The House of Representatives adjourned for August recess on July 25, a week ahead of schedule, and does not plan to reconvene until mid-September. Before leaving for recess, the House Appropriations Committee approved its fiscal year (FY) 2025 Labor-Health and Human Services (LHHS) funding bill in a 31-25 party line vote. The spending measure proposes significant cuts and consolidation of programs across the U.S. Department of Health and Human Services.  The bill provides $287.1 million for Title VIII Nursing Workforce Development Programs, a 6.2% decrease from last year’s spending levels. While most programs would receive level funding, the Nursing Education, Practice, Quality, and Retention programs would receive a $5 million (7.4%) increase, and the Nurse Practitioner Optional Fellowship Program would receive a $1 million (1.5%) increase. The bill would eliminate the Title VIII Nursing Workforce Diversity Program.

The Senate Appropriations Committee was scheduled to consider its FY 2025 LHHS bill on August 1. Congress has until September 30 to pass government funding legislation and avoid a federal government shutdown. Lawmakers are expected to spend the weeks leading up to the end of the fiscal year negotiating a continuing resolution (CR) to extend funding at current levels and keep the government open.

The pharmacy benefit manager (PBM) industry is once again in the spotlight on Capitol Hill following the appearance of leaders from the nation’s three largest PBMs – CVS Caremark, Express Scripts, and OptumRx – before the House Committee on Oversight and Accountability on July 23. During the hearing, lawmakers on both sides of the aisle confronted the witnesses with evidence that PBMs inflate drug costs, steer patients to affiliated pharmacies, and engage in anticompetitive behavior. Members expressed skepticism in response to PBM testimony that drug manufacturers should shoulder the blame for high prescription drug costs, and that it is simply the role of the PBM to implement the benefit design choices – such as pharmacy network size, preferred providers, utilization management, and patient cost sharing – selected by PBM clients. When presented with specific examples of prior authorization and fail first policies negatively impacting patient health outcomes, the witnesses stressed PBMs’ commitment to clinical evidence criteria while committing to considering ways to improve utilization management processes.

During the hearing, lawmakers frequently referenced a recently released interim staff report on PBMs from the Federal Trade Commission (FTC). The FTC report highlights evidence that PBMs and drug manufacturers sometimes enter into agreements that require prior authorization and step therapy to discourage patients’ utilization of generic drugs. The House Oversight and Accountability Committee also released its own congressional report ahead of the PBM hearing detailing PBMs’ pricing tactics and impact on rising health care costs. The report, based on the panel’s review of more than 140,000 pages of documents and communications, asserts that PBMs’ use of tools such as prior authorization, fail first policies, and formulary manipulation have significant detrimental impacts on Americans’ health outcomes. In response to this latest evidence, congressional champions of PBM reform, including Senate Finance Committee Chair Ron Wyden (D-OR), expressed renewed commitment to getting legislation signed into law before the end of the year.  RNS will continue to push for enactment of policies to ensure patients can access prescribed treatments without undue delays and make full use of any copay assistance for which they qualify, including through the Safe Step Act (S.652/H.R.2630), the Help Ensure Lower Patient (HELP) Copays Act (S.1375/H.R.830), and the Improving Seniors’ Timely Access to Care Act (S.4532/H.R.8702).

As a reminder, if you’d like to become more involved in our advocacy work, please drop us a line: advocacy@rnsnurse.org.