News

House Oversight Panel Releases PBM Report

July 29, 2024

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House Oversight Panel Releases PBM Report-The House Oversight and Accountability Committee released a staff report last week examining the role of pharmacy benefit managers (PBMs) in the prescription drug market. The report follows the Committee’s review of more than 140,000 pages of documents and communications and asserts that PBMs “have monopolized the pharmaceutical marketplace by deploying deliberate, anticompetitive pricing tactics that are raising prescription drug prices, undermining community pharmacies, and harming patients across the United States.” The report details the following key findings:

• PBMs use their position as middlemen and integration with health insurers, pharmacies, providers, and manufacturers to enact anticompetitive policies and protect their profit margin-costing taxpayers and reducing patient choice.
• While PBMs cite the savings they provide for payers and patients through negotiation, drug utilization programs, and spread pricing, evidence indicates that these tactics often increase costs for patients and payers.
• PBMs force drug manufacturers to pay rebates in exchange for favorable formulary placement, making it difficult for lower cost competitors to get on formularies.
• PBMs have begun creating foreign corporate entities and moving certain operations abroad in response to proposed state and federal government PBM reforms.
• PBMs’ use of prior authorization, fail first, and formulary manipulations have significant detrimental impacts on Americans’ health outcomes.

The report was released ahead of the panel’s hearing last Tuesday with executives from the nation’s three largest PBMs-CVS Caremark, Express Scripts, and OptumRx-in which the witnesses faced bipartisan criticism for their company’s practices.

House Adjourns, Appropriations Update-House Republican leadership announced last Wednesday that the chamber would adjourn for August recess a week earlier than expected amidst intraparty conflicts on fiscal year (FY) 2025 appropriations legislation. The chamber is not scheduled to return until the week of September 9. It remains unclear whether the House will hold any further votes on its remaining FY2025 bills. Several spending measures have failed or been pulled from floor consideration in recent weeks, including the Agriculture-Food and Drug Administration (FDA) bill, because they did not have enough votes for passage. House Appropriations Committee Chairman Tom Cole (R-Okla.) blamed the absence of language restricting access to abortion medication as one reason the Agriculture-FDA bill failed to secure enough support. Cole also recently stated that the chances of floor consideration of the Labor-Health and Human Services (LHHS) bill are “slim to none.” In the Senate, appropriators moved four more FY2025 spending bills to the floor for votes last week, and are scheduled to markup the remaining five, including LHHS, on August 1. Congress is widely expected to rely on a continuing resolution to avert a government shutdown at the end of the fiscal year on September 30.

Joint Economic Committee Pens Issue Brief on Private Equity-The Joint Economic Committee, currently chaired by Sen. Marin Heinrich (D-N.M.) released an issue brief last week examining the impact of private equity on the U.S. economy and health care system. The report asserts that private equity’s growth in the health care sector negatively impacts Americans’ well-being, highlighting concerning trends in the quality of care provided at private equity-owned institutions. “Private equity’s buy, strip and flip business model, anticompetitive actions, and exploitation of our health care system threaten Americans’ livelihoods,” the brief concludes. In related news, the Senate Health, Education, Labor, and Pensions (HELP) Committee voted on Thursday to authorize a bipartisan investigation into the role of private equity in the bankruptcy of Steward Health Care, the largest for-profit health system in the nation. The HELP Committee also voted to subpoena Steward Health Care CEO Ralph de la Torre to testify before the panel.

E&C GOP Probes Marijuana Rescheduling Process-Republican leaders of the House Energy and Commerce Committee are questioning the process by which the White House has proposed to reschedule marijuana. The letter to the administration highlights that as recently as 2016, following a multi-year review, both the Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services agreed that marijuana continued to meet the criteria to be considered a Schedule I substance. In May, however, the DEA proposed to reschedule marijuana from a schedule I to schedule III controlled substance. “We support research into innovative therapies to improve patient outcomes, but we are concerned with how the normal process was circumvented to achieve a result for political purposes and we have a number of unanswered questions,” the lawmakers write.

NJ Senator Bob Menendez to Resign August 20-Sen. Bob Menendez (D-N.J.) will resign from the Senate effective August 20 following his conviction on federal corruption charges. Menendez, who had faced calls to resign from his Senate colleagues, stated that he plans to appeal the verdict but did not want to involve the Senate “in a lengthy process that will detract from its important work.” New Jersey Gov. Phil Murphy (D) has the authority to name a replacement to serve until the end of the senator’s current term on January 3. Rep. Andy Kim (D) is heavily favored to win the full six-year term in the November election, in which Menendez has filed to run as an independent. Sen. Bernie Sanders (I-Vt.) has expressed interest in filling Menendez’s seat on the Senate Finance Committee.

Congressional Retirements and Resignations –A running list of members of Congress who are retiring or seeking other office can be found below.

Upcoming Congressional Hearings and Markups

Senate HELP Committee executive session to consider S.4776, Older Americans Act Reauthorization Act of 2024; S.4755, Autism Collaboration, Accountability, Research, Education, and Support Act of 2024; and S.4755, Traumatic Brain Injury Program Reauthorization Act of 2024; 10:00 a.m.; July 31

Senate Commerce, Science, and Transportation Committee executive session to markup legislation, including: S.2233, Youth Poisoning Protection Act; S.2645, Preventing HEAT Illnesses and Deaths Act; S.2714, CREATE AI Act; S.3162, TEST AI Act; S.3312, Artificial Intelligence Research, Innovation, and Accountability Act; S.4178, Future of Artificial Intelligence Innovation Act; S.4394, National Science Foundation Artificial Intelligence Education Act; S.4487, Small Business Artificial Intelligence Training and Toolkit Act; S.4596, Artificial Intelligence Public Awareness and Education Campaign Act; S.4769, Validation and Evaluation for Trustworthy (VET) Artificial Intelligence Act; 10:00 a.m.; July 31

Senate Appropriations business meeting to markup an original bill entitled, “Energy and Water Development and Related Agencies Appropriations Act”, an original bill entitled, “Department of Defense Appropriations Act”, an original bill entitled, “Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act”, an original bill entitled, “Department of Homeland Security Appropriations Act”, and an original bill entitled, “Financial Services and General Government Appropriations Act;” 9:30 a.m.; August 1

Senate HELP Committee hearing “Why Is Novo Nordisk Charging Americans with Diabetes and Obesity Outrageously High Prices for Ozempic and Wegovy?” 10:00 a.m.; September 24

Recently Introduced Health Legislation

H.R.9079-To amend the Immigration and Nationality Act to provide nonimmigrant status to nurses working in certain facilities; Sponsor: Beyer, Donald S. [Rep.-D-VA-8]; Committees: House-Judiciary

H.R.9091-To authorize an individual who is transitioning from receiving treatment furnished by the Secretary of Defense to treatment furnished by the Secretary of Veterans Affairs to continue receiving treatment from such individual’s mental health care provider of the Department of Defense, and for other purposes; Sponsor: Thanedar, Shri [Rep.-D-MI-13]; Committees: House-Armed Services; Veterans’ Affairs

S.4729-A bill to amend the Older Americans Act of 1965 to establish a pilot program for family caregivers for individuals with Alzheimer’s disease or a related disorder with neurological and organic brain dysfunction; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate – Health, Education, Labor, and Pensions

S.4731-A bill to amend the Older Americans Act of 1965 to provide for food-based interventions; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate – Health, Education, Labor, and Pensions

S.4732-A bill to amend the Older Americans Act of 1965 to authorize funding for the Research, Demonstration, and Evaluation Center for the Aging Network to engage in certain research and evaluation activities with respect to family caregivers and to revise the definition of the term “family caregiver”; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Health, Education, Labor, and Pensions

S.4733-A bill to amend the Older Americans Act of 1965 to authorize the Secretary of Health and Human Services to make grants to develop or expand in-person and virtual peer support programs for family caregivers; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Health, Education, Labor, and Pensions

S.4734-A bill to amend the Older Americans Act of 1965 to ensure services for home modifications under part B of title III of such Act may be used for certain purposes, and for other purposes; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Health, Education, Labor, and Pensions

S.4735-A bill to amend the Older Americans Act of 1965 to provide financial planning services related to the needs of family caregivers, and for other purposes; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Health, Education, Labor, and Pensions

S.4736-A bill to amend the Older Americans Act of 1965 to develop and expand integrated caregiver support services for family caregivers, and for other purposes; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Health, Education, Labor, and Pensions

S.4739-A bill to advance research to achieve medical breakthroughs in brain tumor treatment and improve awareness and adequacy of specialized cancer and brain tumor care; Sponsor: Blumenthal, Richard [Sen.-D-CT]; Committees: Senate-Health, Education, Labor, and Pensions

S.4741-A bill to amend title XVIII of the Social Security Act to provide a phase-in for plasma-derived products under the manufacturer discount program; Sponsor: Tillis, Thomas [Sen.-R-NC]; Committees: Senate-Finance

S.4743-A bill to improve the Long-Term Care Ombudsman program; Sponsor: Kaine, Tim [Sen.-D-VA]; Committees: Senate-Health, Education, Labor, and Pensions

S.4744-A bill to amend the Higher Education Act of 1965 to establish fair and consistent eligibility requirements for graduate medical schools operating outside the United States and Canada; Sponsor: Durbin, Richard J. [Sen.-D-IL]; Committees: Senate-Health, Education, Labor, and Pensions

S.4745-A bill to establish the Federal Food Administration to protect the public health by ensuring the safety of food, preventing foodborne illness, maintaining safety reviews and reassessments of food additives, reducing the prevalence of diet-related chronic diseases, enforcing pesticide residue tolerances, improving the surveillance of foodborne pathogens, and for other purposes; Sponsor: Durbin, Richard J. [Sen.-D-IL]; Committees: Senate-Health, Education, Labor, and Pensions

S.4755-A bill to reauthorize traumatic brain injury programs, and for other purposes; Sponsor: Mullin, Markwayne [Sen.-R-OK]; Committees: Senate -Health, Education, Labor, and Pensions

H.Res.1375-Recognizing the threat of extreme weather to children’s health and well-being, and expressing the sense of Congress that solutions must be rapidly and equitably developed and deployed to address the unique vulnerabilities and needs of children; Sponsor: McClellan, Jennifer L. [Rep.-D-VA-4]; Committees: House-Energy and Commerce

H.R.9093-To prioritize healthcare facilities and mental or behavioral health facilities in the Community Facilities program for fiscal years 2025 through 2031, and allow loans and grants under the program to be used for medical supplies, increasing telehealth capabilities, supporting staffing needs, or renovating and remodeling closed facilities; Sponsor: Underwood, Lauren [Rep.-D-IL-14]; Committees: House-Agriculture

H.R.9094-To amend chapter 17 of title 38, United States Code, to direct the Secretary of Veterans Affairs to allow a veteran to receive a full year supply of contraceptive pills, transdermal patches, vaginal rings, and other hormonal contraceptive products, and for other purposes; Sponsor: Underwood, Lauren [Rep.-D-IL-14]; Committees: House-Veterans’ Affairs

H.R.9096-To establish pharmacy payment and reimbursement by pharmacy benefits managers; to amend title XIX of the Social Security Act to improve prescription drug transparency; and for other purposes; Sponsor: Auchincloss, Jake [Rep.-D-MA-4]; Committees: House-Energy and Commerce; Ways and Means; Oversight and Accountability; Armed Services

H.R.9098-To provide for surveillance of Clostridioides difficile, and for other purposes; Sponsor: Clarke, Yvette D. [Rep.-D-NY-9]; Committees: House-Energy and Commerce

H.R.9099-To establish the Federal Food Administration to protect the public health by ensuring the safety of food, preventing foodborne illness, maintaining safety reviews and reassessments of food additives, reducing the prevalence of diet-related chronic diseases, enforcing pesticide residue tolerances, improving the surveillance of foodborne pathogens, and for other purposes; Sponsor: DeLauro, Rosa L. [Rep.-D-CT-3]; Committees: House-Energy and Commerce

H.R.9101-To amend title XXXIII of the Public Health Service Act with respect to flexibility and funding for the World Trade Center Health Program; Sponsor: Garbarino, Andrew R. [Rep.-R-NY-2]; Committees: House-Energy and Commerce; Budget

H.R.9104-To amend the Public Health Service Act to establish certain duties for pharmacies to ensure provision of Food and Drug Administration-approved contraception and medication related to contraception, and for other purposes; Sponsor: Kelly, Robin L. [Rep.-D-IL-2]; Committees: House-Energy and Commerce

H.R.9107-To require the Secretary of Veterans Affairs to submit a report on the status and timeline for completion of the redesigned Airborne Hazards and Open Burn Pit Registry 2.0; Sponsor: Ruiz, Raul [Rep.-D-CA-25]; Committees: House-Veterans’ Affairs

H.R.9113-To advance research to achieve medical breakthroughs in brain tumor treatment and improve awareness and adequacy of specialized cancer and brain tumor care; Sponsor: Wild, Susan [Rep.-D-PA-7]; Committees: House-Energy and Commerce

S.Res.769-A resolution recognizing the importance of mental health for youth in the United States and expressing the pressing need for awareness and support for mental health care for children and adolescents; Sponsor: Padilla, Alex [Sen.-D-CA]; Latest Action: Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent.

S.4757-A bill to improve the environmental health outcomes of incarcerated people and carceral facility workers, and for other purposes; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Judiciary

S.4762-A bill to amend the Public Health Service Act to reauthorize programs and research relating to autism, and for other purposes; Sponsor: Lujan, Ben Ray [Sen.-D-NM]; Committees: Senate-Health, Education, Labor, and Pensions

S.4767-A bill to amend the Patient Protection and Affordable Care Act to reduce fraudulent enrollments in qualified health plans, and for other purposes; Sponsor: Wyden, Ron [Sen.-D-OR]; Committees: Senate-Health, Education, Labor, and Pensions

H.Res.1384-Recognizing the seriousness of polycystic ovary syndrome (PCOS) and expressing support for the designation of the month of September 2024 as “PCOS Awareness Month”; Sponsor: Scott, David [Rep.-D-GA-13]; Committees: House-Energy and Commerce

H.R.9119-To direct the Director of the Office of Community Oriented Policing Services of the Department of Justice to establish a training course relating to Alzheimer’s disease and similar forms of dementia; Sponsor: Buchanan, Vern [Rep.-R-FL-16]; Committees: House-Judiciary

H.R.9125-To amend title XVIII of the Social Security Act to improve the accuracy and predictability of Medicare payments to long-term care hospitals; Sponsor: Miller, Carol D. [Rep.-R-WV-1]; Committees: House-Ways and Means

H.R.9127-To amend title III of the Public Health Service Act to include territorial disproportionate share hospitals as covered entities under the 340B drug discount program; Sponsor: Sablan, Gregorio Kilili Camacho [Del.-D-MP-At Large]; Committees: House-Energy and Commerce

H.R.9128-To amend title XVIII of the Social Security Act to establish a designation for territorial safety net hospitals, and for other purposes; Sponsor: Sablan, Gregorio Kilili Camacho [Del.-D-MP-At Large]; Committees: House-Energy and Commerce; Ways and Means; Budget

H.R.9129-To amend title XVIII of the Social Security Act to establish certain standards and requirements with respect to financial assistance and medical debt collection for hospitals participating in the Medicare program, and to amend title III of the Public Health Service Act to establish a grant program for purposes of medical debt relief; Sponsor: Vasquez, Gabe [Rep.-D-NM-2]; Committees: House-Energy and Commerce; Ways and Means

S.Res.771-A resolution supporting the designation of the week of August 26 through August 30, 2024, as the second annual “National Community Health Worker Awareness Week”; Sponsor: Casey, Robert P., Jr. [Sen.-D-PA]; Committees: Senate-Health, Education, Labor, and Pensions

S.Res.773-A resolution supporting the ideals of Bump Day to ensure, through advocacy, awareness, and action, that every mom, regardless of where she lives, the color of her skin, or her ability to pay, gets the care she needs to deliver a safe pregnancy and birth, and a healthy future for herself and the baby she loves; Sponsor: Coons, Christopher A. [Sen.-D-DE]; Committees: Senate-Health, Education, Labor, and Pensions

S.Res.774-A resolution designating June 15, 2024, as “World Elder Abuse Awareness Day” and the month of June 2024 as “Elder Abuse Awareness Month”; Sponsor: Grassley, Chuck [Sen.-R-IA]; Latest Action: Submitted in the Senate, considered, and agreed to without amendment and with a preamble by Unanimous Consent.

S.4771-A bill to amend the Internal Revenue Code of 1986 to expand eligibility for health savings accounts, and for other purposes; Sponsor: Scott, Rick [Sen.-R-FL]; Committees: Senate-Finance

S.4773-A bill to improve the health of minority individuals, and for other purposes; Sponsor: Hirono, Mazie K. [Sen.-D-HI]; Committees: Senate-Finance

S.4774-A bill to provide for the periodic issuance of up-to-date clinical guidance on addressing the health effects of per- and polyfluoroalkyl substances (PFAS), and for other purposes; Sponsor: Shaheen, Jeanne [Sen.-D-NH]; Committees: Senate-Health, Education, Labor, and Pensions

S.4776-A bill to amend the Older Americans Act of 1965 to authorize appropriations for fiscal years 2025 through 2029, and for other purposes; Sponsor: Sanders, Bernard [Sen.-I-VT]; Committees: Senate-Health, Education, Labor, and Pensions

S.4777-A bill to amend title XVIII of the Social Security Act to require hospitals to fulfill certain obligations relating to discontinuation of services or closure; Sponsor: Baldwin, Tammy [Sen.-D-WI]; Committees: Senate-Finance

S.4781-A bill to improve access to the Program of All-Inclusive Care for the Elderly, and for other purposes; Sponsor: Casey, Robert P., Jr. [Sen.-D-PA]; Committees: Senate-Finance

S.4785-A bill to amend the Federal Food, Drug, and Cosmetic Act to restrict direct-to-consumer drug advertising; Sponsor: King, Angus S., Jr. [Sen.-I-ME]; Committees: Senate-Health, Education, Labor, and Pensions

S.4791-A bill to amend title 38, United States Code, to require the consideration of continuity of health care in determining best medical interest under the Veterans Community Care Program, and for other purposes; Sponsor: Rubio, Marco [Sen.-R-FL]; Committees: Senate-Veterans’ Affairs

S.4804-A bill to amend the Public Health Service Act to require the Secretary of Health and Human Services to enforce certain requirements with respect to for-profit corporations that own health care systems, and for other purposes; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Finance

S.4811-A bill to require guidance to improve access to mental health and substance use prevention services for children, adolescents, and young adults; Sponsor: Butler, Laphonza R. [Sen.-D-CA]; Committees: Senate-Finance

S.4812-A bill to establish a pilot program to address behavioral health needs among children, adolescents, and young adults, and for other purposes; Sponsor: Butler, Laphonza R. [Sen.-D-CA]; Committees: Senate-Health, Education, Labor, and Pensions

S.4817-A bill to amend title I of the Patient Protection and Affordable Care Act to authorize the establishment of, and provide support for, State-based universal health care systems that provide comprehensive health benefits to State residents, and for other purposes; Sponsor: Markey, Edward J. [Sen.-D-MA]; Committees: Senate-Finance

H.Res.1389-Supporting the designation of the week of August 26 through August 30, 2024, as the second annual “National Community Health Worker Awareness Week”; Sponsor: Ruiz, Raul [Rep.-D-CA-25]; Committees: House-Energy and Commerce

H.R.9131-To authorize a national program to reduce the threat to human health posed by exposure to indoor air contaminants, and for other purposes; Sponsor: Tonko, Paul [Rep.-D-NY-20]; Committees: House-Energy and Commerce

H.R.9132-To amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for additional preventive care for individuals with chronic conditions without the imposition of cost sharing requirement, and for other purposes; Sponsor: Underwood, Lauren [Rep.-D-IL-14]; Committees: House-Energy and Commerce; Education and the Workforce; Ways and Means

H.R.9133-To amend the Employee Retirement Income Security Act of 1974, title XXVII of the Public Health Service Act, and the Internal Revenue Code of 1986 to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide for 3 primary care visits and 3 behavioral health care visits without application of any cost-sharing requirement; Sponsor: Underwood, Lauren [Rep.-D-IL-14]; Committees: House-Energy and Commerce; Education and the Workforce; Ways and Means

H.R.9138-To expand psychological mental and behavioral health services to Medicare, Medicaid, and CHIP beneficiaries by permitting reimbursement of psychological services provided by certain supervised psychology trainees, and facilitating the reimbursement of those services; Sponsor: Balderson, Troy [Rep.-R-OH-12]; Committees: House-Energy and Commerce; Ways and Means

H.R.9141-To amend the Internal Revenue Code of 1986 to expand eligibility for health savings accounts, and for other purposes; Sponsor: Cammack, Kat [Rep.-R-FL-3]; Committees: House-Ways and Means

H.R.9142-To amend the Federal Food, Drug, and Cosmetic Act to restrict direct-to-consumer drug advertising; Sponsor: DeLauro, Rosa L. [Rep.-D-CT-3]; Committees: House-Energy and Commerce

H.R.9146-To amend title 38, United States Code, to require the consideration of continuity of health care in determining best medical interest under the Veterans Community Care Program, and for other purposes; Sponsor: Franklin, C. Scott [Rep.-R-FL-18]; Committees: House-Veterans’ Affairs

H.R.9156-To amend the Public Health Service Act to require the Secretary of Health and Human Services to enforce certain requirements with respect to for-profit corporations that own health care systems, and for other purposes; Sponsor: Jayapal, Pramila [Rep.-D-WA-7]; Committees: House-Energy and Commerce; Financial Services; Ways and Means; Judiciary

H.R.9157-To amend title XVIII of the Social Security Act to facilitate patient access to certain pediatric technologies; Sponsor: Joyce, John [Rep.-R-PA-13]; Committees: House-Energy and Commerce; Ways and Means

H.R.9161-To improve the health of minority individuals, and for other purposes; Sponsor: Lee, Barbara [Rep.-D-CA-12]; Committees: House-Energy and Commerce; Ways and Means; Agriculture; Oversight and Accountability; Education and the Workforce; Judiciary; Budget; Veterans’ Affairs; Natural Resources; Armed Services; Homeland Security; Financial Services; Transportation and Infrastructure

H.R.9173-To amend title XVIII of the Social Security Act to stabilize payments to long-term care hospitals under the Medicare program and improve patient access; Sponsor: Smucker, Lloyd [Rep.-R-PA-11]; Committees: House-Ways and Means

H.R.9177-To amend title 38, United States Code, to eliminate the requirement of a service-connected disability to furnish veterans with medical care outside of a State, and for other purposes; Sponsor: Van Drew, Jefferson [Rep.-R-NJ-2]; Committees: House-Veterans’ Affairs

H.R.9178-To amend title 38, United States Code, to improve access of health care providers of the Department of Veterans Affairs to prescription drug monitoring programs, and for other purposes; Sponsor: Zinke, Ryan K. [Rep.-R-MT-1]; Committees: House-Veterans’ Affairs