With one unanimous vote, the House Budget Committee may have boosted the prospects for legislation to extend Medicare coverage to blockbuster weight-loss drugs, Victoria reports.

• The Preventive Health Savings Act, approved 30–0 yesterday, would revamp how the CBO scores certain health care bills, to factor in hypothetical cost savings from screenings, health monitoring and other preventive services.

Why it matters: That could extend to GLP-1 drugs approved for weight loss like Wegovy, which can cost tens of thousands of dollars annually and currently aren't covered by Medicare.

• The FDA says the treatments could reduce the risk of heart disease, stroke, diabetes and certain types of cancer.

Don't forget: The CBO, in an October blog post, warned that legislation like the Treat and Reduce Obesity Act to expand federal coverage of the drugs would drive up overall federal spending by adding significant costs to Medicare over the next decade.

Details: The Budget Committee's legislation would allow the CBO not only to factor in cost savings but also to score bills past its customary 1o-year window, to as much as 30 years.

• Bigger savings over a longer period might ease concerns about increasing Medicare spending and threatening the program's insolvency.
• "It would probably save lives because we would be able to approve health care that actually prevents disease rather than the other way around," Rep. Diana DeGette, the bill's Democratic cosponsor, told Victoria.

By the numbers: Wegovy is estimated to have an annual net price of $13,600.

• A recent study estimated that if 10% of Medicare beneficiaries with obesity used Wegovy, the annual cost to Medicare could be as much as $26.8 billion, based on varying estimates of obesity rates in seniors.
• For context, Medicare spent $98 billion on all Part D prescription drug benefits in 2021, KFF noted.

The intrigue: Health policy experts say there's still not enough evidence that using obesity drugs would actually reduce Medicare's long-term outlays.

• "We know for sure that expanding Medicare's coverage of anti-obesity medications would increase program spending initially," said Juliette Cubanski, deputy director of the program on Medicare policy at KFF.
• The hope, she added, is "people who take these medications would have improved health outcomes as a result and in theory, that could reduce future health care spending,"
• But she and others note that although the drugs have been used to control diabetes for years, they haven't been in use long enough for weight loss to calculate long-term budgetary effects.
• In fact, questions remain about how the drugs work, including how long patients should stay on them.

Jackson Hammond, health care policy analyst at the American Action Forum, said evidence shows that in general, only about 20% of all preventive medicine measures are effective at both preventing bad health outcomes and saving money.

• Then there's the question of how long the drugs need to be taken to continue seeing health benefits and keep weight off, said Stacie Dusetzina, health policy professor at Vanderbilt University.
• "While the clinical data on some of the outcomes is really good … having to take those chronically does put a big question mark on what that means for long-term savings," she said. "You have to continue to spend money to get those benefits."

What we're watching: Lawmakers were optimistic that they can get the measure to the House floor, noting that it's seen as a legacy item for Rep. Michael Burgess, who is retiring at the end of this Congress.

The House today narrowly passed legislation that would prohibit quality-adjusted life years from being used in federal health programs, Victoria reports.

Why it matters: The health metric has been widely criticized for being discriminatory and devaluing people with disabilities. But health policy experts say QALYs are critical in analyzing the costs and benefits of drugs.

Driving the news: The bill, a priority of Energy and Commerce Chair Cathy McMorris Rodgers, passed in a party-line vote of 211–208.

• But it could face long odds in the Senate after the White House came out against the measure.
• The Biden administration said Monday that the legislation would undermine the Affordable Care Act by stripping dollars from the law's Prevention and Public Health Fund.
• "Measures of effectiveness are essential to delivering higher-quality and lower health care costs, and are an important part of our health care system," the White House said.
• Energy and Commerce Ranking Member Frank Pallone also argued that it could enable pharmaceutical companies to mount legal challenges to drug price negotiations and contest other efforts to reduce costs.

Catch up quick: QALYS are used to calculate how many years a drug could help prolong a person's life, but factor how a patient feels during those extra years.

• It's one way health program administrators decide if a medicine is worth its price.
• But critics — including former Rep. Tony Coelho, a primary sponsor of the Americans with Disabilities Act — say they're inconsistently applied across federal programs.
• Some House Democrats back the idea of stopping the use of QALYs but want to ensure that other nondiscriminatory comparative effectiveness measures are still used to determine drug coverage.

The House Oversight Committee found some bipartisan consensus on overhauling PBM payments yesterday, advancing a measure that would use a flat fee instead of pegging payments to a percentage of a drug's cost, Victoria reports.

Why it matters: The DRUG Act, which we wrote about in the fall, aims to remove an incentive for PBMs to favor drugs with high list prices.

• But the Oversight Committee considered only the provisions within its jurisdiction covering the Federal Employee Health Benefits program.
• Beyond overhauling payments, there are provisions that prohibit steering patients to pharmacies that are owned by PBMs and ban spread pricing.

Between the lines: The bill was approved 29–11.

• Reps. Eric Burlison and Paul Gosar were the only GOP "no" votes, arguing that delinking was not the way to reduce drug price costs. Nine Democrats voted against the bill, including Ranking Member Jamie Raskin.