A POTENTIAL WIN FOR PBMS — PBM reform is in limbo because talks on a health care package have broken down despite bipartisan interest in reining in pharmacy benefit managers, seven lobbyists and two congressional aides told Ben and POLITICO’s Megan R. Wilson, David Lim and Daniel Payne. PBMs, which manage prescription drugs for health insurers, have been in Congress’ crosshairs in a bid to lower drug prices. The House and the Senate have different approaches, which they haven’t been able to reconcile, with the upper chamber going further than the lower chamber. House members rejected the specific reforms in Senate bills, according to several of the lobbyists. The disagreements over PBM policies helped tank an initial health policy deal lawmakers considered adding to appropriations legislation — with some lobbyists blaming Sen. Bill Cassidy (R-La.), ranking member of the Health, Education, Labor and Pensions Committee, for insisting on his reforms. “The House appears unwilling to entertain significant Senate provisions not already included in the House package,” said a spokesperson for Cassidy, who wrote some of the proposed PBM rules. “Cassidy is committed to negotiations and getting the most robust package that can pass both chambers and be signed into law.” A person with knowledge of the negotiations granted anonymity pointed the finger at Cassidy, saying Cassidy wanted to go beyond consensus in Congress and ban “spread pricing” in the commercial market. That’s a practice in which PBMs charge insurers more for drugs than what they’re reimbursed by pharmacies. The HELP Committee passed such a ban 18-3. The discord between the chambers has some lobbyists and policymakers blaming the House — including Democratic lawmakers who allegedly reject the Senate Finance Committee’s more aggressive reforms and Republicans who don’t want to mandate changes to PBM practices in the commercial market. What’s next: Lawmakers are eyeing a smaller package that would address extenders that would secure funding for community health centers, boost payment for doctors under Medicare and avert cuts to disproportionate share hospitals, according to three of the lobbyists. That’s similar to what Congress has done in previous spending patches. Even negotiations for a smaller package remain fluid, according to another Senate staffer familiar with the discussions. FUNDING FRENZY UPDATE — The top four congressional leaders meet today with President Joe Biden at the White House as federal funding for part of the government, including the FDA and the VA, is set to expire Friday. HHS funding runs out on March 8. The battle over spending has turned to finger-pointing, POLITICO’s Caitlin Emma and Jennifer Scholtes report. Senate Majority Leader Chuck Schumer has accused House Republicans of needing to “sort themselves out,” and House Speaker Mike Johnson blamed snagged negotiations on “new Democrat demands.” Lawmakers must still work through several issues in the Agriculture-FDA measure, including conflict over nutrition funding in the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC. The hurdles are even higher for the other spending bills falling up against the March 8 deadline. As the potential partial shutdown approaches, Biden and Johnson’s lack of a significant relationship makes things more difficult, POLITICO’s Jennifer Haberkorn and Jonathan Lemire report. WHAT TO WATCH FOR THIS WEEK — While appropriators negotiate, health care-related hearings are being held on Capitol Hill this week. The House Energy and Commerce Health Subcommittee meets Thursday to consider a slew of largely bipartisan bills that tackle rare diseases. Rare disease advocates have pushed Congress and the executive branch to tweak the Inflation Reduction Act to lessen its impact on orphan drugs, which are crafted to treat rare diseases. Profiting from the drugs is more difficult than with other ones because of small patient populations. One bipartisan bill under consideration Thursday would expand the orphan drug exclusion from Medicare negotiations. The Senate Budget Committee convenes Wednesday to discuss the “economic harms of restricting reproductive freedom.” Witnesses include a professor of economics, a doctor from Physicians for Reproductive Health and a fellow at the American Enterprise Institute.
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