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Tough choices loom on policies for spending package

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Illustration: Annelise Capossela/Axios

With the deadline for funding the government 10 days away and lawmakers trickling back into town, we're about to get more clarity on what health policies can hitch a ride on the spending package.

The big picture: There's a long way to go for a deal on the health care pieces — and while congressional leaders reached a topline deal on overall government funding, there's still no agreement on allocations for different subcommittees, Senate Appropriations Vice Chair Susan Collins said.

  • She expressed concern that lawmakers have "so little time" before the funding deadline.

Yes, but: The House passed its big health price transparency bill on a bipartisan basis before the break, providing a coherent starting point for cross-chamber talks, possibly with other elements added in.

What they're saying: Senate Finance Committee Chairman Ron Wyden told Axios on Monday evening that he is "absolutely" still pushing his committee's PBM policies for the upcoming package.

  • Those include "delinking" PBM compensation from the price of a drug and pushing back on PBMs' practice of steering patients to pharmacies they own.
  • Wyden did not have anything firm on the likelihood of that happening, though.
  • He said over the break he "would walk into pharmacies in small towns and they would say, 'Get those middlemen.'"

What we're watching: If there ends up being a substantial health care section of the package, the SUPPORT Act reauthorization covering a range of programs for treating and preventing opioid addiction also could make it in.

  • The House and Senate have yet to bridge the gap between their respective versions.
  • A bill to expand access to the opioid addiction treatment methadone also advanced out of the Senate HELP Committee but could face tough sledding with House Republicans, given law enforcement concerns.

Victoria Knight contributed reporting.

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