Illustration: Annelise Capossela/Axios
The last holdup to a major year-end health care package is a dispute over the details of a provision to streamline the prior authorization process in Medicare Advantage, sources say.
Why it matters: Once that dispute is resolved, Congress is poised to have a significant health care deal that can ride on the continuing resolution next week.
Driving the news: A Democratic congressional aide described the last sticking point as Republican attempts to water down the prior authorization changes.
- A GOP aide responded: "Republicans cleared their schedules to fix issues the Biden administration identified that would have undermined CMS authorities."
- "Democrats abandoned talks at the last minute with no interest in addressing them," the aide added.
The big picture: Beyond prior authorization, sources say details of the major package include:
- Two-year extensions of Medicare telehealth flexibilities and community health center funding.
- PBM provisions including "delinking" compensation from the price of a drug in Medicare Part D, and a requirement that rebates be passed through in full to the plan sponsor in the commercial market.
- A bipartisan bill aimed at lowering drug costs that addresses "patent thickets" used to delay generic competition, which has been added back in.
- A hospital cost provision to require a unique identifier number for billing from off-campus outpatient departments
- Reauthorizations of the SUPPORT Act on the opioid crisis and PAHPA on pandemic preparedness.
