The lame duck session could break gridlock that's kept key programs on pandemic preparedness, opioid addiction and the global AIDS epidemic from getting renewed so far this session, Victoria and Peter report.

Why it matters: Some of the efforts continue to get funded through the annual appropriations process, making their renewal less of an imperative but leaving policy updates on hold.

Here's a rundown of expired programs that will command attention, though passage likely depends on a large-scale health deal coming together:

PAHPA

• The Pandemic and All Hazards Preparedness Act's reauthorization expired over a year ago, at the end of September 2023, and there hasn't been much action since.
• Temporary renewals addressing matters like responding to natural disasters have been wrapped into stopgap spending packages since last year.
• One lobbyist told Victoria and Peter that it's possible that such health security provisions would be extended for another two years in the next funding deal. But most everything else is likely to be deferred until after the election.
• House conservatives also continue to oppose a PAHPA reauthorization without changes like cutting funding levels and establishing a vaccine liability commission.

SUPPORT Act

• The reauthorization of the SUPPORT Act, which includes a range of programs aimed at fighting the opioid crisis, has bipartisan backing, but has been stalled since last year's deadline for renewal passed.
• One envisioned bipartisan change would allow state opioid response grants to be used to treat other substance use disorders, such as alcohol addiction, that can co-exist with opioid addiction.
• There's still disagreement over whether to attach separate legislation expanding the availability of methadone as an opioid addiction treatment.

PEPFAR

The President's Emergency Plan for AIDS Relief was authorized for one year when the FY24 funding deal came together this spring. It marked the first time the program wasn't reauthorized for a five-year period since its creation in 2003.

• This short-term authorization leaves the program expiring again in March 2025 if lawmakers don't take action at the end of this year or early in the new Congress, when they'll likely have many other issues on their plate.
• Some congressional Republicans raised concerns last year that some of the program's funds were being used to fund abortions.
• If former President Trump wins the election, he will have more sway over whether and how the program is altered because of the short-term renewal.

More than half of the House is calling on leadership to avert scheduled Medicare physician payment cuts for next year, and to enact longer-term payment reforms, Peter reports.

Why it matters: A letter from a bipartisan group of 233 lawmakers, led by Rep. Mariannette Miller-Meeks, provides momentum for doctor payment issues to be addressed in a year-end health package.

What they're saying: "Continued payment cuts undermine the ability of independent clinical practices — especially in rural and underserved areas — to care for their community, which reduces patient access to care," the letter states.

• It calls for both averting the scheduled 2.8% cut in Medicare payments to doctors next year and enacting longer-term changes, such as a permanent annual payment update that better accounts for inflation.

Yes, but: Addressing physician payment cuts has become an annual rite for lawmakers, and the most likely outcome is another partial fix. Longer term changes may have to wait until next year.

• While there is bipartisan support for changes, paying for those fixes is always an issue. The letter calls for using "bipartisan offsets," but finding enough of those is often easier said than done.

The next Congress and president have few policy options for lowering prescription drug prices that would deliver significant results, CBO says in a new review of seven approaches.

Why it matters: It shows how the ongoing Medicare drug pricing negotiations could be the only vehicle in the near term to bring down some pharmaceutical prices.

The big picture: Growth in U.S. brand-name drug prices has outpaced inflation in recent years, with federal projections showing the retail prescription drug market will total $690 billion in 2031.

• By CBO's measuring stick for a "large effect," a policy would have to reduce average prices for the market by more than 5% in 2031. 

What they found: The only approach that would meet that description would be setting maximum allowed prices based on prices outside the United States — the "most favored nation" policy former President Trump's campaign first embraced but has since dropped.

• Other approaches such as making negotiated drug prices available to all commercial purchasers, or requiring pharmaceutical manufacturers to pay inflation rebates for sales in the commercial market, would result in a 1% to 3% reduction in average prices.
• And steps like eliminating or limiting direct-to-consumer prescription drug ads or facilitating earlier market entry for generic and biosimilar drugs would yield reductions of 0.1% to 1%.

1. Walgreens cuts: Walgreens Boots Alliance is closing about 1,200 stores as it continues to struggle with soft retail sales, labor crunches and low drug reimbursement rates.

2. Opioid lawsuits: Members of the Sackler family who own Purdue Pharma said they intend to fight lawsuits against them by challenging the use of public nuisance laws that have led to billions in opioid-related settlements. More from WaPo.

3. Bird flu: California officials reported five more possible bird flu cases in dairy workers, but said there's no evidence suggesting the virus had increased ability to infect or to spread among people.