Illustration: Sarah Grillo/Axios
The sweeping health section of the continuing resolution text is now circulating, and a copy obtained by Axios shows it includes major provisions on PBMs, hospital costs, telehealth and other health extenders.
Why it matters: It includes a two-year extension of Medicare telehealth flexibilities, funding for community health centers, reforms to how PBMs are paid, and reauthorizations of the Medicare hospital-at-home program, PAHPA and the SUPPORT Act.
- The legislative text we received was dated 7:01 pm on Monday. There's also a section-by-section summary. It's possible that last-minute minor changes could still be added to the text.
What's inside: The major PBM reforms include "delinking" of the price of a drug from PBM compensation in Medicare Part D, and full rebate pass through to the plan sponsor in the commercial market. There's also a ban on spread pricing in Medicaid.
- Those are some major bipartisan reforms on PBMs aimed at lower drug costs that follow years of debate.
- The PBM provisions represent a victory for the pharmaceutical industry, which has blamed PBMs for driving up the costs of medicines.
- That is tempered slightly by the inclusion of the measure cracking down on drug "patent thickets" that supporters say drugmakers use to delay competition with generics.
- On the hospital front, the CR includes a provision requiring each off-campus hospital outpatient department to be assigned a unique identifier number, a preliminary move toward addressing hospital costs, in response to complaints about "dishonest billing."
Zoom in: Here are some of the other measures included in the package.
- It puts off the Medicaid DSH payment cuts for FY 2025 until January 1, 2027.
- It has a temporary increase in the Medicare Physician Fee Payment schedule of 2.5% for 2025, averting most of a scheduled cut.
- It extends certain Medicare telehealth flexibilities until Dec. 31, 2026.
- Acute-hospital-at-home flexibilities are extended through Dec. 31, 2029.
- Medicare coverage of multi-cancer early detection screen tests are extended until Jan. 1, 2029.
- There's an extension of community health center funding through FY2026, with $4.6 billion designated for 2026.
- It includes a five-year extension of the priority review voucher program through FY2029.
- It reauthorizes both SUPPORT and PAHPA programs.
Yes, but: As we reported yesterday, the Medicare Advantage prior authorization reforms were dropped from the text, due to disagreements between Democrats and Republicans on how to actually implement the policy changes.
