Congress successfully passed a continuing resolution (H.R. 9747) to fund the federal government through December 20 before recessing for the month of October. Lawmakers are not scheduled to return to Capitol Hill until November 12, following Election Day. The stopgap spending bill, which keeps government funding at current levels, was passed by the Senate in a 78-18 vote after clearing the House of Representatives in a 341-82 vote. While House Speaker Mike Johnson (R-La.) has promised that Congress will not approve an omnibus spending bill this year, some appropriators have expressed doubts about their ability to avoid a single, large spending package. Congress is only scheduled to be in session for a five-week lame duck period before the December 20 deadline.
Lawmakers did make progress on a number of health care related measures before leaving Capitol Hill for the campaign trail. The House passed the Accelerating Kids’ Access to Care Act (H.R. 4758) on September 17 via voice vote. While the legislation aims to enhance access to health care for children with complex medical needs by streamlining the Medicaid provider screening and enrollment process, the bill also contains a provision to ban the use of spread pricing by pharmacy benefit managers (PBMs) in Medicaid. The legislation would mandate the use of pass-through pricing models in payment agreements with PBMs under Medicaid, and also includes a measure to delink PBM reimbursement from the list price of drugs.
Also of note was the House Energy and Commerce Committee’s markup of the Telehealth Modernization Act (H.R. 7623). The legislation would extend COVID-era flexibilities around geographic and originating site requirements, practitioners eligible to provide telehealth services, the provision of telehealth by Federally Qualified Health Centers and Rural Health Clinics, and the furnishing of audio-only telehealth services through December 31, 2026. These flexibilities are currently set to expire at the end of this year. The bill is offset by reforms to the PBM industry to delink PBM reimbursement from the list price of drugs and pass-through rebates directly to the patient. The measure would also require PBMs to provide detailed annual reports on drug costs, rebates, and fees to Medicare Part D plan sponsors and the government starting in 2027. The bill was unanimously advanced by the Committee on September 18.
PBMs were also the subject of discussion during a House Judiciary Committee hearing on September 11. The panel considered how PBMs influence access to and pricing of medications in the nation’s health care system. Witnesses focused on the pros and cons of vertical integration within the PBM industry, and addressed the trade-off between increased efficiency and the risk of anticompetitive behavior. Panel members inquired about the impact of PBMs on independent pharmacies, voicing concerns about patient access to care, particularly in areas more heavily reliant on independent pharmacists. Lawmakers generally agreed upon the need for greater transparency throughout the entire pharmaceutical supply chain, with witnesses also suggesting that Congress consider requirements around transfer pricing and the publication of true net pricing benchmarks.
As a reminder, if you’d like to become more involved in our advocacy work, please drop us a line: advocacy@rnsnurse.org.