Conservative groups are calling on GOP leaders to roll back the drug pricing provisions of the Inflation Reduction Act and seeking to elevate the issue on the party's agenda for the next Congress, Peter reports.

Why it matters: The letter to Speaker Mike Johnson and Senate GOP Leader Mitch McConnell comes two days ahead of the first presidential debate, and highlights the political stakes around Democrats' efforts to lower drug prices.

What they're saying: The groups portray the Medicare drug price negotiations as heavy handed and economically ruinous.

• "History shows that price controls never achieve their stated ends and the IRA's price controls are further evidence," the letter states, suggesting alternative policies like passing rebates paid to PBMs on to patients.
• The letter is signed by groups including Americans for Prosperity, Americans for Tax Reform and CPAC.
• The effort was organized by Ryan Ellis, president of the Center for a Free Economy and a lobbyist for Akin Gump, which has drug industry clients.

The big picture: Repeal of the IRA drug pricing provisions will realistically only be on the table if Republicans sweep the House, Senate and White House in November.

• Even if that happens, congressional Republicans, while highly critical of the law, have not gone into detail about their plans for next year.

Between the lines: Dean Clancy, senior health policy fellow at Americans for Prosperity, said there are options short of full repeal, including eliminating the 95% tax imposed on companies that refuse to participate in the Medicare negotiations.

• Grace-Marie Turner, president of the Galen Institute and another signer of the letter, said it is unclear if full repeal is possible.
• "Whether the whole thing could be repealed or not is a political question, not a policy question," she said. "But we certainly are going to be at the table offering as many ideas and suggestions as we can."

The other side: Democrats have made drug price negotiations a centerpiece of their campaign pitch, saying they are lowering the cost of some of the costliest drugs to Medicare and saving patients and the government money.

• The CBO has projected about $100 billion in savings over a decade.

House Ways and Means is on track to mark up the Treat and Reduce Obesity Act on Thursday, multiple lobbyists tell Victoria.

Why it matters: It would be a significant first step towards reversing a policy that prevents Medicare from covering blockbuster weight-loss drugs like Wegovy and Zepbound.

Between the lines: There's been much discussion around how Medicare would pay for the anti-obesity medications that are often priced at over $1,000 per month. The CBO has previously warned that coverage could come at a significant cost to the program.

What's inside: Ways and Means Republicans have already discussed scaling back the bill, by limiting coverage to individuals who are already taking the medication and then age into Medicare, said lobbyists.

• A GOP committee spokesperson did not respond to a request for comment.

The big picture: Reducing the number of seniors who would be eligible for coverage of the drugs would likely lower the bill's cost and potentially make it more acceptable to lawmakers concerned about Medicare's finances.

• Ways and Means' Rep. Brad Wenstrup has been a longtime co-sponsor of TROA and wants to see movement on the bill before he retires at the end of this Congress.

Lobbyists said Ways and Means also plans to mark up other bipartisan health bills, including:

• The Ensuring Patient Access to Critical Breakthrough Products Act of 2023, which would allow for Medicare to cover breakthrough medical devices for a four-year temporary period.
• The Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act which would allow Medicare to cover multi-cancer early detection screening tests.

The CBO now projects that extending enhanced ACA subsidies next year would increase the deficit by $335 billion over a decade, Victoria reports.

Why it matters: It puts a dollar figure on savings Republicans could claim if they opt to let the premium tax credit subsidies expire next year.

• It also offers a metric if there's a grand bargain pairing a renewal with an extension of 2017 tax cuts that also expire in 2025.

What's inside: The Congressional Budget Office and the Joint Committee on Taxation were responding to a May request for a score from the House Budget and Ways and Means committees.

• 3.4 million more people on average each year are estimated to become insured if the tax credits become permanent, and there would also be an increase in Medicaid and CHIP coverage.
• The estimate stated that more employers would likely change their insurance offerings if the law became permanent, and there would overall likely be a decline in people enrolled in employer-based coverage.
• The annual tax benefit would be $4,350 on average for those who no longer enroll in an employer plan.
• 69% of the subsidy cost would be for those below 400% of the federal poverty limit under a permanent extension.

What we're watching: Republicans will likely use these figures to make the case that extending the subsidies would negatively affect employer-based coverage and cover people who don't need the financial assistance.

1. Labor-HHS markup: The House Appropriations Labor-HHS subcommittee marks up the spending bill covering HHS Thursday at 8am ET. Watch for the breakdown of allocations to individual agencies like NIH and CDC.

2. SCOTUS decisions: Justices have scheduled decisions for Wednesday, Thursday and Friday, with big implications for the "Chevron deference," abortion care in medical emergencies and Purdue Pharma's bankruptcy.

3. Value-based care: The House Ways and Means health subcommittee holds a hearing on value-based care and ways it can be improved for patients and providers Wednesday at 3pm ET.

4. Vaccine review: CDC advisers begin a three-day meeting tomorrow to begin reviewing options for updated COVID-19, flu and pneumococcal shots and the effectiveness of RSV vaccines.