The House passed a key appropriations package that would fund the Department of Health and Human Services through Sept. 30, including a step toward reforms for pharmacy benefit managers.
The package passed by a 341-88 vote, and it includes elements that would prevent PBMs from tying compensation in Part D to the list price of drugs, and boost price transparency for employers in their PBM contracts. Rep. Buddy Carter, R-Georgia, a pharmacist and vocal supporter of PBM reform, celebrated the passage in a statement.
He urged the Senate to act quickly to enshrine the PBM reforms.
“PBMs have been stealing hope and health from the American people for decades, inflating prescription drug costs, forcing pharmacy closures, and blocking access to medications,” Carter said. “The PBM mafia has officially been put on notice. I call on the Senate to pass this bill and help build a quality, accessible, and affordable health care system for patients.”
The National Community Pharmacists Association also celebrated the bill’s passage, with Anne Cassity, NCPA’s senior vice president of government affairs, saying the reforms “are as welcomed as they are long overdue.”
The Pharmaceutical Care Management Association, the leading lobbying organization for the PBM industry, had the opposite reaction, pushing the Senate to reject the measure.
PCMA CEO David Marin said in a statement that the package will instead drive up healthcare costs and reduce choices for employers.
“The House has just voted to make health care more expensive,” he said. “It has sided with Big Pharma over American families facing a painful affordability challenge. By forcing American employers into a one-size-fits all system, drugmakers are being given even more power to inflate their prices.”
“These mandates undermine President Trump’s work to make drugs more affordable, and the Senate should reject them,” Marin said.
PUBLISHED: Jan. 20 at 4 p.m. ET
The House Appropriations Committee has unveiled proposed outlays for the Department of Health and Human Services (HHS), including key investments in priorities within the Make America Healthy Again movement.
The bill would include $116.6 billion in discretionary funding for the HHS and reduces spending on “federal bureaucracy” at the agency by $100 million, according to a fact sheet (PDF) from the committee. The proposal would allocate $49 billion to the National Institutes of Health for research into key priorities such as cancer, Alzheimer’s disease, diabetes, rare diseases and chronic diseases impacting Americans.
At the same time, the proposal would eliminate the Centers for Disease Control and Prevention’s social determinants of health work, which the fact sheet says “promoted social engineering while distracting grant recipients from combating infectious and chronic diseases.”
In addition to the funding proposals, the legislative package addresses several policy priorities that have taken shape for legislators over the past several years. For one, it aims to boost transparency and oversight of pharmacy benefit managers and would establish flat fees for their services.
It requires that Medicare Advantage plans provide accurate provider lists, addressing so-called “ghost networks” that have come under fire in recent years. It would also require that health systems establish unique identification numbers for outpatient services, allowing the Centers for Medicare & Medicaid Services (CMS) to track pricing in these facilities.
The shift could set the stage for a move toward site-neutral payments, which the CMS has pushed for and had drawn outrage from the hospital industry.
Per the fact sheet, the package would allocate $418 million in funding for rural health, including rural hospitals, as well as maintain $1.9 billion in funding for community health centers. The packages’ text includes fresh extensions of key hospital funding priorities, such as the Medicare-dependent hospital program and the increased inpatient hospital payment adjustment for some low-volume hospitals.
Expiring telehealth and virtual care programs that have largely enjoyed bipartisan support join the list of healthcare extenders as well. This includes acute hospital care at home waiver flexibilities through Sept. 30, 2030, and a slew of other telehealth flexibilities through Dec. 31, 2027.
In addition, the bill sets aside $1.4 billion for supporting the healthcare workforce and to connect them with rural areas when possible. In a similar vein, the bill adjusts an extension for part of the Dr. Lorna Breen Health Care Provider Protection Act, which supports the health and well-being of healthcare workers, from two years to five, carrying it through 2027.
The proposal also allocates $1.2 billion to support maternal and child health, according to the fact sheet.
What the package doesn’t address, however, is the expiry of the Affordable Care Act’s enhanced subsidies, which ran dry Jan. 1 and are playing a key role in driving up insurance premiums. It also doesn’t codify the key elements of the White House’s newly related “Great Healthcare Plan,” which aims to address rising costs.
Tom Cole, R-Okla., chairman of the House Appropriations Committee, said in a statement that the proposal “applies innovation and discipline to deliver results without waste.”
“It reflects the core tenets of American strength: combat-ready forces, secure communities, effective education and health systems, and modern transportation,” Cole said.
Broad spending packages like this often undergo significant changes between the House and the Senate and across various markups, but the initial version enjoys bipartisan support. Appropriations Committee ranking member Rosa DeLauro, D-Conn., said the package “continues Congress’s forceful rejection of extreme cuts to federal programs proposed by the Trump Administration.”
“I strongly support this bipartisan, bicameral funding package. I look forward to voting for it later this week,” she said.
Commentary from leading Sen. Ron Wyden, D-Ore., suggests bipartisan backing extends to the upper chamber of Congress.
“This agreement represents important steps forward on health care priorities like taking on pharmaceutical middlemen and achieving mental health parity,” Wyden said. “Americans have deep concerns about the state of their healthcare, and these reforms represent a down payment on the effort to ensure our system benefits families over giant corporations.”