In a briefing document formatted as a Medical Assistance Advisory Bulleting and shared with the Medical Assistance Advisory Committee (MAAC) last week, the Department of Human Services (DHS) officially proposes to require both in-house and contract pharmacies to include a modifier on all Medicaid managed care drug claims. After the Dec. 22, 2022, MA Bulletin prohibiting contract pharmacies from dispensing 340B drugs was rescinded, DHS convened a workgroup with stakeholders to identify the best strategy for avoiding duplicate discounts at contract pharmacies. PACHC and FQHC representatives actively participated in these meetings and were led to believe that DHS was evaluating the options and considering the input offered and that a decision on strategy was unlikely before 2024. Consequently, the formal proposal without notification of or discussion with the workgroup came as a surprise, as was the choice of a model that is unworkable for large chain pharmacies and burdensome for in-house pharmacies. Comments on the document are due by May 4 and the proposed implementation date is July 1. PACHC will be submitting comments based on feedback from our 340B workgroup and subcommittee as well as from national 340B experts. Questions? Contact Eric Kiehl.

House Appropriations Committee Chairwoman Kay Granger (R-TX) and Labor, Health and Human Services, and Education Subcommittee Chair Robert Aderholt (R-AL) held an Oversight Hearing on the Provider Relief Fund and Health Care Workforce Shortages on Wednesday, April 26. HRSA Administrator Carole Johnson provided testimony at the hearing on Community Health Centers, the National Health Service Corps, and other initiatives to expand the healthcare workforce, investments in innovation, pandemic relief investments, and accountability. The hearing is part of Congress’s annual budget process. Click here to watch a recording of the hearing and here to read her testimony.

Bipartisan leaders of the Senate Finance Committee are working on legislation targeting pharmacy benefit managers (PBMs), the intermediaries in the prescription drug supply chain who negotiate discounts with drug companies on behalf of insurance plans. Finance Committee Chairman Ron Wyden (D-Ore.) and his GOP counterpart Sen. Mike Crapo (R-Idaho) last Thursday released an outline of the issues they aim to tackle as they craft a bill this summer. The senators indicated they are concerned about the lack of transparency in the supply chain, business practices by large, concentrated PBM firms that drive up out-of-pocket costs for seniors, and “misaligned incentives” that make higher drug list prices translate into higher compensation for intermediaries. The committee held a hearing on PBMs and the prescription drug supply chain on March 30, 2023.

Gov. Josh Shapiro signed an Executive Order announcing his customer service transformation strategy and establishing the Commonwealth Office of Digital Experience (CODE PA) to improve online services for Pennsylvanians and streamline the way they interact with the Commonwealth online. As part of this announcement, Gov. Shapiro named Bryanna Pardoe to the role of Executive Director of CODE PA. CODE PA will work to provide digital services that are responsive, user-friendly and accessible to every Pennsylvanian, including building a cross-agency product that allows residents to apply for related benefits that currently live separately with the Department of Human Services (DHS), the Department of Health (DOH) and the Pennsylvania Department of Education (PDE) and make them available through one platform. Click here to learn more.

The Shapiro Administration announced Acting Secretary of Health Dr. Debra Bogen is being honored as 2023 Pediatrician of the Year by the Pennsylvania Chapter of the American Academy of Pediatrics (PA AAP). The chapter gives this award annually to recognize a pediatric fellow who exemplifies the ideals of the profession and advocates for children’s health and increased access to health services. Before joining the Commonwealth, Dr. Bogen was the Director of the Allegheny County Health Department where she was a key partner with Community Health Centers in Pittsburgh. Prior to that appointment, she was a member of the Pittsburgh region medical and research community for more than two decades. She held a primary academic appointment as Professor of Pediatrics at the University of Pittsburgh and secondary appointments in psychiatry and clinical and translational science. Dr. Bogen also served as the Vice Chair of Education for the Department of Pediatrics at UPMC Children’s Hospital of Pittsburgh. She was one of the founders of the Mid-Atlantic Mothers’ Milk Bank and served as the organization’s Volunteer Medical Director until assuming her role at the state. Read more.

This week, the Centers for Medicare & Medicaid Services (CMS) issued the final Notice of Benefit and Payment Parameters for 2024, which specifies requirements for issuers, agents, brokers, and Assisters, to offer qualified health plans (QHPs) through the Federal Marketplace, Healthcare.gov. The final rule includes policies pertaining to plan options, health equity, risk adjustment, and consumer experience.  It also expands the network adequacy requirements by adding Mental Health Facilities and Substance Use Disorder Treatment Centers as new categories of Essential Community Providers (ECPs) and rural emergency hospitals as a new provider type in the Other ECP Category.  The number of QHPs offered in rural areas has been growing but still lags urban areas.

  This brief from the National Academy for State Health Policy (NASHP) considers strategies drawn from states that participated in NASHP’s Policy Academy on Rural Mental Health Crisis Services.

  Commentary from the National Governors Association Center for Best Practices summarizes themes and key takeaways from two virtual roundtables focused on equitable economic development and equitable healthcare for rural communities.