LAME-DUCK BATTLES AHEAD — Now that Congress has wrapped up most of its health care legislative work before the elections, the contours of what could be included in an end-of-year package are taking shape. Both the House Energy and Commerce and Ways and Means committees have advanced telehealth extension bills, and several proposals to reform pharmacy benefit manager practices have surfaced. Nearly every health interest will also jockey to get their priorities into a potential package, which could be a December spending bill. Many lawmakers not seeking reelection will also aim to get their priorities across the finish line to help cement their legacies. The scope of such a package could depend significantly on the outcome of November’s elections. Rodney Whitlock, vice president at McDermott+ Consulting, told Pulse a status quo election — the House remaining in GOP control and the Senate and White House in Democratic control — would maximize the potential scope. “A status quo election … is the least likely outcome,” Whitlock said. “It is the dynamics caused by the shift in control that will ultimately be the limiter on lame-duck activity.” Eli Greenspan, policy adviser at Foley Hoag, said a stopgap spending bill that runs through the middle of December instead of a shorter-term patch would indicate that lawmakers are more seriously eyeing a substantial end-of-year package. Here are some top issues and their current status: Telehealth: Two key committees advancing two-year extensions of eased Medicare telehealth rules must reconcile their differences and potential differences with the Senate, which hasn’t advanced a telehealth extension. Congress is unlikely to let the rules expire at the end of the year, given their popularity and broad bipartisan support. Any additional provisions included in an extension would likely come down to their cost. PBMs: There is bipartisan momentum for reforms to pharmacy benefit managers, which manage drug benefits for health plans. The House passed its Lower Costs, More Transparency Act overwhelmingly last year, but PBM reform didn’t hitch a ride on a spending package this spring. Competing proposals need to be hashed out. BIOSECURE: The House passed the BIOSECURE Act, which would effectively bar Chinese biotechs from doing business in the U.S., in a 306-81 vote last week. But most of the opposition came from Democrats, who control the Senate. That suggests there could be some friction going forward to final passage, either as a standalone or in a package. Doctor pay: A top priority for doctors groups and many lawmakers will be averting Medicare payment cuts for doctors, though major reform is unlikely. A key issue for such end-of-year policymaking is how to pay for it. Here are some potential offsets: PBM reform: PBM-related provisions banning so-called spread-pricing — when PBMs pay a pharmacy less for a drug than what they charged an insurer — and other changes could be potential pay-fors. Pharmaceuticals: A slew of bills aimed at bolstering competition in the pharmaceutical marketplace could save billions, according to the Congressional Budget Office, including patent reforms and more generic-drug competition. Site-neutral payments: Proposals to change Medicare policy so that drugs administered in a hospital outpatient department are reimbursed at the same rate as a doctor’s office have drawn significant opposition. The CBO estimates the policies would save billions. WELCOME TO FRIDAY PULSE. Moo Deng is upset about your misspelling of HIPAA. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.
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