentation be provided no later than June 15.



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