Inside the Hill’s health care reform momentum

Presented by Kaiser Permanente

With Megan R. Wilson and David Lim

Driving the day

HIGH HOPES ON CAPTURING HEALTH MOMENTUM — Reining in the cost of health care — and medicines, in particular — remains a priority for lawmakers in both parties. What happens on Capitol Hill over the next few weeks could be pivotal for how the battle over prices plays out over the rest of the year, Megan reports.

Looking toward the 2024 elections, Senate Majority Leader Chuck Schumer is evidently hoping to seize the bipartisan moment to bring a package of drug pricing bills to the floor this month. The New York Democrat is interested in legislation that would cap the cost of insulin, make pharmacy benefit managers less opaque and bolster access to generic drugs.

It’s all still coming together — and the debt ceiling kerfuffle puts timing in flux — but here’s what to watch:

  • The Senate Health, Education, Labor and Pensions Committee kicks it all off tomorrow with a markup of three measures that would increase access to generic drugs and a 91-page bill targeting PBMs’ business practices. Keep an eye on which amendments are offered. Next week, the committee will hear from executives from the top three insulin manufacturers and the three largest PBMs.
  • Senate Finance Chair Ron Wyden (D-Ore.) and ranking member Mike Crapo (R-Idaho) last month unveiled a framework of the PBM-centric policies they agreed to pursue. Wyden wants to drop a bill on those issues by the summer.
  • The Senate Judiciary Committee advanced several bills meant to lower drug prices by targeting how brand-name drugmakers use the patent system — something Schumer has been mulling, including in his drug pricing effort.
  • The Senate Commerce Committee moved legislation from Sens. Maria Cantwell (D-Wash.) and Chuck Grassley (R-Iowa) that takes on PBMs, including giving the Federal Trade Commission more power to oversee them. It’s viewed skeptically by some Republicans who fear the FTC will overstep.
  • In the House, the Energy and Commerce Committee has taken a more wide-ranging approach that puts the spotlight on PBMs, health plans and hospitals for their role in rising health care costs. Most of the 17 proposals under consideration have bipartisan support, including some PBM-centric proposals similar to measures in the Senate and another that would step up price transparency rules for hospitals and insurers.

WELCOME TO MONDAY PULSE — We would be remiss if we did not take a moment here to appreciate our colleague Eugene Daniels’ hot pink tux at the WHCA dinner over the weekend, a ray of velvet light at the nerd prom. Any good gossip to share the weekend’s festivities? Send it over, along with news and tips, to [email protected] and [email protected].

TODAY ON OUR PULSE CHECK PODCAST host Ruth Reader talks with Ben Leonard about legislation that would give Medicare patients permanent access to virtual care and the DEA regulation that could simultaneously curtail telemedicine access to some drugs.

Lobby Watch

FIRST IN PULSE: PhRMA’s ANTI-PBM CAMPAIGN — The Pharmaceutical Research and Manufacturers of America is launching a seven-figure nationwide ad buy spanning TV, radio, social media and print that slams pharmacy benefit managers — part of a yearslong campaign against the industry, Megan reports.

The ad focuses on a criticism that PBMs — which negotiate discounts on medicines with drugmakers and choose which drugs a health plan will cover — favor covering higher-cost drugs because they can extract larger rebates, a claim the industry denies.

“Because PBMs receive fees and rebates often tied to the price of medicines, they have a financial incentive to refuse coverage for lower-priced treatments. Ultimately, it’s patients who pay the price,” Robby Zirkelbach, a spokesperson for PhRMA, writes in blog post this morning.

— There has been a flurry of high-dollar industry group advertising to push preferred policies as momentum for bipartisan health care measures grows on Capitol Hill.

America’s Health Insurance Plans, the top insurer industry group, recently kicked off its own seven-figure ad blitz that hits pharmaceutical manufacturers and blames them for high drug costs.

Earlier this year, PBMs launched a seven-figure nationwide ad campaign to promote the benefits of the industry, which is pushing for patent reform legislation and slamming the Commerce Committee’s bill.

But that’s not all. There’s also the recent push from hospitals, which are firing back against bipartisan proposals to tweak site-neutral payment policies that would ensure Medicare and patients pay the same amount for a service regardless of where it’s performed.

In Congress

WILL VULNERABLE DEMS CAVE ON FOOD AID? House Republicans’ hope of forcing concessions on food aid in the debt limit talks rest on a handful of moderate Democratic senators, reports POLITICO’s Meredith Lee Hill.

Republicans are trying to convince Democratic senators up for reelection in swing states in 2024 that increasing work requirements for federal food assistance would be good politics back home.

Flipping those handful of moderate senators would raise the pressure on President Joe Biden to consider some version of the GOP proposal in any potential deal he makes with House Republican leaders to raise the debt ceiling later this year.

Sen. Joe Manchin (D-W. Va.) has signaled he could be open to such proposals, but other vulnerable Democrats have so far avoided weighing in too much about the GOP push for additional SNAP restrictions.

If the Democratic caucus holds firm, there’s little chance the GOP will be able to tack on new food aid restrictions to any final agreement.

Abortion

FACING ABORTION ‘HEAD ON’ — Republican National Committee Chair Ronna McDaniel said Sunday that Republicans must directly address abortion if they hope to succeed in 2024, POLITICO’s Kelly Garrity reports.

“Abortion was a big issue in key states like Michigan and Pennsylvania, and so the guidance we’re going to give to our candidates is, ‘You to have to address this head-on,’” McDaniel said during an interview on “Fox News Sunday,” referring to the outcome of the 2022 midterms.

“You need to say, ‘Listen, I’m proud to be pro-life.’ ... We need to find consensus among Democrats and Republicans.”

At the White House

FENTANYL AND SURVEILLANCE — The Biden administration is leaning into the need to crack down on fentanyl trafficking from Mexico to convince lawmakers to reauthorize a controversial surveillance program, POLITICO’s Erin Banco and John Sakellariadis report.

Administration officials have been stressing the need to track Mexican cartels and their Chinese suppliers in their push for Congress to reup the Foreign Intelligence Surveillance Act’s Section 702 before it expires at the end of the year.

The hope is that lawmakers can be convinced it’s worth reupping the program — which some say has become a backdoor for the FBI to surveil Americans — by invoking a drug crisis that has sparked outrage among politicians across the country.

Fentanyl and other opioids killed more than 70,000 Americans in 2021 alone, according to the Centers for Disease Control and Prevention.

At the Agencies

FOURTH SHOT AUTHORIZED FOR IMMUNOCOMPROMISED KIDS — The FDA has authorized emergency use of a fourth dose of the Pfizer-BioNTech’s Covid-19 bivalent vaccine for certain immunocompromised kids aged 6 months through 4 years old that already received three shots, David reports.

“Additional doses that may be administered at the discretion of the healthcare provider, taking into consideration the individual’s clinical circumstances,” the agency said in a press release Friday.

What We're Reading

Surgeon General Vivek Murthy writes in The New York Times about America’s loneliness epidemic.

Doctors and researchers in the UK say they’ve developed an AI tool that can accurately detect cancer, the Guardian reports.

As pandemic lockdowns continue in women’s prisons in California, residents’ mental health has taken a hit, STAT reports.