American Health Insurance Plans (AHIP), the national association of healthcare insurance plans, recently called for the White House and Congress to increase the scrutiny of private equity control of providers, raising concerns about their potential to impact quality and cost.
In May 2022, the group sent letters to President Joe Biden and congressional leaders, outlining its new policy road map and priorities.
AHIP identified ten key areasof the United States healthcare system that could use improvement to “improve affordability and access for everyone.” AHIP believes that the ten steps below would lead to “real solutions that work.”
- Support consumer-centric expansion of home-based advanced care via value-based care and payment models
- Bring transparency to private equity firms’ monopoly power in air ambulance, emergency, and certain specialty services that often provide services on a fee-for-service basis
- Advance site-neutral payments, to prevent patients from having to pay more for the same services, depending on the site of care
- Remove impediments to telemedicine, including modernizing network adequacy regulations and guarding against regulatory structures that reduce competitive benefits
- Address the harms caused by the dialysis duopoly and prevent its further expansion
- Stop consolidated health systems from using their monopoly position impose all-or-nothing, anti-tiering, or other take-it-or-leave-it contract terms that stifle negotiation and innovation
- Accelerate the availability of biosimilars by speeding up the approval process for interchangeability and shortening the exclusivity periods
- Stop manufacturers from playing “patent games” to maintain monopoly profits
- Reform the system for “provider-acquired drugs”
- Address the abuse of charitable foundations by drug manufacturers that focus on profits instead of patients.
Patent Recommendations
AHIP recommended three potential avenues for the “patent games,” including passing legislation that ends “pay-for-delay agreements,” taking steps to curb evergreening, and taking steps to limit and address harm caused by product hopping.
Charitable Foundations
As we have seen several times in the past few years, certain companies may be playing fast and loose with the charitable foundation rules. AHIP recommends that the judiciary – as well as state and federal legislators – preserve the existing protections against the abuse of charitable structures that currently exist and increase scrutiny of existing patient assistance charities. As far as legislation, AHIP recommends that legislation be passed at state and federal levels that stop “bait-and-switch tactics in the commercial market, such as coupons.”
Letters
The letters to President Biden and Congressional leaders included four “straightforward commitments to patients, consumers, and businesses” that AHIP used to come up with the ten suggestions above: improving patient choice; improving transparency; protecting patients, consumers, and businesses from overpaying for care; and stop[ping] the drug pricing games.”
“While improving transparency of health care prices at the federal level has been a major focus, only the recent Executive Order related to nursing home care has applied to the activities of private equity entities of the health care marketplace, which have vastly different business models than other health care organizations,” the letters to President Biden and Congressional leaders said.
The letters also stated, “Big Pharma has gamed our health care system and consumers pay the price. We must stop patent schemes that distort the marketplace to maintain monopoly profits, crack down on provider-acquired drugs to stop the rapidly escalating markups on such drugs, and address the ways in which drug companies abuse charitable structures and prescription drug coupons to protect monopolies rather than help patients.”