TAKEAWAYS FROM THE HEALTH CARE DEAL — Pharmacy benefit managers may soon have to comply with new regulations under an agreement from Congress, Ben reports. Congressional leaders released bill text Tuesday night that would fund the federal government into March, including a health care package that contains a significant overhaul of PBM business practices. The package comes after much back and forth over the scope of the deal between Republicans and Democrats. The deal, expected to be signed into law, signals that lawmakers wanted to wrap up this Congress’ business and largely clear the decks for President-elect Donald Trump’s agenda. It could get pushback from conservatives, who have said the stopgap measure addresses too many issues not directly related to government funding. Here are the winners and losers. Winners: The pharmaceutical industry: The pharmaceutical company has spent years and tens of millions of dollars targeting PBMs — companies that negotiate drug prices on behalf of insurers and employers — after they were dealt a blow by the Inflation Reduction Act, which allowed Medicare to negotiate drug prices for the first time. PBMs are set to face significant new regulations, such as delinking the reimbursement PBMs get in Medicare from the list price of drugs and cracking down on so-called spread pricing in Medicaid. Still, the package contains changes to the drug patent system to address “patent thickets,” overlapping patents that critics have said stifle competition, similar to ones the industry has opposed. Telehealth advocates: Lawmakers agreed to two key healthcare extensions: Eased rules for telehealth services will continue for two more years under Medicare, and some commercial insurers and Medicare patients can receive hospital care in their homes for five more years. Addiction treatment advocates: Lawmakers are poised to extend for five years the opioid-fighting SUPPORT Act, which expired more than a year ago. The legislation authorizes programs and funding to help curb opioid addiction. Losers: PBMs: Pharmacy benefit managers have cast the proposed changes as ones that would substantially hurt their ability to negotiate lower drug prices. “If the massive Big Pharma giveaway spending bill passes, big drug companies will get billions in windfall profits, and seniors will face further disruption to their drug plans and may lose Medicare Part D coverage as they know it — certainly, seniors will be forced to pay much higher premiums,” the Pharmaceutical Care Management Association, a PBM lobby, said in a statement. “The bill also represents a precedent-setting government intrusion into commercial market contracting.” Doctors: After debate, lawmakers didn’t add new rules for prior authorization in Medicare Advantage. Prior authorization, insurers’ practice of requiring providers to get their approval before beginning treatment, is a top complaint of doctors and patients. The proposal also includes a 2.5 percent payment boost for doctors in Medicare, but not enough to offset a 2.83 percent cut CMS finalized in November. It would also have a 3.53 percent bonus for alternative payment models. Still, the changes aren’t the longer-term solution doctors have been pushing for. Backers of Chinese biotech crackdown: The BIOSECURE Act, which would curtail Chinese biotechnology companies’ ability to do business in the U.S., wasn’t included in the legislation. Supporters had warned that Beijing could use some named firms in the act to obtain sensitive information like Americans’ genomic data due to China’s intelligence laws regarding private business. WELCOME TO WEDNESDAY PULSE. Spotted up on Capitol Hill on Tuesday: Santa hats, a gingerbread Capitol and my desperate search for a fun, warm seasonal drink. Any favorite coffee spots on the Hill? I’d love a peppermint mocha. Let me know and send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.
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