Illustration: Sarah Grillo/Axios
The House Energy and Commerce health subcommittee on Wednesday laid the groundwork for continuing last year's efforts to overhaul PBM business practices, possibly including new transparency measures and eliminating spread pricing in Medicaid.
Why it matters: There may still be bipartisan support for pursuing PBM legislation, as long as it's not combined with a partisan bill — a red line that Democrats reinforced during the hearing.
State of play: A package of PBM changes advanced out of the committee last Congress and was included the December health package.
- Health subcommittee Chair Buddy Carter referenced his Drug Price Transparency in Medicaid Act, which would have banned spread pricing in Medicaid, among other goals.
- E&C Chair Brett Guthrie raised questions around rebate models, as well as transparency and delinking PBMs' compensation from the cost of drugs in Medicare.
Friction point: But Democrats remain upset that Republicans pulled out of a bipartisan deal and dropped the large package of health provisions from the year-end funding deal that addressed PBMs, drug patents and other issues.
- E&C Health Ranking Member Diana DeGette said that Republicans should keep PBM policies out of their reconciliation package — possibly because of "germaneness" — and bring up a standalone bill.
- "What is the plan of the majority to get that bipartisan plan, including PBM reform [and] all these important health care extenders that we agreed on last year, to the floor?" DeGette asked.
- Carter responded that the GOP isn't clear on next steps, but that "it will be cleared up soon."
- DeGette said she'd guarantee that a bill combining PBM reforms and extensions of expiring health programs would get every Democratic vote, if it's brought up under suspension before the next government funding deadline.
What we're watching: It's still unclear whether House Republicans will try to revive the health package intact or wrap PBM policies into some other bill later in the year.
- Temporary health extenders funding community health centers, delaying Medicaid DSH payment cuts to safety net hospitals and extending Medicare telehealth flexibilities expire by the end of next month.
Last night's tight budget resolution vote also loomed large at the hearing.
- Democrats repeatedly brought up potential Medicaid cuts, while Republicans said they want to target only "waste, fraud and abuse."
