Lots of Healthcare Activity in Congress 

Activity in Congress focusing on healthcare issues has increased over the last few weeks and is not slowing down anytime soon. This week, the Senate Health, Education, Labor, and Pensions (HELP) Committee will hold a markup of three measures that would increase access to generic drugs and a bill targeting pharmacy benefit manager (PBM) business practices. The Senate Finance Committee will also hold hearing on mental health provider networks, and the Senate HELP Committee will hold a hearing on reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA). PAHPA’s current expiration date is September 30, 2023. This would be PAHPA’s first reauthorization since the COVID-19 pandemic, and there are significant lessons learned and issues to address from this experience.

Last week the House Energy and Commerce Committee held a hearing on 17 pieces of legislation focusing on transparency and competition in the healthcare system, that could have a significant impact on certain providers, plans and PBMs. During the hearing, committee members expressed bipartisan support for increased transparency to better understand what drives high pharmaceutical and healthcare costs. PBM practices were also a major concern to the committee. It appears that the common denominator across the House and the Senate may be PBMs. However, what is key to any bill moving forward is the Congressional Budget Office score. Bills that can save the government money are in the most demand, and those that save money and have bipartisan support are definitely in the running to move forward. Bills that cost money have potential if they have bipartisan support, but they need ways to be paid for—which brings us back around to why bills that save money are so attractive.

On April 27, 2023, the Centers for Medicare & Medicaid Services issued two proposed rules for the Medicaid Program: Ensuring Access to Medicaid Services, and Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality. Together, these proposed rules are designed to establish consistent access standards via greater transparency and new and updated reporting requirements for states and Medicaid managed care plans. If the proposed rules are enacted, the Administration believes these changes would make it easier to review and assess Medicaid payment rates across states, and enrollees would be better able to compare plans based on quality and access.