A prospective new CBO score could boost chances for action on a long-stalled measure revamping insurer preapprovals in Medicare Advantage, Victoria reports.

Why it matters: The legislation would require MA plans to standardize electronic prior authorization systems. Although that could help speed seniors' treatment approvals, it remains a major friction point between providers and insurers.

State of play: Sources tell Victoria that a preliminary CBO score concludes that an amended version of the Improving Seniors' Timely Access to Care Act's wouldn't result in new spending.

• That could make it easier to include the bill in a year-end package or to pass it by unanimous consent in the Senate or under suspension of the rules in the House.
• A previous version of the bill passed the House by voice vote in 2022 but stalled after the CBO said it would cost $16 billion.
• A prior authorization rule the Biden administration issued this year to reduce red tape in Medicare Advantage helped lower the bill's cost, sources said.
• A majority of lawmakers in both chambers have signed on as sponsors on the bill, as of this fall.

What they're saying: "We're trying to do what we can to get it attached to any other bill. I think it has a chance for unanimous consent," main sponsor Sen. Roger Marshall told Axios.

• "That there's something in life that's actually zero cost for taxpayers should help," said Rep. Mike Kelly, one of the main sponsors in the House.

The other side: Insurers argue that it's necessary for patients to get preapprovals for procedures and services to prevent costly, unnecessary care.

• The prior authorization bill would require MA plans to provide more reporting on their decisions to HHS, which would have the power to set deadlines for insurers to respond to various types of requests.
• The Better Medicare Alliance, a Medicare Advantage advocacy group, supports the bill. AHIP hasn't weighed in.

Inside the room: Multiple sources said that departing physician-lawmakers Brad Wenstrup, Michael Burgess and Larry Bucshon urged Speaker Mike Johnson this week to do prior authorization during the lame duck.

Threat level: Backers of the bill say that the incoming Trump administration could roll back the Biden administration prior authorization rule, sending the effort back to square one.

• The Biden rule requires health insurers to streamline information within existing electronic prior authorization systems and issue coverage decisions within specified times.
• "If they [the Trump administration] wipe out the rule, our bill will cost $16 billion again," said Peggy Tighe, a health lobbyist and legislative counsel to the Regulatory Relief Coalition. "We got all the savings out of the rule.… That's a really important reason to do this now."

The big picture: Physician groups are already asking Congress to delay the nearly 3% Medicare payment cut that's looming in January — a big ask that will require budgetary offsets.

• They maintain prior authorization shouldn't get lost in the shuffle, since it's an administrative burden and a big driver of professional burnout that makes it harder for patients to get needed treatment.
• "The overall goal of this legislation and other efforts like on the regulatory side, is to lessen the burden … on physicians who have to spend an inordinate amount of time dealing with these authorization requests," said Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association.

A divided Senate Judiciary Committee narrowly approved the PREVAIL Act 11–10 today after multiple delays, including the bill getting abruptly pulled from a markup last week.

Why it matters: The controversial bill could have major implications for drug development and would raise the bar for challenging patents at the Patent Trial and Appeal Board, as an alternative to going to the courts, Victoria reports.

• Sponsors Chris Coons and Thom Tillis have argued that it's a much-needed update to make the current patent system less expensive and easier to navigate.

Driving the news: Senators split over whether the bill would drive up drug prices by making it easier for pharmaceutical companies to protect their intellectual property.

• Coons offered a manager's amendment in response to those concerns that aims to ensure that generic drug companies and patient advocacy groups continue to have access to the patent board.
• Sens. Amy Klobuchar, Peter Welch and Richard Blumenthal said the manager's amendment and possible additional tweaks addressing drug costs were enough to secure their conditional support.

Still, Democrats Alex Padilla, Jon Ossoff and Sheldon Whitehouse voted against the bill.

• Sen. Josh Hawley, who joined six other Republicans in voting against the bill, said that he was also concerned about the prospect of potentially increasing patients' drug costs.

What we're watching: The divisions on the committee likely mean the bill won't get any further this Congress.

• The fate of another patent bill that was pulled last week, the PERA Act, remains unclear.
• PERA would alter which kind of inventions are eligible for patent protection and has implications for gene technology and other biotech discoveries.

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3. Brain health: The Senate this morning passed by voice vote bipartisan legislation led by Susan Collins to reauthorize funding for public health initiatives to fight Alzheimer's, including awards to state health departments to promote brain health.