Any matters that would present any potential conflict. Chairman hatch do you know of any person or any reason, personal or otherwise, that would in any way prevent you om honorably discharging the responsibilities to the office to which you have been nominated . Ms. Verma i do not. Chairman hatch do you agree without reservation to respond anyreasonable inquiry reasonable summons to appear and testify before any nor any duel constituted committee of the congress if you are confirmed . Ms. Verma i do not. Chairman hatch you are willing to do that . Ms. Verma i am willing to do that. Chairman hatch ok. Finally, do you commit to provide a prompt response in writing to any questions addressed to you by any senator on this committee . Ms. Verma i do. Chairman hatch thank you. Let me now get into just some questions. I know you are aware of the historic bipartisan medicare access and chip reauthorization called i whats macra. Among other things the law got rid of the dreaded s. G. R. Formula and made improvements to how medicare pays physicians. Im pleased that our work on the implementation of these changes continues to be bipartisan. Both in how republicans and democrats in the congress have worked together and how congress had worked with the Obama Administration. In fact, the Obama Administration took great pains to engage physicians and other stakeholders through the initial implementation phase. It strikes me that this process of consultation early and often should be the rule and not the exception. What is your view on how to gage stakeholders to approve to arrive at the best policy decisions for medicare and other c. M. S. Programs . Ms. Verma thank you, senator. I applaud it, Congress Efforts to pass mack a. I think its an important step forward, not only to providing more stability for providers, but also moving us towards Better Outcomes. In terms of stakeholders, i think that the most important thing that we can do is engage with stakeholders as quickly as possible on the front end and all the way through the process. Understanding stakeholder perspective and what folks are going through on the front end. What their challenges are. As were developing policies and programs to have that open communication, i think is helpful towards any successful implementation. Its not a onetime thing. Its not just on the front end. Its all the way through the process. And even after the programs established, its always important to have that dialogue with stakeholders because they can tell you whats working and whats not working. And when you think of new ideas and you are thinking about implementing them, they can help you figure out whether its going to work or not. I know i have had that experience in my career and i have always found it very helpful and integral part of success. Chairman hatch as the baby boomer generation ages, the number of persons age 65 and older in the United States is expected to dramatically increase. Having an increase in demand for Longterm Services and support. Notably the medicaid is the primary payer of these services. What changes, if any, should be made to meet the expected increase and demand while ensuring the fiscal sustainability of the Medicaid Program . Ms. Verma i think medicaid is a very important program. Its been the safety net for some many vulnerable citizens. When i think about Medicaid Program, i think about some of the individuals that i have met. One person in particular i think about is a quad a pliegic. Hes on a breathing machine and requires 24hour care. I think about the mother of a disabled child. This is the face of the Medicaid Program. As i think about Medicaid Program and where were today, i think that we can do better. We have the challenge of making sure that were providing better care for these individuals. But the program isnt working as well as it can. There is very intractable program. Its inflexible. States are in a situation where they are having to go back and forth doing reams of paperwork, trying to get approvals from the federal government. And at the end of the day are we achieving the outcomes that we want to achieve . So as i think about the Medicaid Program, i think there is an opportunity to make that program work better so that were focusing on improving outcomes for the individuals that are served by the program. Chairman hatch all right. In 2014 i worked closely with senator widen and leaders from the house ways and Means Committee to enact a bipartisan, bicameral law called the proving medicare transformation or impact act. The impact act serves as a critical building blocktocheeve future medicare quality measurements and payment reform. Specifically the impact act requires that it requires the collection of standardized data to have medicare not only compare quality across the different post acute care settings, but also improve hospital and post acute discharge planning. Our goal was to produce datadriven evidence that congress can use to debate the best ways to align medicare postacute payments that improve Patient Outcomes and save taxpayer dollars. And our intention is to ensure that were able to do this type f thing. I want to ensure the beneficiaries are receiving the highest quality post acute Care Services in the right setting at the right time. Now, will you commit to working with me, members of congress, and this committee, and the post acute Provider Community on the implementation of the impact act . Ms. Verma it would be my pleasure to work with the committee, stakeholders, and anyone else that was interested to make that program a success. Chairman hatch thank you. Well turn to senator wyden. Senator wyden thank you very much, ms. Verma. Thank you for your testimony. I want to start with a comment you made that you were committed to coverage, which of course is what this is all about. Unfortunately, what i have seen since the beginning of the year has been basically about rolling back coverage. In fact, congressman price sat in your seat a couple weeks ago and refused to commit to making sure that no one would be worse off in terms of coverage. Now, the president said in his campaign, quote, were going to have insurance for everybody. The American People are going to have great health care, much less expensive, and much better. Thats what the president said. Sterday c. M. S. Did the exact opposite. The first rule to come out of the agency, the agency that you would like to head, after secretary price was confirmed, meant less coverage, higher premiums, and more outofpocket costs for working families. How would you square what President Trump said in the campaign with what c. M. S. Did yesterday . Ms. Verma in terms of the rule that you speak of, i have not been involved in the development of that rule out of respect for the committee and for the nomination process. I have not been involved in that. I have not been to c. M. S. I havent been involved in that and cant vehicle to that. What can i tell you is that i am committed to coverage. I have been fighting on this issue for 20 years. I will continue to do that if im confirmed. Senator wyden i just read you quotes its not like atomic secrets or classified materials. What the president said is very different than what c. M. S. Did yesterday. And you read newspapers. You are a pretty informed person. Talked about cutting the Enrollment Period. Im looking at the headline, cut the Enrollment Period in half which really is going to limit our ability to get the very people we need most, the younger, healthier people, one more try. How would you square with the president what the president said with what happened yesterday . Ms. Verma i think the president and i are both committed to coverage. I cannot speak to the rule. I have not had an opportunity to review that. But again i think the president and i both agree that we need to fight for coverage and make sure that all americans have access to affordable, high Quality Health care. Senator wyden what troubles me about yesterday is once again Insurance Companies are coming first and patients come later. Tell me one thing you would change to put patients first. Ms. Verma one thing that i would do is i think whats very important is that patients be in charge of their health care. Patients get to drive the decisions about their health care. That they get to make the choices about what kind of Health Care Plan works well for them. I think its important that our quality have access to coverage, to the doctors, to their choice of doctors, and their choice of plan. Get us wyden could you a specific on that . Because thats an admirable philosophy, but i still dont know yesterday was good for Insurance Companies. And it was bad for patients. Id like to have a specific example, and well keep the record open, of something you would do to put patients first. And i respect the fact that you have articulated a philosophy, but i really want to know a specific about what you do to put patients first. Lets move on with respect to another area of responsibility youll have and thats prescription drugs and medicare. We all know that these prescription costs are just clobbering families and seniors and federal government and a whole variety of stakeholders that you refer to. As the administrator of the agency, you are going to have an opportunity to address this problem. The president s been vocal on it. Again, give me a specific change to Medicare Part d that you would suggest to bring costs down. Ms. Verma i think that the issue of drug pricing is something that all americans are concerned about. Antipresident is concerned about that as well. People want to make sure that when they need the drugs, when they are going through an illness, think about my mom, i think about my neighbor, and when they need the drugs that they need, they want to know that they have access to it and that its affordable. I think were all concerned about that specific issue. Part d i think has been a good program. It has expanded access to medications for people that didnt have it before. And i think the structure of the program in terms of how it put Senior Citizens in charge of their health care, they can go on plan finder, go online senator wyden my time, i voted for part d. Still got the welts on my back to show for it. I asked you for specific change Going Forward that you would do to help seniors and others hold down their costs. As you know, theres discussion of making changes so that medicare could bargain. Is there one specific you could give me the reason that the medicare question is so important is not only does this affect older people so dramatically, but your experiences on the medicaid side. I respect that. People have different experiences. So i very much would like to hear a specific on this key medicare issue that you would actually be for. Ms. Verma i would be for policies that continue to put Senior Citizens in charge of their health care. That puts them in the drivers seat of making the decision that is work best for them so that they can figure out what plan covers the medications that they need. What plan is affordable to them. And allows them to make the decisions about their health care and that gives them access to the medications that they need. That doesnt limit that in any way and that is affordable to them. Senator wyden my time is expired. I still didnt get the specific example. I happen to be for a host of things on transparency, on negotiation, on trying to make sure that we squeeze more cost savings out of the middlemen. Im going to hold the record open, but i have asked you for specifics in two areas putting patients first, and how you would hold down the cost of part d. Didnt get a ly i didnt specific hold the record open. I think senator grassley, are you going to call out names on your side . Senator grassley im next. Senator wyden that didnt take much time. Senator grassley what aim going to talk to you about is things that have happened. C. M. S. In the past. And hopefully coming from an administration that wants to drain the swamp, i think i would expect changes to be made under your leadership in this agency. And i would suggest that you probably cant do anything about the suggestion im going to give you to respond to the last question of my colleague. But if you would push doing away with pay for delay programs between brand drugs and generics, it would go a long ways to helping get drugs cheaper. C. M. S. Has told me that it does not have much authority to do anything about some frauds committed against its programs even those even if those actions are in c. M. S. s own words, quoteunquote, a clear violation of the laws. Common sense tells me that if its a clear violation of the law, c. M. S. Can do something about t if thats their attitude there, i would ask you to see whether the past interpretation is right by checking that interpretation. But in a january 28 letter to me about the medicare drug rebate program, c. M. S. Said it could tell a manufacturer when its drug is misclassified and then quoteunquote, attempt to reach an agreement. In other words, after the moneys been stolen from the taxpayers, take some trouble to get it back if you can reach an agreement. But there are a lot of tools that the government has to fight fraud. And the most effective one we have is a false claims act. Since 1987, when i got that law in place, the department of justice has used the false claims act to recover more than from juston just lost the Health Care Fraud alone. But cooperation between the department of justice and Health Care Program administrators is very important in these cases. It seems like c. M. S. Could at least picked up the phone and given the department of justice a head up when shes manufacturers refused to cooperate and properly classify their drugs. A Pretty Simple question, might even be called a softball question, but its important to mee. Would you commit to proactively cooperating with the department of justice andn fraud cases and to fully supporting the use of the false claims act to combat fraud on government Health Care Programs . Ms. Verma i will absolutely do that. And i applaud your efforts on the false claims act. I think its been an integral component of preventing fraud and recovering dollars when there is fraud. I thank you for your service and your work on that. Senator grassley next question. In the fall of 2016 and january of 2017 i sent several oversight letters to c. M. S. Regarding the steps that it took to hold miland accountable for misclassifying the epipen as a generic under the Medicaid Drug Rebate Program. C. M. S. Has publicly stated that it, quote, expressly advised myland that their classifications of the epipen for purposes of the Medicaid Drug Rebate Program was incorrect, end of quote. However, c. M. S. Has failed to fully respond to my oversight requests and refuses to provide records of communication with mi mylan. C. M. S. Has also not been entirely as to what the authority has to do with to correct drug misclassifications. Because of epipens misclassification, the government and states are owed hundreds of millions of dollars from mylan, congress, and the American People are owed answers. So if confirmed, would you commit to fully responding to my oversight request and providing the requested records of communication beyond mylan and c. M. S. . I hope thats a short yes. Ms. Verma thats a short yes. Senator grassley in light of epipens misclassification and potentially other drugs that have been misclassified under medicaid, what steps will you take to ensure that drugs are properly classified under medicaid . Ms. Verma i think what happened with the mylan pen and epipen issue is very disturbing. The idea that perhaps Medicaid Programs, which are struggling to pay for those programs, that they could have potentially received rebates is disturbing to me. So film confirmed, i would like to review the processes in place there in terms of the classifications. In terms of brand and generic to ensure at that type of thing doesnt happen again. Senator grassley what you just said you want to do i want to do. Thats why i want those communication from c. M. S. I hope youll get them for me. Ms. Verma i hope youll ill be happy to get that to you. Senator stabenow first thing, many questions i have. First regarding medicare. Do you believe that Medicare Programs should negotiate the best price for seniors on medicare . Ms. Verma i think we need to do everything that we can do to make drugs more affordable for seniors. Im thankful that we have the b. M. P. B. M. s and the Part D Programs that are performing that negotiation. Senator stabenow do you believe we could get a better price if medicare was negotiating was the v. A. Does, as other private entities do to get the best price for seniors . Ms. Verma i think that competition is the key to getting good prices. I think senator stabenow is that yes or no . Ms. Verma i dont think thats a simple yes or no answer because i think there are many ways to achieve that goal. And the goal is to make sure that were getting affordable prices for our seniors. If we look at the Part D Program and the way the p. B. M. Has negotiated this, we know that when there is a lot of competition, the price goes down. I think we have to figure out ways and im happy to work with you on that, but how we can increase our competitiveness and support the Part D Program. What i like about the Part D Program is it puts seniors in charge of making the decisions about the drugs that they need. U