Skepticism is building over the likelihood of a major health package before the end of the year as Congress weighs whether to dispense with a slew of unresolved health issues or opt for a bare-bones lame duck session.

Why it matters: The fate of PBM reforms, drug patent changes and prior authorization measures hinges on how ambitious lawmakers get, Peter and Victoria report.

Between the lines: Much of the immediate focus is on whether to pass a short-term government funding extension into early next year, which would decrease prospects for a big health package.

• A CR that extends to March, for example, would give the incoming Trump administration and the next Congress more options for shaping health policy.
• House Majority Leader Steve Scalise is also suggesting a push to continue funding through September, as our colleagues at the new Axios Hill Leaders newsletter reported.
• But if lawmakers instead decide to "clear the decks" for the incoming administration, there's a better path forward for health riders.
• Senate Democrats will likely push for an omnibus package, seeing it as their last opportunity to influence policy for at least two years.

President-elect Trump is visiting the Capitol tomorrow, which should help crystallize the GOP's views on next steps.

Don't discount that a number of retiring lawmakers will push their health priorities, including retiring Energy and Commerce Chair Cathy McMorris Rodgers, who wants the Lower Costs, More Transparency Act to become law.

• Retiring physician Reps. Brad Wenstrup, Michael Burgess and Larry Bucshon also want to address a nearly 3% Medicare physician payment cut that takes effect in 2025.

State of play: A number of health extenders expire at the end of the year that will at least have to be addressed even in a minimalist session.

• They include community health center funding and Medicaid DSH payment cuts to hospitals.
• Also, programs including pandemic-era Medicare telehealth flexibilities and the Medicare hospital at-home program are also widely expected to be extended for several years.
• Prospects also are good for a limited "doc fix" partially addressing the Medicare physician payment cut.

The big picture: Items not facing must-do deadlines face a tougher path, even if they have the advantage of saving money that can be used to pay for other priorities.

• Those include PBM changes, site-neutral reforms to Medicare hospital payments and legislation addressing "patent thickets" that slow down generic drug competition and insurers' pre-treatment approvals.
• The Biosecure Act, meanwhile, could have a separate track in the National Defense Authorization Act, though its fate is not certain.

The bottom line: Much will depend on what Trump wants in a spending deal, since that will likely be the vehicle for add-ons other than the Biosecure Act.

• It's never a bad bet with Congress to assume things will be punted.

AARP is launching a million-dollar ad campaign aimed at getting Congress to pass a tax credit for family caregivers, Maya Goldman scoops.

Why it matters: Trump said last month that he supports a tax credit for people who take care of their family members.

• Bipartisan legislation in Congress, backed by AARP, would create a tax credit for employed family caregivers who attend to a loved one who is certified by a medical provider as needing long-term care.

AARP will pay $1 million overall to run ads targeted at the D.C. policy crowd today through Nov. 21.

• The ads will appear in Axios, Punchbowl, Fox News, the New York Times and other news outlets, and on social media.
• A 30-second spot will air Sunday during Fox's and CNN's morning political shows.
• It's the most money AARP has invested at one time to advance a family caregiver tax credit, the organization told Axios.

Zoom in: The ads will air during the lame duck session but call on the next Congress to pass the tax credit.

• "More than 48 million people take care of their parents, spouses and other loved ones, spending over $7,000 every year from their own pockets. Family caregivers can't afford that," the video ad says.
• "With a new Congress, it's time to act," it continues.

Here's an update as of 1pm ET on the House and Senate races we told you to watch that could help shape next year's health care agenda:

• Gabe Evans defeated Rep. Yadira Caraveo in a tight contest for Colorado's 8th Congressional District.
• Rep. David Schweikert prevailed over physician Amish Shah in Arizona's 1st Congressional District.
• And Sen. Jacky Rosen defeated Sam Brown in Nevada, while Sen. Tammy Baldwin held off Eric Hovde in Wisconsin.

1. Brain drain: A second Trump administration could trigger an exodus of scientists and career staff from federal health agencies, Axios' Caitlin Owens, Alison Snyder and Tina Reed report.
2. Drug patents: The Senate Judiciary Committee is due to mark up a pair of bills that aim to overhaul the patent process, including for drugs and genomics. It begins Thursday at 10am ET.
3. 340B oversight: With 75% of the vote tallied, the California ballot initiative to require that 98% of revenue from the federal drug discount program be used on patient care is still too close to call. (NYT count here)
4. Research chimps: NIH reversed course in a standoff with animal welfare advocates and authorized the transfer of a group of elderly former research chimpanzees to a federal sanctuary in Louisiana, Science reports.

1. Price transparency: An HHS inspector general's report found that almost half of 100 surveyed hospitals weren't fully complying with CMS' hospital price transparency rule.
2. Health equity: CMS announced it was establishing a health equity advisory committee and solicited nominations for members to be appointed by the director of the Office of Minority Health.
3. Hospital deductibles: Medicare announced inpatient hospital deductibles and hospital and extended care coinsurance amounts for services provided in 2025.