January 23, 2024
Happy Tuesday. We have a look at how efforts to renew legislation to address the opioid crisis are dividing the House and Senate ahead of a critical funding deadline.
- Plus, more than a dozen senators want an update on a federal probe of PBMs.
β‘οΈDon't miss: Download our latest white paper on drug pricing and health care legislation to watch this year.
1 big thing: Chambers split on opioid response
Illustration: Shoshana Gordon/Axios
Key efforts to fight the opioid overdose crisis are among the many issues that Congress has punted to the looming March 1 government funding deadline, Peter reports.
Why it matters: The House and Senate need to work out their differences on the SUPPORT Act reauthorization and related policies if the anti-addiction measures are going to hitch a ride on the larger government funding package.
- Lobbyists and aides say the chambers are not close to a deal and that there are at least three prominent sticking points.
Xylazine: The House version would make xylazine, a drug increasingly linked to overdose deaths, a Schedule III controlled substance, a provision not included in the Senate measure.
- It remains to be seen if any Democrats put up a fight on the argument that criminalizing drugs is not the most effective approach.
Methadone: On the flip side, the Senate HELP Committee approved a measure to make methadone, a treatment for opioid addiction, more available.
- The effort has support from the American Society of Addiction Medicine, which says it would be a major step in fighting the opioid crisis.
- HELP Ranking Member Bill Cassidy supported that bill, but it faces an uphill climb among House Republicans, given law enforcement concerns about improper use of methadone.
- Existing methadone clinics, where patients often have to travel in person, are also lobbying against the measure, which would expand access outside of the clinic system.
Medicaid: Republicans have put a priority on making permanent an option for states to provide Medicaid coverage for inpatient addiction treatment β a policy referred to as lifting the IMD exclusion.
- Democrats in exchange could seek to include policies around Medicaid coverage for people getting out of prison, given that people are much more likely to overdose upon being released.
- Republicans have said that providing coverage for up to 30 days before release, as stipulated in the Medicaid Reentry Act, is too costly.
- So narrower, less expensive options are being considered. The House package would require states to suspend, rather than fully terminate, Medicaid coverage while someone is in prison, to make it easier for them to restart coverage once released.
- Senate Republicans have yet to agree to requiring states to do that.
What they're saying: Senate Finance Committee Chairman Ron Wyden on Monday pointed to the mental health and addiction policies included along with PBM changes in what his panel advanced in November.
- Asked about Medicaid coverage for people leaving prison, Wyden said: "We need some new policies that help us get people who are in our care off of drugs, because they're going to be back on the street. The policies of yesteryear don't fit."
- Rep. Paul Tonko, a lead sponsor of the Medicaid Reentry Act in the House, said he is "pushing hard" for its inclusion to ensure "targeted, compassionate treatment to our most vulnerable."
2. First look: Senators want update on PBM probe
Illustration: Tiffany Herring/Axios
A bipartisan group of senators wants an update from the Federal Trade Commission on its probe of PBMs, according to a letter from 14 lawmakers, Axios' Maya Goldman scoops.
Why it matters: The FTC has been studying business practices of the six largest PBMs for a year and half now β including clawbacks charged to pharmacies, reimbursements, and the rebate systems set up by drug manufacturers β but it hasn't produced any findings.
- Congress is expected to require changes to PBM practices this year, though action won't happen until the next government funding deadline, at earliest.
- The Senate Judiciary Committee also advanced a bill in September that would require the FTC to study pharmacy benefit consolidation and send a report to Congress within one year.
What they're saying: The letter, led by Sens. Chuck Grassley and Maria Cantwell, urges the FTC to complete its study "in a timely manner" and to release a status report in the interim.
- "A commitment to a timely study and interim progress report will provide transparency, insight about possible competitive harms, and inform the responsiveness and cooperation of impacted parties," the letter says.
The FTC can subpoena information. In May, it expanded its study to look into two companies that negotiate rebates on behalf of PBMs.
The other side: An FTC spokesperson told Axios the study is ongoing and would not comment on when findings could be released.
- It's not unusual for FTC studies to take years. The agency took three years to complete research into businesses that acquire patents from third parties, in connection with IP litigation reform.
β Thank you for reading Axios Pro Policy, and thanks to editor Adriel Bettelheim and senior copy editor Bryan McBournie.
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