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PBM bills, other health policies fail to make funding package

A healthcare package that would have advanced pharmacy benefit manager legislation and other healthcare priorities including enhanced community health center funding will not move alongside the next round of federal appropriations.

Committee leaders who hoped to build a legislative package around bipartisan PBM measures and other popular items were unable to come to agreement, and Senate and House leadership declined to add healthcare legislation to the fiscal 2024 government funding bill they are expected to release Tuesday or Wednesday.

Appropriations for large parts of the government, including the Health and Human Services Department, run out at midnight Friday. Funding for other parts of the government, including the Food and Drug Administration, cleared Congress March 8 along with a previous healthcare package that focused on Medicare physician reimbursements, community health center funding and Medicaid disproportionate share hospital payments.

The PBM bills, which varied in scope, attracted bipartisan support in the House and Senate. The lower chamber overwhelmingly passed the Lower Costs More Transparency Act of 2023 in December, and the Senate Finance and Health, Education, Labor and Pensions committees approved other PBM measures on bipartisan votes last year.

But disputes over issues such as whether new regulations on PBMs should apply only under programs such as Medicare and Medicaid or extend to the private insurance market were unresolved when Congress moved the prior appropriations bill.

Finance Committee Chair Ron Wyden (D-Ore.) and ranking member Mike Crapo (R-Idaho) attempted to revive the PBM legislation last week with an eye on the second spending bill, which Congress must send to President Joe Biden before the Friday deadline to avoid a partial government shutdown.

The new bundle of healthcare measures would have included many of the PBM bills the Senate committees and the House advanced, which feature transparency requirements and restrictions on PBM business practices, including how pharmacy benefit managers compensate themselves.

In addition, community health centers would have received $5 billion more in 2025 than Congress allocated in the previous spending bill, and programs for pandemic preparedness and the opioid crisis would have been renewed.

Attaching new policy to the pending appropriations bill was always considered a stretch on Capitol Hill, largely because the most conservative House Republicans strongly oppose sweeping "omnibus" federal spending bills, and Speaker Mike Johnson (R-La.) pledged to heed their concerns.

GOP and Democratic leaders alike also are keen to finish setting spending levels for fiscal 2024, which began more than five months ago.

"We haven't had a government shutdown since 2019. There's no good reason for us to have one this week now that we're getting very close to the finishing the job," Senate Majority Leader Chuck Schumer (D-N.Y.) said on the Senate floor Tuesday. "Senate and House appropriators are now working swiftly to turn this agreement into legislative text as soon as possible so members can review, finalize and ultimately take a vote in the coming days."

Congressional aides said a healthcare deal nearly came together Friday and only collapsed over the weekend after some committee leaders withheld full support and top congressional leaders backed away.

One source called the near-miss a "real bummer," and another characterized it as "sad," considering the bipartisan popularity the PBM legislation earned. This issue is now likely to sit on a shelf through this year's campaign season.

That broad support, however, suggests a similar package could emerge after the elections, when the lame duck Congress will again have to fund community health centers and address Medicare physician pay and Medicaid DSH funding by Dec. 31.


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