DEAL TO BE HAD, BUT WHICH? Legislation to rein in practices by pharmacy benefit managers has long been considered a contender for inclusion in an end-of-year legislative package after it was left out of a springtime spending measure. But which party controls the White House — and one or both chambers of Congress — will likely determine whether members try to “clear the decks” before January or hold out hope for a better deal next year. For nearly two years, Congress has grappled with how to reform the drug-pricing middlemen, the practices of which critics say hamper patient access to medicines and drive up prices. Meanwhile, PBMs argue they’re the only entity negotiating with the pharma industry, which ensures market competition. Health lobbyists aren’t writing off a possible deal. But one told Prescription Pulse that Hill staff is itching to move on from the issue, while another wondered whether the Federal Trade Commission’s PBM lawsuit “takes the wind out of Congress doing anything.” Plus, the House-passed bill is one of many proposed to put guardrails around the industry, signaling that, while there might be consensus in Congress around taking action on PBMs, lawmakers aren’t necessarily united on what that should look like. Another take: Rep. Jake Auchincloss (D-Mass.) introduced his own PBM bill with GOP Rep. Diana Harshbarger of Tennessee in July with an eye toward year-end negotiations. “We need to focus efforts on building bipartisan support for tough reforms because what I don't want to have happen is ‘transparency’ and then move on. That would be a win for PCMA, and we must prevent that,” he told Lauren, referring to the Pharmaceutical Care Management Association, the PBM lobbying group. Auchincloss said he wants to see Congress “delink” PBMs’ service fees from a drug’s list price and, “ideally,” as many provisions as possible from his bill, which would prohibit PBMs from steering patients to pharmacies they own and tie pharmacy reimbursements to the national average drug acquisition cost. Rep. Brett Guthrie (R-Ky.), chair of the Energy and Commerce Health Subcommittee, said he would press for PBM legislation next Congress, even if something passes in December. “If I get to be chair of this committee, we will continue down the path to PBM reform,” he said. “This is just a bite at the apple.” Over the Hill: Sen. Tim Kaine (D-Va.) vented his frustration during a September hearing on Novo Nordisk’s GLP-1 drug prices that PBM legislation approved by the Senate Health, Education, Labor and Pensions Committee had yet to advance despite an 18-3 vote. “As a committee with wide ideological difference, when you get a vote that overwhelming, you should do it,” he said later in an interview. “I like passing legislation that goes right at pharmaceutical companies with things like negotiated pricing, but I don't like leaving PBMs without the same level of scrutiny.” IT’S FRIDAY. WELCOME BACK TO PRESCRIPTION PULSE. Your host who’s a parent is once again grappling with hand, foot and mouth disease in her household. Send tips and ideas (for stories and for avoiding illness) to David Lim (dlim@politico.com or @davidalim) and Lauren Gardner (lgardner@politico.com or @Gardner_LM).
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