March 28,2019

House-Passed Medicaid Package Includes Two Grassley Bills

WASHINGTON – U.S. Senate Finance Committee Chairman Chuck Grassley of Iowa today released the following statement regarding the unanimous passage of a House Medicaid package earlier this week, which includes both the ACE Kids Act and the Right Rebate Act, bipartisan bills he co-authored with Sen. Michael Bennet of Colorado and Senate Finance Committee Ranking Member Ron Wyden of Oregon, respectively.
“Thankfully, most children are healthy. But there are some children with medically complex needs that see multiple different doctors to keep them healthy and out of the hospital. On average, these children can require five to six doctors and as many as 20-30 allied health care professionals. Families of these children are frequently left alone to navigate a complicated health care system. ACE Kids will provide those families with an option to have better care coordination for their children. This legislation puts the families in charge with the necessary support to make the best health care decisions for these very vulnerable children. Better coordination of care and empowering patients and families will result in better health outcomes.
“Pharmaceutical companies that participate in the Medicaid Drug Rebate Program and make billions of dollars every year, much of it coming from taxpayer-funded programs like Medicaid, should not be allowed to bypass government oversight and scrutiny. Those companies that intentionally defraud taxpayers by exploiting a government loophole need to be aware that what they’re doing isn’t just wrong, it will soon be subject to penalty under the Right Rebate Act.
“The House passage of this package, which also includes important long-term services and supports policy extensions, is a positive signal to the American people that Congress is capable of working together on the issues that matter most. I hope this same spirit of bipartisanship will continue as we fight to lower prescription drug costs and find workable solutions to the nation’s biggest health care challenges.”
The bipartisan Advancing Care for Exceptional (ACE) Kids Act would provide children with medically-complex conditions the option of patient and family-centered, improved coordination of care.
The bipartisan Right Rebate Act would close a loophole in Medicaid that has allowed pharmaceutical manufacturers to misclassify their drugs and overcharge taxpayers by billions of dollars. It would provide the Department of Health and Human Services (HHS) with additional authorities to monitor drug manufacturers who participate in the Medicaid Drug Rebate Program (MDRP) and also impose reporting and transparency requirements on the government to show how the additional authorities have been used. The bill would also allow the secretary to require drug manufacturers to reclassify their drugs and impose civil monetary penalties when drugs are knowingly misclassified. The bill was included in the IMPROVE Act last year, which cleared the House of Representatives 400-11.
Grassley is a longtime advocate for lower prescription drug prices and has been a vocal critic of EpiPen’s exorbitantly high cost. Iowans regularly contact Grassley by phone, email and at his annual 99 county meetings about the difficulties they faced paying for the anti-allergy EpiPen device. After conducting oversight of the issue in 2016 and 2017, Grassley learned that Mylan, EpiPen’s distributor, classified its popular anti-allergy medicine as a generic instead of as a brand name product in the MDRP. That incorrect classification allowed Mylan to pay smaller rebates to States and government programs, such as the MDRP. Grassley’s investigation also found that HHS and the HHS Inspector General did not have adequate authorities to properly oversee the MDRP and ensure drugs were properly classified. The costly practices were confirmed by the HHS Inspector General when it found – at Grassley’s request – that taxpayers may have overpaid for the EpiPen by as much as $1.27 billion over 10 years. The Inspector General also found that additional drugs could be misclassified.  
Grassley continually pressed for the accurate classification of prescription drugs under the MDRP. He sought answers from CMS on whether it sought to recoup tax dollars overpaid for EpiPens from Mylan. He sent a follow-up letter after receiving no response from CMS, reiterating his initial request for information.
Grassley continued pressing for answers when news broke that EpiPen maker Mylan was in discussions with the Department of Justice (DOJ) to settle a False Claims Act case and repay the taxpayers for over-charging for EpiPen. Grassley sent a letter to then-President-elect Trump urging appropriate classification under the Medicaid Drug Rebate Program. That letter is available here. Grassley also sent a letter to the outgoing administration on the issue, which is available here. His Oct. 3 letter to the prior administration on the EpiPen misclassification is available here. When the DOJ and EpiPen-maker Mylan settled its case over the drug’s misclassification, Grassley issued a statement of disappointment, saying it shortchanged taxpayers.
On behalf of Iowans, Grassley also wrote to Iowa Attorney General Tom Miller seeking clarification regarding his office’s ability to determine the value of reimbursement to the state necessary to make Iowa whole from EpiPen’s apparent misclassification. A few months later, Grassley followed up with another letter seeking additional details and accompanying documentation regarding the state’s receiving $1.5 million as part of a DOJ settlement with Mylan.

In August of 2018, the U.S. Food and Drug Administration (FDA) approved the first generic version of the EpiPen. Grassley praised the move, saying that it was “great news for millions of Americans who depend on life-saving, anti-allergy devices.” Grassley believes getting more generics approved is one of the most important market-based strategies for lowering drug prices overall.