President Trump’s Great Healthcare Plan Explained

Introduction (00:02):
Welcome to Health Law Talk presented by Chehardy Sherman Williams. Health law broken down through expert discussion, real client issues, and real life experiences. Breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:21):
Good morning, good afternoon. Whenever you’re listening to this, welcome to another episode of Health Law Talk where we give you the latest and greatest of health law. Rory Belina, Conrad Meyer. Good morning, Rory.

Rory Bellina (00:32):
Morning. How are you?

Conrad Meyer (00:34):
I’m good. I’m

Rory Bellina (00:34):
Good.

Conrad Meyer (00:35):
I’m glad it’s Friday.

Rory Bellina (00:37):
Yes.

Conrad Meyer (00:37):
I’m glad to be here. I like doing this. I mean, we’ve been doing this now. I think this will be our 60th episode. So 60 episodes.

Rory Bellina (00:49):
Yep. Yeah.

Conrad Meyer (00:50):
I know we kind of had a law last year, but

Rory Bellina (00:53):
I’m

Conrad Meyer (00:53):
Glad we’re back.

Rory Bellina (00:54):
Last year was a busy year. We got distracted, but we’re back. We’re committed to doing this on a weekly basis, hopefully and we’ll just keep this going.

Conrad Meyer (01:03):
Absolutely. And you know what? Today is really, really timely topic. I mean, just happened two days ago. President Trump comes out with the great healthcare plan.

Rory Bellina (01:12):
You heard

Conrad Meyer (01:12):
About that?

Rory Bellina (01:13):
Yes, I did. I did. That’s what we’re going to talk about today. The great healthcare plan right now, I know that it’s getting a lot, it’s a framework essentially that’s gotten a lot of attention, kind of a lot of confusion in the national media and people are curious what it includes. So we’re going to go through that.

Conrad Meyer (01:31):
Everything’s great, right? Everything’s got to be great. Great healthcare plan. And look, I mean, I think we’re on a roll, but I mean, I get it. That’s his language. That’s his mantra. But I’m very curious to see what’s behind the language because that’s going to be where the details matter. Details matter. So Roy, walk us through. Give us at a high level. What are the four things that are going to comprise the great healthcare plan?

Rory Bellina (01:56):
So just so everyone is clear, right now this is just framework. It is-

Conrad Meyer (01:59):
Talk. Yeah.

Rory Bellina (01:59):
It’s just talk. Not actually a law yet. Congress would need to pass this. We don’t know if or when that would happen. A lot of healthcare experts are skeptical about how much is actually going to make it through. But yes, the plan does signal where we’re heading and so that’s what we’re going to go over. So like you said, four pillars and then we’ll break down all four. Pillar number one, lower drug prices. Obviously an easy one as a softball for everyone.

Conrad Meyer (02:25):
But yeah, what does that mean when you say lower drug? How do we do that? What’s the high level?

Rory Bellina (02:29):
Okay. So we’ll jump right into the first one. I’m going to rattle off all four and then we’ll kind of go into something. Okay, good.

Conrad Meyer (02:35):
That’s fine. All right.

Rory Bellina (02:36):
First one is lower drug prices.

Conrad Meyer (02:38):
Okay.

Rory Bellina (02:39):
Number two, lower insurance premiums. Three, hold insurance companies accountable. Very broad statement.

Conrad Meyer (02:45):
That’s right.

Rory Bellina (02:46):
And four, maximize price transparency. Why

Conrad Meyer (02:49):
Do I feel like I’m hearing an election speech? I mean, don’t all politicians be

Rory Bellina (02:54):
Credited- Come back with big ideas and then- Or to just

Conrad Meyer (02:56):
Say this.

Rory Bellina (02:56):
We’re

Conrad Meyer (02:57):
Going to lower prices and get high quality.

Rory Bellina (02:59):
I

Conrad Meyer (02:59):
Mean, I hear that. I’ve heard that for 30 years.

Rory Bellina (03:03):
I know. I know. Well, let’s take them one by one and we’ll go over what the outline looks like and we’ll see where we get. So for lower drug prices, kind of the bullet points for that is this most favored nation, this MFN pricing where the concept is that Americans would pay the lowest price for drugs than any other developed nation would have.

Conrad Meyer (03:22):
Love that.

Rory Bellina (03:22):
I think that’s

Conrad Meyer (03:22):
A great

Rory Bellina (03:23):
Idea. So according to the White House, they have 16 pharmaceutical companies including Pfizer AbbVie that have already signed on to this and the plan would make these mandatory through legislation.

Conrad Meyer (03:36):
Nice.

Rory Bellina (03:37):
Another kind of high level point on this is expand over the counter drugs. Most drugs available, obviously everyone knows what an over the counter drug is, but expand that so that not so many require prescriptions so then you lower the barrier of actually having to go to a provider and get that prescription. And then lastly, under this- I love this one. … category, the trumprx.gov website. Why does he

Conrad Meyer (03:58):
Have to have his name in

Rory Bellina (03:59):
It? I didn’t have to look in … Well, it’s his legacy. I didn’t get to look and see if the website is up or if the domain is taken. I’m going to try to look. Yeah, look at it. I’ll try to look. See if it’s taken right now.

Conrad Meyer (04:09):
But it has to have his … Why couldn’t he just say USA something?

Rory Bellina (04:12):
Yeah, the website, it’s a- No. Oh,

Conrad Meyer (04:14):
It is. Look at that.

Rory Bellina (04:15):
The website’s available. It just says-

Conrad Meyer (04:18):
Wait, go back, come back. He’s got his picture on

Rory Bellina (04:20):
It. He does. Wow. It’s an official website of the US government.

Conrad Meyer (04:23):
I love Trump.

Rory Bellina (04:24):
Coming soon.

Conrad Meyer (04:25):
I mean, because he’s so magnanimous, he’s got to have his picture, his name, and everything. Anyway, go

Rory Bellina (04:30):
Ahead. We’ll see. We will see if this goes anywhere, but the- Would you

Conrad Meyer (04:33):
Expect anything less?

Rory Bellina (04:34):
The website’s there. The goal with this website is it’s going to be a platform for cash paying patients to buy discounted drugs.

Conrad Meyer (04:41):
Really?

Rory Bellina (04:42):
Yeah. Yeah.

Conrad Meyer (04:43):
Interesting.

Rory Bellina (04:43):
All right. Number two, we said it wants lower insurance premiums. This is like

Conrad Meyer (04:47):
A staple. I’ve heard this for 50

Rory Bellina (04:49):
Years. I know.

Introduction (04:50):
Jesus.

Rory Bellina (04:51):
So instead of paying subsidies to insurance companies, the goal would be to send the funds directly to Americans maybe through an HSA. I already know. I already have concerns with that because if you send subsidies to people and you tell them they’re supposed-

Conrad Meyer (05:05):
They’re going to spend

Rory Bellina (05:06):
It. They’re going to spend it. They’re not going to save it. They’re going to spend it. And then they’re going to say it’s

Conrad Meyer (05:09):
Free money and we’re going to go to the casino. And then all of a sudden they’re going to say, “Wait a minute, what happened to that

Rory Bellina (05:15):
Money?” Right. You’re supposed to save that. All

Conrad Meyer (05:17):
Right.

Rory Bellina (05:17):
This other thing, it is called a cost sharing fund cost sharing reductions, a CSR. Yeah, I

Conrad Meyer (05:24):
Never heard of this.

Rory Bellina (05:25):
The plan is that this would save taxpayers $36 billion over a decade and it would reduce those silver plan premiums, which were under the- We’re going to have to see what that’s

Conrad Meyer (05:35):
About.

Rory Bellina (05:36):
And then this one is always interesting.This is coming up. We talked about this last week and we’re going to do a couple of special episodes on it. PBMs, the goal is to end these PBM kickbacks, stop payments for PBMs to broker to brokers, which inevitably is raising

Conrad Meyer (05:55):
Insurance. I can’t wait till we do that. I am so

Rory Bellina (05:57):
Looking forward to that.

Conrad Meyer (05:59):
Yes, absolutely.

Rory Bellina (06:00):
Number three, we said hold insurance companies accountable. What does that mean? Require clear, understandable policy language. I think that’s easy.

Conrad Meyer (06:08):
You think it’s easy.

Rory Bellina (06:09):
I

Conrad Meyer (06:10):
Mean,

Rory Bellina (06:10):
We’ve read those things.

Conrad Meyer (06:11):
I know. Do you think the common person could read?

Rory Bellina (06:15):
I know.

Conrad Meyer (06:15):
I mean, it is very, very difficult.

Rory Bellina (06:18):
And then also under that is insurers must publicly post- I

Conrad Meyer (06:22):
Like this.

Rory Bellina (06:23):
Yes.

Conrad Meyer (06:24):
I love this.

Rory Bellina (06:24):
Their medical loss ratios, which is- Because

Conrad Meyer (06:26):
This was supposed to be in the ACA, right? It was supposed to have- And

Rory Bellina (06:29):
I don’t think it made it. I think it got pulled at the end.

Conrad Meyer (06:31):
Right. So I would really like to see the medical loss ratio because that’s going to tell you how much premium is being paid to the member.

Rory Bellina (06:40):
On care.

Conrad Meyer (06:40):
On care.

Rory Bellina (06:41):
Versus

Conrad Meyer (06:42):
Administrators.

Rory Bellina (06:43):
Versus administrative. Yes, exactly.

Conrad Meyer (06:45):
Exactly.

Rory Bellina (06:45):
Claim denial rates, average wait times for care. I love

Conrad Meyer (06:48):
That boy. That’s going to be great. You know what? They should put that publicly on some website

Rory Bellina (06:51):
That

Conrad Meyer (06:51):
They have to do it. So everyone in the world can see it. Boy, would that be great?

Rory Bellina (06:55):
And then a penalty provision if there’s non-compliance penalties. For

Conrad Meyer (06:59):
Posting it? I don’t know. We’ll have to get into that.

Rory Bellina (07:00):
Yeah, I don’t know.

Conrad Meyer (07:02):
But wouldn’t that be great because you drive down … I’m going on a tangent here, but you drive down the highway and you see the ER wait

Rory Bellina (07:08):
Times. ER wait times. Yeah.

Conrad Meyer (07:09):
So you see, oh, this ER’s got a 10 minute wait time. Wouldn’t it be great to see medical loss ratios, claim denial rates for the majors all over the country?

Rory Bellina (07:18):
Yeah, absolutely.

Conrad Meyer (07:19):
I think that would be great.

Rory Bellina (07:20):
Absolutely. Because then you could really compare what these different payers are. I guarantee you.

Conrad Meyer (07:24):
They don’t want that.

Rory Bellina (07:25):
No. Oh,

Conrad Meyer (07:25):
Guarantee you.

Rory Bellina (07:26):
And then maximize price transparency was- And this is interesting. … the fourth one. A mandatory posting of any provider or insurer that is accepting Medicare and Medicaid must post pricing and fees at their place of business. Right now, they’re supposed to place them online. I think this was in Trump’s first term. He had some requirements where hospitals had to post their prices for different things, different procedures, surgeries. This allows patients to essentially shop for care.

Conrad Meyer (07:53):
So we want to be clear though to everyone listening that this is not a replacement for ACA. No. So ACA is not going away. No. So this is just an amendment or I guess a change in Medicare benefits or it’s just going to be changes on top of ACA. Correct. So people who are listening thinking, “Oh no, we got the great healthcare plan. It’s going to take away ACA.” No, that’s not what it’s intended to do.

Rory Bellina (08:16):
No. The only thing that this ties in with the ACA is that I think that there’s a possibility that it destabilizes the marketplace because if you start to take these subsidies and you pay them directly to consumers versus the insurance companies, you might have defeated the marketplace at that point because people are, like you mentioned, people are not going to save this money. They’re going to use it how they wish. I

Conrad Meyer (08:38):
Think historically they’re going to do that. So we’ll see. Well, let’s dive right into it. Talk about the most favored nation drug pricing. How does that work for

Rory Bellina (08:46):
You? Yes. All right. A little background on the MFN. This was tried during Trump’s first term through an executive order. It was challenged and blocked almost immediately. So going back to May of 2025, President Trump has signed various executive orders and negotiated deals with these 16 large pharmaceutical companies. Now they want to codify these deals into a law to make it mandatory and not voluntary. So how it would work is that the US government essentially would pay for these drugs based on an index, I’m quoting the language, based on an index of prices from other developed countries, typically much lower than US prices. President Trump claimed this would bring drug prices down 80 to 90% in some cases. So what do you think about that?

Conrad Meyer (09:33):
I think it’s interesting. I don’t know if you realize this NPR just reported that all 16 companies that signed deals still raised their prices. Oh, I’m sure. 872 brand named drugs. I’m

Rory Bellina (09:43):
Sure.

Conrad Meyer (09:43):
That was just a month ago, almost this month in January. So the median increase was 4%, same as last year. But if you look at it, are we really going to see decreases? Are we really going to do that when year over year we’re seeing increases?

Rory Bellina (09:58):
Yeah. I don’t know. I know that these different research firms on drug prices saying that although these deals have been made, we’re still pretty much in line with the raises, which seem to be around 4% per year. The

Conrad Meyer (10:14):
Problem is we don’t know the deals. They’re all secret.

Rory Bellina (10:15):
I know.

Conrad Meyer (10:16):
We can’t see

Rory Bellina (10:16):
Them. I know. Yeah. And these discounts for this TrumpRX gov website, that’s going to be for cash paying patients. So it’s not going to necessarily apply to using your Medicare benefits or your Part D in this case. So

Conrad Meyer (10:29):
What are we seeing in Congress? What’s going on there? Because

Rory Bellina (10:33):
It’s

Conrad Meyer (10:33):
Got to go through Congress.

Rory Bellina (10:35):
It does. I know that Speaker Johnson, I should say, it does not like this MFN pricing. We don’t have a lot of information why, because this is very new, but I know he came at it and said he was not a big fan and there would be more information on that. And then there was a lot of exclusion from Republican lawmakers in this reconciliation mega bill that we plan to see. The other thing is that there’s no true blueprint for what this would look like statutorily. I don’t know how you’re going to do this where- And where would you put it? You’re regulating private companies on drug pricings and deals that they have to make. I’m not quite sure. Not quite sure where we’re going to go with it, honestly, or how it can be implemented.

Conrad Meyer (11:18):
So here’s what I want to know. I mean, I’m sure the industry’s already opposed to this. Big pharma

(11:24):
Is probably, no doubt, would argue that MSN pricing would threaten research and development. I mean, that’s the first thing you’re going to say. So you’re going to lose a lot of money for R&D. It would undermine access to cutting edge therapies. I mean, I guess that goes along with R&D. They’re going to say that too. They’re going to also look at this one, two punch to innovation. So with combined IRA drug pricing negotiations, you’re not going to get … I think the innovation’s going to go away. You’re not going to get new drugs like you see on TV all the time, I guess. And then of course, they’re going to say, “This really isn’t our fault. It’s not us. It’s the PBMs, which we haven’t got to yet. We haven’t got to, but we’re going to get to shortly.”

Rory Bellina (12:02):
So from a Louisiana perspective, I think that everyone should just know that this is just what President Trump and his administration wants, I wouldn’t expect anything immediately to happen. It’s important for physicians and pharmacists to watch different formularies. So if some of these drugs do get cheaper, I would expect the pharmaceutical companies to … They’re not going to want to lose the profit. So if they’re going to be mandated to make certain drugs cheaper, are they going to make other drugs more expensive? I’m just guessing. I’m not quite sure.

Conrad Meyer (12:34):
Well, we’ll have to see what happens.

Rory Bellina (12:35):
And when this website launches right now, it’s in a coming soon phase. Is there going to be some cash discounts for uninsured patients? And we don’t know how this would affect 340B.That’s a wild card as well.

Conrad Meyer (12:50):
I hear you. I hear you. Well, let’s go to the next thing.

Rory Bellina (12:52):
Okay. All right. Okay. Direct

Conrad Meyer (12:53):
Payments, ACA. I mean, this was a big controversy,

Rory Bellina (12:56):
Big deal.

Conrad Meyer (12:57):
So Rory, walk us through.

Rory Bellina (12:59):
All right. So this is the most controversial portion I think of this whole plan is to send the premium subsidies directly to the consumers instead of the insurance companies. Sounds somewhat good in theory. Who wouldn’t want the money sent directly to them instead of the insurance companies so that they could decide maybe they’re going to invest it, maybe they’re going to put it in a market account and earn a litle bit of interest on it, but where could this go wrong?

Conrad Meyer (13:24):
I think people get free money.

Rory Bellina (13:26):
And then they don’t spend it. And

Conrad Meyer (13:28):
They spend it and they don’t put it where

Rory Bellina (13:29):
It’s supposed to go, right? Correct. Because then the concept from the administration, the current system is that, well, let’s back up a step.

Conrad Meyer (13:37):
Well, they’re going to put it through HSAs. So they would be limited because if they don’t spend it on healthcare,

Rory Bellina (13:42):
Then

Conrad Meyer (13:42):
You get … I think you get

Rory Bellina (13:43):
Taxed

Conrad Meyer (13:44):
On that.

Rory Bellina (13:44):
We think they’re going to put it through the HSAs.

Conrad Meyer (13:46):
Oh, we don’t know.

Rory Bellina (13:48):
I don’t think we absolutely know. We don’t know if it’s going to be a check through every American.

Conrad Meyer (13:51):
Well, this is so new. We don’t know. We

Rory Bellina (13:53):
Have a single legislature. Exactly. Because right now these subsidies go directly to the insurers to reduce the premiums for low income enrollees. The proposal is that the money would go directly to the individuals. We think through HSAs, that makes the most sense to me, but I could see an instance where it’s either an offset on your income taxes or it’s an actual check. I’m not sure. President Trump’s framing of this is that he wants to stop making the insurance companies rich and give money to the people. But the problem is that are they going to be responsible enough on saving? I don’t know. So what are the problems that you’ve researched on this?

Conrad Meyer (14:31):
So I looked at this earlier and basically the whole argument is that getting the premiums to the individuals would destabilize the marketplace. Each individual state has its own marketplace. It was required by law. So healthier people might not buy expensive plans.

(14:49):
And so therefore, the whole point was … And going back to ACA, remember it was … And people didn’t realize this at the time, but the whole point of the mandated coverage was to get young people to buy in to help fund the people who are old and getting sick. That was the whole point. And then of course, when I got struck down, right? So now you have a gap, that’s why it failed, or it’s not, I guess, not optimal if you want to call it that. So people don’t give them the money directly. Well, I’m just going to get the cheapest plan and I’m going to pocket the money for the rest. I’ll just save it for a later date, maybe a deductible or what have you. So it could leave sicker people in the AC marketplace and it will drive up premiums. Not good, not good.

(15:29):
One of the things that it would be, like you said, how do we administer this? Monthly payments, advanced payments, how do you true up? How do you reconcile? Again, we don’t know. I did see something about this preexisting condition protections if you go outside of the ACA. But one thing I want to comment about that HIPAA has some language about coverage on preexisting conditions. If you could look at that, I know that sounds crazy, but if you look at the HIPAA regulation itself, there is a prohibition on preexisting condition, but it’s deep, deep, deep. It’s not in the regular wear to glue. We’re thinking about PHI. I’ll show you that.

Rory Bellina (16:07):
Okay.

Conrad Meyer (16:08):
And then of course we have no idea. We don’t know. Nobody’s written this yet. This has just been pie in the sky. Sounds good, right? So let’s talk about this. The enhanced premium tax credit debate, Rory, I know you looked into that. Tell us a little bit about that.

Rory Bellina (16:23):
Yeah. So this is what may make this kind of urgent, I would say, is that these … And I think we talked about this last episode. The enhanced premium tax credits that made ACA coverage quote unquote affordable expired December 31st, 2025. So on average, I think analysts are estimating that about 22 million Americans are going to face a premium increase for calendar year 2026. There’s been various reports of people having to make big choices on how they’re going to handle these premium increases. The House passed a three-year extension, but only 17 Republicans supported it. So it was essentially debt on arrival on the Senate. President Trump’s plan at this point does not address this. It’s a whole new structure which is going to take time to figure out and we know that the Senate is working on a bipartisan compromise, but we still have this enhanced premium tax credit rebate that ended that we don’t see is going to get renewed.

Conrad Meyer (17:19):
So what does this mean for Louisiana, Rory? How do we fare in this?

Rory Bellina (17:23):
Well, I would say the concerns are if you are on the hospital side or on the provider side, I think you’re unfortunately going to see people that can no longer afford their insurance and are going to have to go back to the ER model, essentially. The hospital model, if you can’t afford it- The charity system. It’ll

Conrad Meyer (17:39):
Be the charity system of the old.

Rory Bellina (17:40):
You drop your coverage, charity care increases, that people are going to seek free or reduced care. So the ER with wait times are going to go up quality of care. We’re going to have issues. You’re going to have more debt on these hospitals. That would be my concern is that we’re going to have a little reversion back to that model.

Conrad Meyer (18:00):
So let’s delve in on the next pillar, price transparency.

Rory Bellina (18:04):
We’ve heard this a lot.

Conrad Meyer (18:05):
Yes we have.

Rory Bellina (18:07):
And look,

Conrad Meyer (18:07):
I like it. I think it’s a great concept.

Rory Bellina (18:09):
Yeah. The first administration really pushed for this, especially for the hospitals, but so what’s different here?

Conrad Meyer (18:17):
Well, okay. So according to the 2021 current requirements, hospitals must post machine readable file with all prices. They must be consumer friendly insurers must post in network negotiated rates and then you have the out of network allowed amounts, the prescription drug pricing, and there’s penalties for non-compliance. So I get that. And I forgot, what was it called, the name of that bill in 2021? Oh my gosh, I just looked at this.

Rory Bellina (18:49):
It had an acronym. It was-

Conrad Meyer (18:50):
Yes. We have so many healthcare

Rory Bellina (18:53):
Acronyms. I know.

Conrad Meyer (18:53):
But anyway, all right, not a big deal. So, but what’s in the new great

Rory Bellina (18:57):
Healthcare plan?

Conrad Meyer (18:58):
How does this change?

Rory Bellina (18:58):
All right. We’re expanding the scope. That’s kind of the theme of this is that all providers accepting Medicare, Medicaid must post prices prominently at their place of business on their services. The penalties are going up. We don’t know what they are right now. I believe it was 300 a day for hospitals. We know that the plans are going up. I’m sorry, the penalties are going up. The plain English standard, insurance companies must use clear, understandable language. That’s right. And then again, what you mentioned before, posting the rate and coverage comparisons, medical loss ratios, claims denial rates, average wait times. Providers must answer pricing questions clearly unfrontly. So all very broad, grandiose ideas that we’d like to see, but we don’t have the true language of what … We don’t know what is going to actually make it into the bill.

Conrad Meyer (19:48):
And that’s the billion dollar question.

Rory Bellina (19:50):
Correct. So

Conrad Meyer (19:50):
Look at this. Cynthia Cox, KFF, which is a healthcare policy research group said that this is not going to be a magic bullet that most patients don’t shop for healthcare. They go what their doctor tells them. And I would agree with that. I mean, most doctors are going to say, “Oh, go here, go there.” Patients who aren’t, I guess consumer savvy would just go with that because they trust their doctor, the white coat syndrome. There’s an unintended consequence. Some hospitals have used transparency to negotiate higher rates from insurers. So what they do is they go and they put them on and then they look at their competition, right? And then they go and say, “Okay, when my contract’s up for renewal, we’re going to negotiate higher rates.” Yeah. Why

Rory Bellina (20:27):
Is the hospital down here? Down the street, why are you paying them $100 more for this? I

Conrad Meyer (20:33):
See. Right. So that’s going to be an issue. Probably a relatively small share of healthcare spending that is able to be moved to price transparency. So maybe a smaller sliver and of course elective procedures like cosmetic surgery, fertility, things like that where patient shop might be carved out. So you just have to see about that.

Rory Bellina (20:53):
So right now it’s just important if you’re listening to this and you run a hospital system, make sure you’re complying with the current regulations that your prices are posted, they’re accurate, up to date, easily accessible. This physical posting requirement, we don’t know what prominently post really means. It could mean signage. It could be more than just the website, which is what’s required now, which makes it difficult to update it. Getting your front desk staff familiar with this so they can answer the questions clearly and upfront and then if the penalties go up, obviously be aware of that. CMS is going to have to address this. That’s where all the details are going to be in this. So we don’t know what that looks like, but this is the plan.

Conrad Meyer (21:33):
Well, I like the plan. All right. Well, moving on. So PBM reforms.

Rory Bellina (21:38):
Yeah. If there’s one thing that could happen, I think we’re getting so much pressure on PBMs from a national and a Louisiana state level.

Conrad Meyer (21:45):
100%.

Rory Bellina (21:45):
That this is really where we need the movement. It’s been in Baton Rouge on PBMs lately. Our last episode was all about this. So there’s bipartisan support for PBM reform. I think this is the one thing if you had to pick out of this list of pillars, I think this is the one where- So

Conrad Meyer (22:04):
What does the great healthcare plan say about this?

Rory Bellina (22:06):
All right. Well, the proposal is, and the phrase to use was kickbacks, which you and I could go down a different topic on if, is that the right term or not, but in the kickbacks paid their words, not mine, and the kickbacks paid by PBMs to brokers. So what does that mean to you if you hear that?

Conrad Meyer (22:22):
Well, it tells me, well, if I’m wearing my healthcare hat, if I get kickbacks, that tells me there’s some sort of a scheme going on. There’s some sort of a scheme where someone’s making money inflating prices to take a cut because either they’re entitled or they feel entitled, or they just want more money. I mean, that’s a kickback.

Rory Bellina (22:42):
Because the concern is that these kickbacks, that these fees/rebates that are going to the brokers are inflating the insurance costs and it’s really not benefiting the patients. So the PBMs are saying, “No, no, no, this reduces costs and you need to blame the manufacturers,” which I don’t think is the case at all. So what Congress has already passed as of this month is this transparency requirements for Part This Part D linking, which is discusses separating PBM compensation from drug prices, Medicaid spread pricing ban where PBMs can’t profit from the spread between what Medicaid pays and what the pharmacy receives, which is very interesting.

Conrad Meyer (23:26):
But that’s what they’re doing.

Rory Bellina (23:28):
Yes. And then some changes to network access standards. So PBMs is, I would say, the one that I’m the most interested in for all of this because I think that prescription drug prices affect … I mean, obviously insurance coverage is very important, but drug prices really do affect everyone.

Conrad Meyer (23:44):
But it’s not just prescription. I mean, they

Rory Bellina (23:46):
Have

Conrad Meyer (23:46):
The OTC. So the over the counter drugs are going to be more available.

Rory Bellina (23:49):
Making more actual drugs available over. Correct. Yeah. Our current administrator of CMS mentioned that there are a lot of drugs- Dr. Oz. That he mentioned that there are a lot of drugs that are on the prescription schedule that should be over the counter. Benefits of that, obviously you don’t need to go to the doctor to get the prescription competition because now if it’s being made as a generic over the counter, you’re going to have all these manufacturers vying to make the same thing and it’s going to reduce your insurance costs because now your insurance does not cover over the counter drugs. So it’s- The

Conrad Meyer (24:24):
Only problem with that is you’re going to have FDA issues because the FDA is going to have to analyze all this and see what prescriptions can go to OTC and that’s going to take a little bit of time. But I can see the benefit of that.

Rory Bellina (24:34):
And on the flip side is that if you move it from prescription to OTC, now your insurance doesn’t pay for it. Well, what if it’s very expensive over the counter and people relied on their insurance paying for it and now they’re going to have to pay cash for it because insurance doesn’t pay for over the counter.

Conrad Meyer (24:51):
True.

Rory Bellina (24:51):
So what if you got one of these NSAIDs that Dr. Oz wants to move from prescription over the counter? He does that. Well, then you

Conrad Meyer (24:57):
Just have market dynamics. I mean, they just won’t sell. And

Rory Bellina (25:00):
So if

Conrad Meyer (25:00):
They don’t sell, then you have to compete.

Rory Bellina (25:03):
You have to adjust your price. But if it’s something that a patient relies on and now it’s over the counter and it’s $100 versus prescription and their copay was $10, I think that’s a concern that- That

Conrad Meyer (25:13):
Is a concern.

Rory Bellina (25:13):
Maybe

Conrad Meyer (25:14):
Some regulatory constraints on that.

Rory Bellina (25:16):
I don’t know. So what’s going to actually happen here? And there’s been some experts that are saying what the likelihood of this plan becoming a law is we’ve got some of their different quotes that we’ve got. What are your thoughts on that?

Conrad Meyer (25:28):
So interestingly, Spencer Perman from Vita Partners talked about this. Less more of a plan was the comment, but more of a political press release. And I could see that because we don’t know anything about it. And so the thought was that the policies either have a little chance of being enacted given the gridlock in Congress, which we see all the time. Jim Potter for the Coalition of Healthcare-

Rory Bellina (25:54):
Same thing.

Conrad Meyer (25:55):
Same thing.

Rory Bellina (25:55):
Yeah.

Conrad Meyer (25:56):
Same thing. This is just political grandstanding.

Rory Bellina (25:59):
This is one of those things where when you read it on paper, I think we were talking about this before we started recording. It sounds like when you hear any president, it doesn’t have to be President Trump, any president address the nation, they say, “I’m directing you, Congress, to do this, to do that. ” And he looks over and they pan the cameras to everyone in Congress sitting and sitting in the diet. Now what? Now

Conrad Meyer (26:19):
What,

Rory Bellina (26:19):
Right? And then it’s, “I’m directing you to do this. I’m directing you to do that. ” And they’re all sitting there like, “Yeah, sure. We have to do the hard work

Conrad Meyer (26:25):
Or- I want to tell you something. I want to pivot for just a second. Okay? And here’s my thing for this. I don’t think our listeners or even the American people know how that works, right? In other words, they hear these people, whether it’s the president or any politician stand up and say, what do we hear? We’re going to lower cost and increase quality. We want to give you this, right? And it sounds good. It

Rory Bellina (26:48):
Gives you

Conrad Meyer (26:48):
Warm fuzzies, right?

Rory Bellina (26:49):
My first hundred days in office, I’m going to get this accomplished.

Conrad Meyer (26:53):
Yes. And I got warm fuzzies and I think it’s great.

Rory Bellina (26:55):
And that’s who you vote for. You vote for the ideas that you share.

Conrad Meyer (26:58):
Create. But here’s what happens. Those congressmen and those senators, they have what they call draft writers. These are people who are supposedly nonpartisan, supposedly, that are responsible for drafting the legislation. They’re the ones that sit in an office, take the statute and draft this thing. So when you hear a plan like the great healthcare plan, I guarantee you those drafters are like- Are hitting

Rory Bellina (27:23):
Their head against the wall. Oh my God,

Conrad Meyer (27:25):
What are we going to … This is going to

Rory Bellina (27:26):
Be

Conrad Meyer (27:26):
A massive project.

Rory Bellina (27:28):
Right. Or they’re sitting in their office saying, This is impossible and here’s 50 reasons why we can’t do it.

Conrad Meyer (27:34):
Right.

Rory Bellina (27:35):
And so you’re right. It’s hearing an idea and then executing the idea two completely different things.

Conrad Meyer (27:40):
And then when you see it on TV, like it’s some massive 1000 page bill and then you hear the senators or the congressmen or women saying,” We need to pass it now, but you haven’t even read it. “You don’t even know. I mean, I bet you if we sat down, the only people that really know are the people who drafted it

Rory Bellina (27:59):
And the staffers that are forced to read it and- Forced

Conrad Meyer (28:02):
To read

Rory Bellina (28:02):
It

Conrad Meyer (28:02):
And give them talking

Rory Bellina (28:03):
Points. Digest it to the centers. No one’s reading all that.

Conrad Meyer (28:06):
Do you honestly think that’s a good way?

Rory Bellina (28:09):
I’m just

Conrad Meyer (28:09):
Asking, do

Rory Bellina (28:10):
You think that’s- No, I don’t. I

Conrad Meyer (28:11):
Think

Rory Bellina (28:12):
That’s crazy

Conrad Meyer (28:12):
Because you’re binding 300 million people to this.

Rory Bellina (28:17):
Something that you have not read. Yeah.

Conrad Meyer (28:19):
And you just got talking points and a bullet point sheet to stand up on a

Rory Bellina (28:22):
Grandstand

Conrad Meyer (28:23):
And talk about this.

Rory Bellina (28:24):
And then it gets challenged to the Supreme Court and then- Correct. Yeah.

Conrad Meyer (28:27):
Anyway, so what else? Okay, so

Rory Bellina (28:29):
What

Conrad Meyer (28:29):
Actually might pass, Rory?

Rory Bellina (28:30):
I think PBM reforms, if you said Rory pick something on this sheet that’s going to pass, PBM reforms, that’s got bipartisan support. Some have already passed in appropriations. That’s very important to the American public and to farmers. I think you’re

Conrad Meyer (28:44):
Right on that.

Rory Bellina (28:46):
I

Conrad Meyer (28:46):
Think you’re right. What about price transparency?

Rory Bellina (28:50):
Maybe through a regulatory action. I don’t know if it’s going to pass through legislation. I could see it going through a regulatory agency, which would be a whole other topic on administrative law powers. It’d

Conrad Meyer (29:00):
Have to be like the CBO, like a nonpartisan place, right?

Rory Bellina (29:04):
Right. And then the CSR funding under Affordable Care Act and then-

Conrad Meyer (29:09):
That’s the car sharing reductions.

Rory Bellina (29:10):
Yes. Okay. And then over the counter drug expansion, that’s more of an administrative action through the FDA as well where they’re manipulating the schedules and saying, this was prescription. Now it’s already done. Let me ask

Conrad Meyer (29:21):
You this. I mean, given the lightning warp speed that FDA did during COVID, do you

Rory Bellina (29:25):
Think

Conrad Meyer (29:25):
They could do that with OTC?

Rory Bellina (29:27):
I do. I think so too. I think so. The FDA has been moving. I was reading an article last night. The FDA just requested or gave permission for GLP-1s that they are now allowed to remove the suicide warning from their packet for GLP-1. So they

Conrad Meyer (29:44):
Haven’t

Rory Bellina (29:45):
Been around that long for them to … I mean, that’s a big decision that’s been made. So the FDA is, like you said, still moving fast. I think the FDA could handle this OTC drug expansion. Okay. So let’s

Conrad Meyer (29:55):
Flip. What do you think not going to pass?

Rory Bellina (29:58):
All of it’s not all going to pass together. I don’t think there’s going to be this one huge package. I think it’s going to be piecemeal. I think we’ll get some, maybe one or two things, maybe the PBM thing this year, we might get something next year and then some things may or may not happen at the end of this term or before the end of this term. The direct payment structure, I don’t see that happening. I think there’s too much concern with the marketplace.

Conrad Meyer (30:22):
I know what it was in 2021. I found out the No Surprise Act.

Rory Bellina (30:27):
That’s where

Conrad Meyer (30:27):
It was. That’s what it was. I told you. I didn’t even look it up. How about that? The no surprise. That’s what it was.

Rory Bellina (30:34):
So that’s what I think. And then this codified pricing, I don’t think that’s going to … There’s too many variables to codify.

Conrad Meyer (30:43):
Yeah.

Rory Bellina (30:44):
I don’t see …

Conrad Meyer (30:46):
But he went out so strong on it. I mean,

Rory Bellina (30:48):
He

Conrad Meyer (30:48):
Really went hard on it.

Rory Bellina (30:50):
I know. But like any politician-

Conrad Meyer (30:52):
I agree with him though.

Rory Bellina (30:53):
I know.

Conrad Meyer (30:54):
I mean, should we as Americans pay more than every other country for the same drug?

Rory Bellina (31:00):
No.

Conrad Meyer (31:00):
And

Rory Bellina (31:01):
They

Conrad Meyer (31:01):
Make it here?

Rory Bellina (31:02):
Well, a lot of the drugs aren’t being made here. I think that’s the rub is that a lot of these over the counter drugs are being made in other countries. No,

Conrad Meyer (31:10):
I’m talking about prescriptions.

Rory Bellina (31:11):
Oh, prescription drugs. Okay. Well, still a lot of them aren’t made here. I mean, like your typical Tylenol, Advil, I know those are all made overseas and we are paying more when they’re shipped over here.

Conrad Meyer (31:21):
Interesting. Okay.

Rory Bellina (31:22):
I

Conrad Meyer (31:23):
Did not know that.

Rory Bellina (31:24):
Oh yeah.

Conrad Meyer (31:24):
Interesting. Okay. So why does everything matter? Why are we here? Why is this important now?

Rory Bellina (31:32):
I think from a cost perspective, even if this doesn’t become law, it just shows what the priority is. And I think healthcare for everyone America is an aging country. We’ve got a lot of people that are aging and so costs are going up. Medicare costs are skyrocketing. I think Dr. Oz, he wants to ruffle some feathers and get

Conrad Meyer (31:54):
Some stuff. It’s not just that though, insurance premiums. I mean, I feel like they do … When have we ever heard of a … I think you and I talked about this off the record, but when have you and I ever heard of an insurance company coming back the next year and saying, “We’re going to decrease you. ” Right,

Rory Bellina (32:07):
Right. No.

Conrad Meyer (32:07):
It’s never, like never.

Rory Bellina (32:09):
No.

Conrad Meyer (32:10):
Never.

Rory Bellina (32:10):
It doesn’t happen. So it’s a priority for this administration. We just have to see what actually gets accomplished. So big on promises, details, not so much right now and congressional hurdles. So what are your takeaways, Conrad, for our local

Conrad Meyer (32:28):
Providers? So for local folks, for our local Louisiana healthcare providers, don’t expect dramatic changes overnight. This is going to be like watching grass grow. I mean, we’re going to be watching a slow moving train, but do, I think you do prepare for what we talked about for the price transparency enforcement. I think you look at that. I would watch for formularies and financial programs as the ACA subsidy plays out, the situation plays out there. And stay tuned because CMS rulemaking coming up this summer for the physician fee schedule and the inpatient IPPS and OPPS. So we’ll have to see where things are going to go. But yes, I think we had to just watch out for what’s coming up.

Rory Bellina (33:10):
Yep. Yep. All right. That’s it for today.

Conrad Meyer (33:12):
That’s it for … See, look, Roy, you closed out.

Rory Bellina (33:15):
That’s it. That’s it. That’s my closing.

Conrad Meyer (33:16):
That’s your closing. Well, look, everyone, thank you so much for this. I think that’s going to wrap it up. Thank you again for listening to Health Law Talk. Remember, listen to this podcast, send us an email. If you have any suggestions, leave us that five star rating. We did a good job. We hope we did. See you again next time. Have a great weekend. Take care.

Introduction (33:34):
Thanks for listening to this episode of Health Law Talk presented by Chehardy Sherman Williams. Please be sure to subscribe to our channel. Make sure to give us that five star rating and share with your friends. Chehardy Sherman Williams is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does this podcast establish an attorney-client relationship. Reference to any specific product or entity does not count as an endorsement or recommendation by Chehardy Sherman Williams. The views expressed by guests on the show are their own and their appearance does not imply an endorsement of them or their entity that they represent. Remember, please consult an attorney for your specific legal issues.