President Donald Trump on Tuesday afternoon signed a massive funding package that ends a brief government shutdown and provides full-year funding for the federal government through the end of the year.
The House voted earlier in the day to pass the package by a vote of 217-214.
As part of negotiations between Senate Democrats and the White House, the House moved forward to vote on a package that included five appropriations bills while splitting off a funding bill for the Department of Homeland Security (DHS). The legislation will provide temporary funding to DHS for two weeks to allow both parties to try to hash out a deal to impose new restrictions on federal immigration enforcement. Senate Democrats demanded time to negotiate new oversight policies for immigrant agents after two recent fatal shootings in Minneapolis.
The stalled funding package includes $116.6 billion in discretionary funding for the Department of Health and Human Services and reduces spending on “federal bureaucracy” at the agency by $100 million, according to a fact sheet (PDF) from the House Appropriations Committee.
The legislation also finalizes several key healthcare extenders including provisions of the Medicare telehealth program and the Acute Hospital Care at Home waiver as well as major supplementary funding programs for rural hospitals and those with high proportions of government-covered patients. The bill provides a five-year extension of the Acute Hospital Care at Home program and a two-year extension for Medicare telehealth flexibilities. The telehealth provisions in the bill include removing Medicare’s geographic requirements for telehealth and expanding the types of practitioners able to furnish telehealth services for the government health program.
The bill also introduces reforms to pharmacy benefit manager practices, including 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.
Other provisions in the bill require 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 to track pricing in these facilities.
The National Community Pharmacists Association (NCPA) celebrated the law’s signing and passage of the PBM reforms.
“Community pharmacy owners are the canary in the coal mine when it comes to federal or state prescription programs,” NCPA CEO B. Douglas Hoey, pharmacist, said in a statement issued Tuesday. “For years, our members and we have been telling anyone who will listen—and worked to convince others who wouldn’t listen—about the PBM-insurer conglomerates gobbling up market share, driving up drug costs, crushing small-business pharmacies, and making it more difficult for patients to receive the care they need. We’ve been warning that unless action is taken, more pharmacies will close, and more pharmacy deserts will grow. Unfortunately, as time passed, we were proven correct and finally, there is action to help reverse these trends.”
The National Association of Chain Drug Stores (NACDS) also cheered the PBM reforms that will be enacted as part of the appropriations legislation.
“Congress and the Trump Administration are delivering a historic win for the American people and for the trusted pharmacies that serve as the face of neighborhood healthcare. These PBM reforms are integral to reducing people’s drug costs and keeping pharmacy care within reach, and they must be implemented swiftly, effectively, and as intended by Congress,” NACDS President and CEO Steven Anderson said in a statement. “The abuses of the dominant PBM middlemen are widely recognized, and this landmark federal action reflects the broad, bipartisan commitment to confront and remedy them. This is the most important federal achievement yet for PBM reform, and it will sustain and build momentum for further reforms where needed.”
A group representing community oncologists also applauded the PBM oversight and transparency measures.
“Reining in PBM abuses is a lifesaving measure for cancer patients. For too long, these middlemen have profited off of the backs of Americans with cancer by undermining patient care and leaving pharmacy and medical deserts in their wake,” said Ted Okon, executive director of the Community Oncology Alliance, in a statement.
The Pharmaceutical Care Management Association (PCMA), the leading lobbying organization for the PBM industry, said the government funding bill is a big win for pharmaceutical companies and asserts that the PBM measures will instead increase prescription drug costs.
In a statement, Brendan Buck, chief communications officer for the PCMA, said the PBM measures signed into law today are the culmination of a “years-long effort by drugmakers to convince Congress that PBMs are the problem with high drug costs.”
Buck also warned that new oversight of drugmakers’ actions is on the way.
“It is long past time for lawmakers to look into the ways the pharmaceutical industry games the system to block competition and artificially keep drug prices high. Patent abuse, shadow pricing, direct to consumer advertisements, pay for delay, switching … the tactics are many. All of them are in service of keeping prices high,” Buck said. “There are other players in the drug supply chain, such as the large wholesalers and their PSAOs, worthy of inquiry. But the time has come for drugmakers themselves to face the scrutiny they deserve.”
Many virtual care groups celebrated the Medicare telehealth and hospital-at-home provisions in the package. The five-year extension of the Acute Hospital Care at Home program marks a pivotal step in making hospital-level care in the home a long-term, sustainable part of the U.S. healthcare system, Moving Health Home said.
“This five-year extension is a critical step toward making hospital-at-home a durable part of our health care system,” said Krista Drobac, executive director of Moving Health Home, in a statement. “Long-term certainty allows providers to plan, invest, and scale these programs in ways that benefit patients, caregivers, and communities. Crucially, it also allows large scale collection of data and evidence that we feel confident will definitively convince lawmakers to make this program permanent. Moving Health Home is proud to have worked alongside Congress and our members to advance a model of care that delivers high-quality, patient-centered care where people want to be—at home.”
The five-bill minibus reinstates key telehealth flexibilities for multiple years.
“At a time of political volatility, telehealth continues to stand out as a core bipartisan priority …” said Alexis Apple, deputy executive director of ATA Action, the affiliated policy and legislative advocacy arm of the American Telemedicine Association. “These extensions provide critical stability and certainty for patients and healthcare providers but also underscore the work still ahead.”
ATA Action will continue to advocate for permanent telehealth policy solutions, Apple said, noting that the multiyear extensions will give government agencies, legislators and advocates needed time to hammer out the details of permanent provisions.
America’s Essential Hospitals commended Congress for passing the funding package, which eliminates two years of Medicaid disproportionate share hospital cuts and extends the Medicare telehealth program and Acute Hospital Care at Home waiver.
“These policies are even more critical in light of the onerous hospital cuts passed by Congress last summer. However, we are disappointed that the bill increases administrative burden through unnecessary paperwork requirements for hospital outpatient sites of care,” Jennifer DeCubellis, president and CEO of America’s Essential Hospitals, said in a statement.