The House GOP reconciliation bill includes a provision that would expand the number of drugs exempt from Medicare drug price negotiations.

Why it matters: Backers say the provision would encourage innovation to treat rare diseases, but drug pricing advocates say it amounts to a handout to pharmaceutical companies.

Driving the news: The bill would expand an existing carve-out for "orphan" drugs that treat rare diseases.

• Currently, orphan drugs that treat one rare disease are exempt from Medicare drug price negotiations. The bill would broaden that to include drugs that treat two or more rare diseases or conditions.

What they're saying: The Biotechnology Innovation Organization called the measure a "pro-patient, pro-innovation proposal."

• "Unintended consequences should never stand between patients and the new treatments and cures they desperately need," the group said in a statement.
• Merith Basey, executive director of Patients for Affordable Drugs, countered that the measure is "simply put, a giveaway to pharma."
• "Americans are asking Congress to do more to lower drug prices, and believe that drug prices are far too high," she added. "This is going exactly in the opposite direction that voters are demanding."
• CBO finds the change will cost $4.8 billion over 10 years.

The big picture: Although the provision would benefit some manufacturers, drug companies did not get everything they wanted in the reconciliation package.

• The bill does not address what industry terms the "pill penalty," which would involve syncing the length of time that small molecule drugs and biologics are exempt from negotiations.
• House Republicans did not include President Trump's "most-favored nation" policy to equalize U.S. drug prices with those in other developed countries — which the industry vehemently opposes.
• Republicans remain uncomfortable with the idea of government price-setting, though Trump could still implement the policy through executive action.

Between the lines: The standalone version of the orphan drug bill, sponsored by Rep. John Joyce, does have a handful of Democratic cosponsors, including Rep. Don Davis.

• Joyce said the measure helps ensure "millions of Americans with rare diseases can continue to have hope for the future" when he introduced the measure in February.
• A spokesperson for Energy and Commerce Democrats said the provision is "just another example of Republicans taking people's health care away and making prescription drugs more expensive in order to give handouts to giant corporations."

The rescissions package the White House sent Congress yesterday calls for deleting $900 million for global health programs — including PEPFAR, which is causing heartburn for some Republicans.

Why it matters: Public health experts warn that the cuts would restrict access to lifesaving treatments and hinder U.S. soft diplomacy.

• The State Department–run HIV/AIDS program is still operating even though it hasn't been officially reauthorized, but it's limited and doesn't cover many HIV prevention efforts.

What's inside: The $9.4 billion rescissions package identified $900 million in DOGE-directed cuts to State Department and USAID global health programs for Congress to codify.

• The document OMB sent to the Hill calls for eliminating $500 million for USAID programs related to child and maternal health, HIV/AIDS and infectious diseases.
• It states that the proposal "would not reduce treatment but would eliminate programs that are antithetical to American interests and worsen the lives of women and children, like 'family planning' and 'reproductive health.'"
• An additional $400 million would be rescinded for controlling HIV/AIDS, which includes PEPFAR.

What they're saying: Senate Appropriations Chair Susan Collins told reporters yesterday that she wouldn't support a package that cuts PEPFAR.

• The program "has saved literally millions of lives and has been extremely effective and well-run," Collins said.
• She referred to it as a legacy program of former President George W. Bush.

But House Foreign Affairs Chair Brian Mast told Victoria yesterday that there was "a lot of pretty specific waste within PEPFAR" and that this rescissions package would make it "a better program."

• House Appropriations Chair Tom Cole also said that although he was "worried about PEPFAR," he was going to support the rescissions package, adding, "I think most of our members will.… I don't think it will have a hard time passing."

What's next: House GOP leadership said in a statement on Tuesday that a floor vote is planned next week.

• Congress has 45 days to act on the package, and it needs only a simple majority for passage in the Senate.

1. SUPPORT Act: The House is on track today to reauthorize programs for opioid use disorder prevention, treatment and recovery. The law was signed during the first Trump administration in 2018 but wasn't renewed in 2023. (We'll be back in your inbox if anything unexpected happens.)
2. FDA appropriations: House appropriators today released their FY26 Ag-FDA spending bill, which would keep funding for the FDA relatively flat and in line with the administration's budget request, at $6.79 billion. The measure will be marked up in subcommittee tomorrow.
3. CDC resignation: The official overseeing updates to COVID-19 vaccine recommendations resigned following an order from HHS Secretary Robert F. Kennedy Jr. to force an update to agency guidance, CBS News reports.
4. EMTALA guidance: CMS voided Biden-era guidance telling health providers who perform emergency abortions that they're protected under federal law irrespective of state bans, Adriel Bettelheim reports.