 Health Care |
Health Care |
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Congress missed a chance at PBM reforms. Will they get another? |
Lawmakers ended 2024 on the cusp of passing a significant health package, including changes to the pharmacy benefit manager (PBM) industry payments to community health centers, a rollback of physician payment cuts and more. |
The policies put forward in December never passed amid an 11th-hour revolt by conservatives. And it's not clear whether it could happen in the new GOP-majority Congress this year. Ready to roll: Most of the work on PBM reforms was done ahead of the government spending bills passed in March of last year. When last-minute disagreements derailed their inclusion, lawmakers and staff hammered out the final details ahead of the December funding deadline. The language is now already written and could be inserted ready-made into a new bill. Favorable conditions: Analysts expect congressional pressure on PBMs to continue. The spending bill that ultimately passed just before Christmas only funds the government through mid-March, so the next version could be a vehicle for those same policies that were jettisoned in December. Additionally, the telehealth flexibilities and health center funding that passed in December were only extended until March, giving lawmakers another incentive. A spokesman for incoming Senate Finance Committee Chairman Mike Crapo (R-Idaho) wouldn't speculate on what a path forward may look like for the health items not included in the most recent funding package. But he noted the senator is committed to passing his health priorities, which include those in the original bill that didn't make the cut. Partisan priorities: With full GOP control of government, lawmakers may burn a lot of precious time on partisan issues. Major Medicaid changes are likely on the horizon, as is a potential rollback of the Inflation Reduction Act's drug pricing changes. That may not engender much bipartisan cooperation to pass any of the provisions as a standalone, though there is bipartisan support for PBM changes. Republicans also want to raise the debt limit and pass an extension of President-elect Trump's 2017 tax cuts using the party-line reconciliation process, which would potentially rule out including health care changes in those bills. |
Welcome to The Hill's Health Care newsletter, we're Nathaniel Weixel and Joseph Choi — every week we follow the latest moves on how Washington impacts your health. |
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How policy will be impacting the health care sector this week and beyond: |
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Eli Lilly is seeking to end a lawsuit filed by a pharmacy trade group against the Food and Drug Administration (FDA) by joining as a defendant, stating it wants to end the “entitlement” some pharmacies have practiced in mass-marketing copies of its highly popular GLP-1 medications. The lawsuit in question concerns the FDA’s decision to officially declare the shortages of Mounjaro and Zepbound, both firms of … |
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More people experienced gastrointestinal illnesses while aboard a cruise ship in 2024 than any other year since 2012, according to data from the Centers for Disease Control and Prevention (CDC). The CDC reported that there were 16 outbreaks of stomach illnesses aboard cruise ships last year, which affected 1,894 passengers and 245 crew members. The data shows that there were also 16 outbreaks of stomach bugs in 2012 but indicated … |
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Broccoli sold at Walmart stores in 20 states has been recalled. Braga Fresh last week issued a voluntary and precautionary advisory for 12-ounce bags of Marketside Broccoli Florets that may be contaminated with Listeria monocytogenes. According to the U.S. Food and Drug Administration (FDA), which posted the advisory Tuesday, the pathogen can cause “serious and sometimes fatal infections” in young children, … |
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Branch out with a different read: |
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Medicare's new drug price cap kicks in Jan. 1 |
A key cost-saving provision of the Inflation Reduction Act (IRA) goes into effect in the new year, limiting annual out-of-pocket spending on prescription drugs to $2,000 for Medicare beneficiaries. Starting on Jan. 1, 2025, an estimated 19 million Medicare beneficiaries will see their out-of-pocket Medicare Part D spending capped at $2,000 for the year. This annual cap will be indexed to the rate of inflation every year going … |
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Local and state headlines on health care: |
- Medicaid expansion: What are its chances in 2025? (Mississippi Today)
- Mental health advocates ask Texas lawmakers to replace expiring COVID-19 relief funding (Texas Tribune)
- State Health Department calls Syracuse a "community of concern" over high lead levels (CNY Central)
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Health news we've flagged from other outlets: |
- How health insurers racked up billions in extra payments from Medicare Advantage (The Wall Street Journal)
- Health care start-ups are trying to open. An old law stands in their way. (The Washington Post)
- Turning patients into profit: How Steward embodies the risk of private equity's push in American health care (The Boston Globe)
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Most read stories on The Hill right now: |
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A federal appeals court ruled this week the Federal Communications Commission (FCC) lacked the authority to restore certain net neutrality rules last … Read more |
| Progressives in Washington are facing an existential crisis like never before as they brace for the incoming Trump administration. Not only are … 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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