This Week in Washington: House Republicans release debt ceiling plan, Speaker McCarthy moves forward with proposal that includes Medicaid work requirements

Congress

House

Debt Ceiling Text Released

On April 19, Speaker Kevin McCarthy (R-CA) unveiled the bill text of his proposal for raising the debt ceiling, cutting federal spending and negating some of President Biden’s priorities and initiatives. 

The Speaker plans to bring the bill to the House floor for a vote this week even though it is unclear that even with the Republican caucus there are enough votes to pass the proposal. Republicans have 222 votes, and 218 are needed to pass.

The proposal is estimated to save over $4.5 trillion and includes a proposal to require Medicaid work requirements.

Conservative members want deeper cuts and stricter language on work requirements for food stamps, while moderates are concerned about spending cuts that are dead on arrival in the Senate. Some are concerned about cuts to energy tax credits and would oppose stricter language about food stamps.

For more information, click here.

Pharmacy Benefits Manager Accountability Act Introduced

On April 20, Reps. Kuster (D-NH), Carter (R-GA), Eshoo (D-CA) and Guthrie (R-KY) introduced the “Pharmacy Benefits Manager Accountability Act.” The bill would raise reporting requirements for pharmacy benefits managers (PBMs) in an effort to increase transparency in the drug supply chain. The bill will specifically:

  • Require PBMs to submit an annual report to employers, health insurers and prescription drug sponsors starting Jan. 1, 2025, detailing which prescription drugs were dispensed by the PBM during the reporting period and outlining each drug’s wholesale acquisition and out-of-pocket costs. The report would also require PBMs to reveal how much they received in drug rebates, fees and alternative discounts, and how much health plan sponsors spent on prescription drugs during the reporting period;
  • Require health insurers offering group health insurance coverage or entities providing pharmacy benefits management services to report the practices of pharmacy networks to the Comptroller General of the United States; and
  • Strengthen the enforcement powers of the Secretary of the Department of Health and Human Services, the Secretary of the Department of Labor and the Secretary of the Department of the Treasury to ensure that violators are held accountable.

For more information, click here.

Doctors of Community Act Introduced

On April 11, Reps. Pallone (D-NJ), Vasquez (D-NM) and Ruiz (D-CA) introduced the Doctors of Community (DOC) Act. The bill would authorize the Teaching Health Center Graduate Medical Education (THCGME) program to support and fund primary care medical and dental residents. It would increase funding from $277 million in fiscal year (FY) 2024 to $582 million in FY 2033 and would increase the number of residency slots available each year. The THCGME program is a Health Resources and Services Administration (HRSA) program that seeks to support the training of medical professionals preparing to work in rural and underserved communities.

For more information, click here.

Senate

INSULIN Act of 2023 Introduced

On April 21, Sens. Shaheen (D-NH) and Collins (R-ME) introduced the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act of 2023. The bill will foster competition among the insulin product market, broaden patient access and extend patient protections. The bill specifically:

  • Limits out-of-pocket costs for patients with diabetes by requiring group and individual market health insurers to waive any deductible and limit cost-sharing to no more than $35 or 25 percent of the list price of at least one insulin of each type and dosage form;
  • Prohibits pharmacy benefit managers (PBMs) from placing utilization management tools on products with capped out-of-pocket costs;
  • Requires PBMs to pass along to plan sponsors 100 percent of insulin rebates and discounts received from manufacturers;
  • Creates a new expedited Food and Drug Administration (FDA) approval pathway for biologic drugs;
  • Strengthens oversight over the FDA’s citizen petition process;
  • Allows Medicare Part D plans to place biosimilar drugs on formulary immediately upon their introduction to the market; and
  • Requires the Secretary of the Department of Health and Human Services (HHS), Administrator of the Centers for Medicare and Medicaid Services (CMS) and the Commissioner of the FDA to submit a report to Congress identifying variables delaying or restricting competition among the biosimilar insulin market.

For more information, click here.

Drug-Price Transparency for Consumers Act Reintroduced

On April 20, Sens. Durbin (D-IL) and Grassley (R-IA) reintroduced the Drug-Price Transparency for Consumers (DTC) Act. The bill seeks to strengthen prescription drug transparency by requiring prescription drug and biological product advertisements to disclose the list price of the drug or product being marketed.

Senate Finance Committee Releases Legislative Framework to Address PBMs

On April 20, Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) released a legislative framework that the committee will use to develop policy solutions to modernize federal prescription drug programs and address the role of pharmacy benefits managers (PBMs). The bipartisan framework outlines the four challenges committee members have identified within the prescription drug supply chain and explains what steps the committee will take to address and resolve them.

For more information, click here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.