The House and Senate will have to resolve differences over issues including NIH reorganization, antitrust spending and EPA funding for next year's appropriations bills — so get ready for a busy lame duck.

Why it matters: That's not a lot of time for Congress to figure this out. Here's a cheat sheet for what to watch when it begins work, compiled by Victoria with Pro's Ashley Gold, Mackenzie Weinger and Nick Sobczyk.

Health care

HHS funding: There's about a $15 billion difference between the House and Senate, with the House pursuing a 7% cut to the department, citing spending pressures under the caps outlined in the Fiscal Responsibility Act of 2023.

• The House blueprint calls for a 22% cut to the CDC and would eliminate programs for climate change and gun research. Funding for Title X family planning would be zeroed out.
• Senate appropriators would give CDC a small funding increase and maintain Title X while adding spending for pandemic preparedness.

NIH reorganization: The House's Labor-HHS bill also proposes a large-scale reorganization of NIH that would reduce the number of institutes from 27 to 15, streamline research areas and establish an oversight entity to review high-risk research proposals.

• The Senate has no such plans and would boost NIH spending by $2.05 billion over FY24 levels.
• The GOP argues that the overhaul would restore trust in science that it says was eroded during the COVID years. But Democratic critics say any discussion of the subject needs to be bipartisan and bicameral.

Tech

Antitrust spending: The Justice Department is angling for more money for its antitrust division as it ramps up efforts to reel in tech companies, but House Republicans are targeting the agency's appropriations as part of their campaign against what they call the "weaponization of the federal government."

• The antitrust unit would get at least $288 million, a record level, in the Senate's bipartisan Commerce-Justice-Science bill, compared with the House GOP bill's $193 million.

R&D dollars: The heads of tech agencies including NIST and NSF have been on the Hill this year warning that cuts would hurt efforts to outcompete Beijing and make it difficult to protect existing federal staff.

• House Republicans are looking to give NSF a 2% increase above FY24 to $9.3 billion, while the Senate's aiming for $9.55 billion.
• In the House GOP bill, NIST would get $1.4 billion, 3% below this year's level and $83.5 million below the president's ask.
• The Senate bill would provide about $1.54 billion and notably would fund the U.S. AI Safety Institute, which is housed at NIST.

Energy

EPA funding: House Republicans' proposed 20% cut to EPA isn't going to stand, but the agency is headed for another year of constrained funding.

Riders: The big ones include an attempt by House Republicans to toss out the Biden administration's LNG export permitting pause and halt EPA auto emissions and power plant rules.

• But on energy-water, the House is in something of a weak position after leadership was forced to pull the bill from the floor last month.
• Republicans were threatening to vote against it over perceived excessive spending, parochial water project funding and a battery storage provision.

What we're watching: Proposals in the spending bills to force Interior to list copper as a "critical mineral" and respond to the so-called Rosemont decision on mine waste have bipartisan support.

• Sen. Joe Manchin's permitting overhaul is a candidate to ride on a year-end omnibus if he can get the blessing from House Republicans.

Health care industries are rolling out new advocacy campaigns as summer comes to a close, gearing up for the stretch run and hoping to cut through the campaign din, Peter reports.

Why it matters: Things are slow on the Hill at the moment, but preparations will soon ramp up for a year-end health package that could bring big changes to the business models of PBMs or hospitals.

Driving the news: Some advocacy efforts are already launching ahead of Congress' return.

• The employer and insurer group Better Solutions for Healthcare is launching a five-figure digital ad campaign calling on the Senate Finance Committee to act on the SITE Act on site-neutral payments.
• On the other side, the hospital group Coalition to Strengthen America's Health Care said it will launch another seven-figure ad buy in the coming weeks. It did not specify the exact topic, but it has pushed back on site-neutral efforts before.
• The American Hospital Association said health systems spent August engaging with lawmakers over the break about "why additional support is needed to protect patient access to care."
• On another front, 40 patient groups wrote to congressional leaders last week, pushing for extending the enhanced ACA subsidies that are due to expire at the end of next year.

What they're saying: "Everybody's been off in August, which is fantastic and great, but the brains have reset, and they're trying to figure out what that looks like for the end of this year," said Katie Berge, senior director of federal government affairs at the Leukemia & Lymphoma Society, one of the signers of the letter.

Between the lines: PBMs have a target on their back, with a flurry of bills across both chambers and parties.

• PhRMA is pushing for action in the lame duck session. "It's hard to find an issue with as much bipartisan agreement, as many diverse voices calling for action and as widespread voter support as PBM reform," said Alex Schriver, senior vice president of public affairs at the drug industry lobby.
• Greg Lopes, a spokesman for the PBM group PCMA, said pharma is "blaming everyone else, particularly pharmacy benefit companies, for high prescription drug prices" and said PBMs are pushing for policies to increase competition in the drug market.

The Biden administration and Johnson & Johnson are sparring over a company plan to change how safety net providers can get discounts on two popular drugs under the federal 340B program.

Why it matters: The dispute comes as a Senate working group eyes changes to 340B, and after J&J struck agreements with CMS to lower the list prices on the drugs — the blood-thinner Xarelto and the anti-inflammatory Stelara — as part of the first round of Medicare price negotiations.

Driving the news: J&J told 340B hospitals last week that as of mid-October it will require them to buy the drugs at full price, then submit claims data to receive a rebate for the discounted 340B price once they're verified. Ordinarily the savings are realized at the time of purchase.

• HHS' Health Resources and Services Administration, which administers the program, told J&J its rebate plan is inconsistent with federal law, which requires the HHS secretary's sign off, an agency spokesperson confirmed to Axios.
• The secretary has not approved the model, and HRSA "will take appropriate actions as warranted," the spokesperson said.
• A J&J spokesperson said the 340B program isn't meeting its goal of allowing safety net providers to obtain discounted medicines for vulnerable patients and that the company "is implementing reasonable, standard business practices used across other government programs and contracts."
• The rebate model is consistent with the 340B statute, which specifically references rebates as a payment mechanism, the spokesperson said.

340B Health, which represents providers in the program, is urging HRSA to take immediate action and warn other drugmakers, saying a rebate model would impose new cost and administrative burdens on safety net providers.

• The American Hospital Association said it contacted HRSA after the new policy was announced and was also told the rebate model is inconsistent with the 340B statute.

1. Kidney donations: In a bid to ease an ongoing shortage, a House bill proposes giving a $50,000 tax credit to people who donate a kidney, NPR reports.

2. Parents in peril: Surgeon General Vivek Murthy issued an advisory highlighting stress factors that weigh on parents and caregivers, Axios' Tina Reed reports.

3. PBM testimony: House Oversight Chair James Comer wrote to executives of top PBMs, asking them to correct remarks they made at a July hearing that he said contradict committee and FTC findings about the industry's self-dealing.