 Health Care |
Health Care |
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PRESENTED BY PBM ACCOUNTABILITY PROJECT |
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PBMs targeted in health deal |
Lawmakers agreed to attach a sweeping health care package to a year-end stopgap government funding legislation, according to text obtained by The Hill ahead of the release of the full bill. |
The provisions in the bill, if passed, could represent some of the biggest health policies in Congress this year. The health portion runs more than 550 pages and contains: - Pharmaceutical benefit manager (PBM) industry reforms
- Extensions of Medicare telehealth flexibilities
- Reauthorizations of legislation to prevent pandemics and address the opioid crisis
- Payments to community health centers
- A rollback of physician payment cuts and other policies.
The PBM changes would put guardrails on the business practices of the industry, something that's been a bipartisan priority for years but, until now, never made it to the finish. - The package includes a ban on linking PBM compensation to a drug's Medicare list price.
- The bill also requires PBMs to "fully pass through 100 percent of drug rebates and discounts … to the employer or health plan."
- The package includes new reporting requirements to increase transparency
- It would ban "spread pricing," changing how PBMs get paid by Medicaid for prescription drugs.
The three biggest PBMs are UnitedHealth Group's Optum Rx, CVS Health's Caremark and Cigna's Express Scripts. PBMs wield enormous power on the accessibility and affordability of prescription drugs, and those three companies represent about 80 percent of all U.S. prescriptions. PBMs also negotiate the terms and conditions for access to prescription drugs for hundreds of millions of Americans. They are responsible for negotiating prices with drug companies, paying pharmacies and determining which drugs patients can access and how much they cost. The industry has faced intense scrutiny on Capitol Hill this year, and essentially every committee with jurisdiction over health care has drafted PBM reform legislation. |
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How policy will be impacting the health care sector this week and beyond: |
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A poll found 41 percent of adults under 30 consider the killing of UnitedHealthcare CEO Brian Thompson acceptable, more than the 40 percent in that demographic who consider it unacceptable. |
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Manhattan District Attorney Alvin Bragg (D) announced Tuesday that a grand jury handed up an indictment against Luigi Mangione, the suspect in the killing of UnitedHealthcare's CEO. Mangione faces 11 charges, including first-degree murder and two counts of second-degree murder. The first-degree murder charge, which carries up to life in prison without parole, requires an aggravated factor. The indictment describes the alleged … |
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Sen. Tommy Tuberville (R-Ala.) said on Tuesday that Robert F. Kennedy Jr. told him he has come to an agreement with President-elect Trump on the issue of abortion, concluding the matter will be left to the states to decide. Speaking to reporters after his meeting with Trump's pick to lead the Department of Health and Human Services (HHS), Tuberville recounted their discussion on abortion and recalled asking Kennedy about his … |
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Branch out with a different read from The Hill: |
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Rep. Jerry Nadler (D-N.Y.) criticized Texas Attorney General Ken Paxton (R) for filing a lawsuit against a New York doctor for providing abortion care to a Texas patient via telemedicine. |
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A MESSAGE FROM PBM ACCOUNTABILITY PROJECT |
Congress: Real PBM reform is needed NOW |
There is bipartisan agreement to: improve transparency, break the link that allows PBMs to tie their profits to the price of the drug, and force PBMs to share discounts with seniors.
Finish the job and pass S. 2973 and S. 3430 this year. Learn more. |
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Local and state headlines on health care: |
- Bird flu confirmed in Galveston County. Here's what to know (The Houston Chronicle)
- Nearly 100,000 California veterans are not enrolled in VA health care (LAist)
- Tennesse sees obstetric residency applications drop (Nashville Banner)
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| Health news we've flagged from other outlets: |
- What Kennedy has said about the polio vaccine in recent years (The New York Times)
- Bipartisan task force sets health AI oversight priorities for the next Congress (Stat)
- Trump's picks for top health jobs not just team of rivals but 'team of opponents' (KFF Health News)
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Most read stories on The Hill right now: |
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Republicans released a report Tuesday reviewing the "failures and politicization" of the now-disbanded House Jan. 6 committee, capping their investigation … Read more |
| The Biden administration announced a rule Tuesday clarifying who can apply for an H-1B work visa, a key program to attract international talent that's … Read more |
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Opinion related to health submitted to The Hill: |
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You're all caught up. See you tomorrow! |
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