Those hoping for meaningful drug pricing and prior authorization reform this holiday season received a lump of coal instead.
On Saturday, President Joe Biden signed a narrower spending bill that avoided a government shutdown but left out several healthcare provisions that were included in the original bill. The original was opposed by Tesla CEO Elon Musk and President-elect Donald Trump, who argued that it included government waste, according to the Washington Post.
Because of this, drug pricing reform became “collateral damage” and was part of the healthcare provisions that were excluded in the new bill, advocacy organization Patients for Affordable Drugs Now said in an announcement. The reforms cut out from the package included:
The Affordable Prescriptions for Patients Act, which limits the number of patents pharmaceutical companies can apply to biologics
A provision of the Lower Costs, More Transparency Act, which addresses a hurdle in generic drug approvals by requiring the FDA to provide clearer guidance on ingredient differences
The Modernizing and Ensuring PBM Accountability Act, which seeks to disconnect pharmacy benefit managers’ (PBM) revenue from drug prices in Medicare Part D, reducing the incentives for PBMs to push higher-cost medications. It would also require them to disclose drug pricing and related information to Part D plan sponsors
“These critical reforms had strong bipartisan support, saved taxpayers billions of dollars, and would have delivered real relief for patients,” said Merith Basey, executive director of Patients For Affordable Drugs Now, in a statement. “Leaving these bills out of the end-of-year package means that Americans will continue to pay the highest drug prices in the world. Regrettably, politics and powerful outside interests took precedence over the needs of patients.”
The organization added that excluding these measures means the next chance to pass them won’t be until the next Congress, delaying relief for millions of Americans.
Drug pricing reform wasn’t the only healthcare provision left out of the updated spending bill. Prior authorization reform also didn’t make it in the final package, as well as a provision to address declining reimbursement rates for Medicare. This was blasted by the American Medical Association.
“Congress heads home today leaving in place a 2.83% cut for doctors,” said Bruce A. Scott, MD, president of the American Medical Association, in a statement. “It did not provide a rational permanent, inflation-based update as the Medicare Payment Advisory Commission recommended. It didn’t even offer doctors a Band-Aid in the form of a cut reduction, as the cost of delivering care rises 3.5% next year.”
The new spending bill also provided shorter extensions for Medicare telehealth flexibilities and the Acute Hospital Care at Home program. Both of these provisions are extended through March 31, 2025. The original bill included a two-year extension of the Medicare telehealth flexibilities and a 5-year extension of the Acute Hospital Care at Home program.
Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, said the outcome wasn’t what the organization had “fully hoped for,” but that the legislation is still “an important step to avoid disruptions in critical areas of telehealth access.”
Photo: MikeyLPT, Getty Images
