Congress Faces Countdown: Must-Pass Health Policies Before Year-End

Congress has returned to Washington with five weeks left in the legislative calendar. A Continuing Resolution (CR) will expire on December 20, 2024. Congress needs to pass either a year-end spending package or a new CR to fund the government. Important health policies are under consideration, including extensions for Medicare telehealth flexibilities, Pharmacy Benefit Manager (PBM) reform, and the BIOSECURE Act.

Must-Pass

Telehealth Extension: Medicare Flexibilities

The Issue: Medicare telehealth flexibilities from the COVID-19 pandemic will expire at the end of this year. Before the pandemic, telehealth access was limited to rural areas. Current flexibilities include a moratorium on in-person visits for mental health services, removal of geographic restrictions, inclusion of all Medicare beneficiaries, and authorization for audio-only services.

Potential Congressional Fixes: Several bills aim to extend these flexibilities:

• H.R. 7623: The Telehealth Modernization Act of 2024 proposes a two-year extension, amended from a permanent extension to include funding through PBM reform.
• S. 3967: The Telehealth Modernization Act aims for a permanent extension, but no progress has been made.
• H.R. 8261: This bill seeks to extend key flexibilities through December 2026 and has cleared the House Ways and Means Committee.

Strong bipartisan support suggests that an extension will likely be addressed before expiration.

Voucher for Pediatric Rare Disease Drugs Extension

The Issue: The Rare Pediatric Disease Priority Review Voucher (RPD PRV) program will expire unless extended. This program incentivizes the development of therapies for rare diseases by providing faster FDA reviews.

Potential Congressional Fixes:
H.R. 7384 and S. 4583: Both bills propose extending the voucher program until FY2029 but have not made significant progress. An extension is likely needed to prevent expiration.

Other Expiring Provisions:

• Medicare extenders and payments, including:

1. Low-Volume Payment Adjustment
2. Medicare-Dependent Hospital Program
3. Delay of Medicaid Disproportionate Share Hospital payment cuts

May-Pass

PBM Reform

The Issue: Bipartisan agreement supports reform for Pharmacy Benefit Managers (PBMs), which dominate 80% of the market and contribute to higher patient costs.

Potential Congressional Fixes: Key committees have held hearings, leading to several bills:

• H.R. 5378: Requires PBMs to report on spending and prohibits spread pricing.
• H.R. 4758: Prohibits spread pricing in Medicaid and passed out of the House.
• S. 2973: Proposes audits and transparency measures for PBMs in Medicare.
• H.R. 5385/S. 2254: Establishes stricter reporting requirements under Medicare.
• S. 1339: Adds requirements for PBMs to provide detailed reports and remit all rebates to sponsors.

BIOSECURE Act

Medicare Physician Payment Fix

The Issue: Proposed Medicare physician cuts have faced significant opposition. A House majority urged Congress to protect physicians from these cuts.

Potential Congressional Fixes:
H.R. 10073: This bill proposes a 4.73% payment increase to offset cuts. Multiple other bills are also focused on Medicare payment reforms, showing strong bipartisan support.