Policy + Advocacy News for May

May 2, 2022 | News and Events

Accessia Health monitors American health policy updates at the state and federal levels in order to inform our organizational policy decisions and agenda. Following are some recent highlights you may find interesting.*


New Tool Makes It Easier for People to Apply for SSI and Other Benefits (LINK BELOW!)

The Social Security Administration (SSA) recently launched a new tool people can use to tell SSA that they – or someone they are helping – wants to apply for Supplemental Security Income (SSI) and other benefits. 


The tool can be found here: Get Started to Apply for SSI | SSA

The process takes only a few minutes and asks for basic information about the person who wants to apply for SSI. A Social Security representative will schedule an appointment and e-mail the appointment information. In some cases, they may call you to schedule the appointment.

Note that by using this tool, you are documenting your intent to file an application and establishing a protective filing date. This is important because this date determines when payments can begin for approved applicants.

Certain third parties, such as parents of minor children, family members, representatives, or members of advocacy groups, can also use the tool to express interest about applying for SSI on behalf of someone they are helping. For people unable to use the tool, SSA will continue to establish the protective filing date based on a written statement of intent to apply or an oral inquiry about program eligibility.

SSA reports that this tool is part of their commitment to expanding online services and making it easier for people who face service barriers to get the support they need.


Biden unveils steps to strengthen ACA, expand coverage

At a White House event marking 12 years since the Affordable Care Act was signed into law, President Joe Biden announced new efforts to strengthen the ACA, including a new executive order instructing federal agencies “to do everything in their power” to expand coverage and simplify enrollment and a proposed rule that would eliminate the so-called family glitch in the health care law. The glitch means some people with family coverage might not be eligible for the same premium assistance they would if they sought coverage as individuals, affecting an estimated 5.1 million people. 

Full Story: ABC News (4/5),  FierceHealthcare (4/5) 

Medicare report shows both cost increases, decreases

The Medicare Index Report produced by eHealth showed a combination of cost hikes and decreases among private Medicare plans this year. Main points in the report included the following: 87% of year 2022 applicants selected $0 premium plans; average monthly premiums still rose slightly from 2021; Medicare Supplement premiums saw the highest increases; 2022 annual deductibles showed an increase; and Medicare Advantage participants are seeing lower out-of-pocket costs. 

Full Story: HealthLeaders Media (4/14)

Kaiser Family Foundation Report Finds Drug Prices Increased Faster than Inflation

A recent report from the Kaiser Family Foundation found that drug prices increased faster than inflation for half of all drugs covered by Medicare in 2020. According to the analysis, 50% of 3,343 drugs under Part D and 48% of 568 drugs covered under Part B had price increases greater than the 1% inflation rate from July 2019 to July 2020. Of the Part D drugs, 17% increased more than 7.5% in that time frame while 18% of Part B drugs increased more than 7.5%. Of the 568 Part B drugs, 46% experienced a price reduction while 41% of the 3,343 Part D drugs experienced a reduction in price.

CMS Finalizes Medicare Coverage Policy for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease

The Centers for Medicare & Medicaid Services (CMS) released a national policy for coverage of aducanumab and any future monoclonal antibodies directed against amyloid approved by the FDA with an indication for use in treating Alzheimer’s disease.  

Medicare will cover monoclonal antibodies that target amyloid (or plaque) for the treatment of Alzheimer’s disease that receive traditional approval from the Food and Drug Administration (FDA). CMS, as a part of this decision, will provide enhanced access and coverage for people with Medicare who are participating in CMS-approved studies. This decision is specific to individuals who have a clinical diagnosis of mild cognitive impairment (MCI) due to Alzheimer’s Disease or mild dementia with a confirmed presence of plaque on the brain.  

For a fact sheet on Medicare coverage policy for monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease, visit https://www.cms.gov/newsroom/fact-sheets/medicare-coverage-policy-monoclonal-antibodies-directed-against-amyloid-treatment-alzheimers-disease. 

Biden-Harris Administration Announces a New Way for Medicare Beneficiaries to Get Free Over-the-Counter COVID-19 Tests

On April 4, The Biden-Harris Administration announced that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, now have access to FDA approved, authorized, or cleared over-the-counter COVID-19 tests at no cost. People with Medicare can get up to 8 tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency. 

This initiative adds to existing options for people with Medicare to access COVID-19 testing, including: 

  • Requesting free over-the-counter tests for home delivery at covidtests.gov. Every home in the U.S. is eligible to order 2 sets of 4 at-home COVID-19 tests. 
  • Access to no-cost COVID-19 tests through health care providers at over 20,000 testing sites nationwide. A list of community-based testing sites can be found here. 
  • Access to lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost through Medicare. 
  • In addition to accessing a COVID-19 laboratory test ordered by a health care professional, people with Medicare can also access one lab-performed test without an order and cost-sharing during the public health emergency. 

People with Medicare can get additional information by contacting 1-800-MEDICARE and going to: https://www.medicare.gov/medicare-coronavirus. Medicare also maintains several resources to help ensure beneficiaries receive the correct benefits while also avoiding the potential for fraud or scams. More details—particularly on identifying scams due to COVID-19—can be found at https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse. 

Pharmacies and other health care providers interested in participating in this initiative can get more information here: https://www.cms.gov/COVIDOTCtestsProvider. 

More Information: Fact Sheet 

Stat: Many Medicare Part D Beneficiaries Don’t Fill Prescriptions For Pricey Drugs

Medicare Part D beneficiaries who have low incomes and receive government subsidies were nearly twice as likely to fill a prescription for a high-priced medicine for cancer or other illnesses compared with Americans who don’t receive such support, according to a new study. The analysis found that many beneficiaries who do not receive subsidies — which can cap or lower out-of-pocket costs — did not fill their prescriptions. For instance, 30% of prescriptions for cancer drugs were not filled and more than 50% of prescriptions written for medicines used to treat high cholesterol or immune disorders also went unfilled. (Silverman, 4/6) (N.B. The study was conducted by Kaiser Family Foundation.)

Modern Healthcare: Biosimilars, Generics To Slow Drug Cost Increases In 2022

Biosimilars and generic drugs are poised to slow drug cost growth this year, a new report indicates. Total drug spending increased 7.7% from 2020 to 2021 to $576.9 billion, driven by an uptick in the utilization of COVID-19 therapies, according to an American Society of Health-System Pharmacists analysis. Drug prices only increased 1.9% in 2021, in part thanks to new biosimilars and generics that came to market. Drug spending rose 4.9% to $535.3 billion from 2019 to 2020 while prices ticked up 0.3%. (Kacik, 4/6) 

COVID-19 Over-the-Counter Tests webpage

Study links childhood risk factors to future CV events

A study published in The New England Journal of Medicine identified risk factors in childhood — including body mass index, cholesterol, triglycerides, blood pressure and youth smoking — that can affect the risk for fatal and non-fatal cardiovascular events in adulthood. “While interventions in adulthood like improving diet, quitting smoking, being more active and taking appropriate medications to reduce risk factors are helpful, it is likely that there is much more that can be done during childhood and adolescence to reduce lifetime risk of cardiovascular disease,” researchers said. 

Full Story: PhillyVoice (Philadelphia) (4/7) 

Food can be an effective tool to prevent, treat disease

Good dietary habits are important in addressing disease, but many US medical schools do not require nutrition courses for their students, according to a report from the Center for Food as Medicine and Hunter College NYC Food Policy Center. “If physicians are inadequately trained on how to guide patients with regard to nutrition, we will continue to see a proliferation of diseases that could be minimized with proper nutrition,” said Dr. Fatima Cody Stanford of Massachusetts General Hospital in response to the report. 

Full Story: Healio (free registration) (4/7)

Study examines disparities in use of acute pediatric asthma care

Research published in the journal Annals of Family Medicine found that Latino children who preferred speaking Spanish were more likely to visit a community health center for their acute asthma symptoms compared to non-Hispanic white children, while non-Hispanic Black children had lower use of clinics and had the highest proportion of moderate to severe asthma. Findings also showed that the odds and rates of asthma-related emergency department use were higher for non-Hispanic Black children compared to non-Hispanic white children. 

Full Story: Healio (free registration) (4/5)

Cost of Chronic Disease in Retirement Is Highest for Women and People of Color

The National Council on Aging (NCOA), the national voice for every person’s right to age well, has found that the economic burden of chronic disease in the United States falls more heavily on women and people of color aged 60 and over, who also have the lowest incomes and other assets to afford it, according to a new analysis released today. The research was done in collaboration with the LeadingAge LTSS Center at the University of Massachusetts, Boston.

*Helping patients better access and afford their health care is what we strive to do. We know that patients can’t benefit from medications and care that they can’t afford, so we will continue to advocate for policy change that will enable patients to directly benefit from payment assistance programs. If you have questions or comments about Accessia Health’s government affairs and policy work, please contact Ashlea Christiansen at [email protected].

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