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Elon Musk’s gift to PBMs?

The year-end government funding bill was still in jeopardy as of the writing of this newsletter. If it crashes and burns, a major health care package could go with it. We’ll keep you informed.

Republicans and Democrats negotiated a health care deal replete with PBM reforms, a Medicare pay hike for doctors, an extension of telehealth services, drug patent reforms, and the beginnings of what could lead to a cut in pay for hospital inpatient services, according to reporting by Rachel Cohrs Zhang.

But as House Speaker Mike Johnson faced a conservative rebellion on Wednesday stoked by the world’s richest man, Elon Musk, his team had to return to the drawing board to find a way to avert a government shutdown. It’s unclear whether health care legislation could survive.

RFK Jr. building support on Capitol Hill

Robert F. Kennedy Jr. is continuing his meetings on the Hill ahead of his confirmation process for HHS secretary. So far, Republican senators seem to care less about his personal views and more about whether he will conform to Trump’s agenda, STAT’s D.C. team reports.

Comments from Sen. Ted Budd (R-N.C.) on Wednesday crystallized the sentiment: “The goal is to make sure that he aligns with Trump’s policies, and those policies are already proven,” Budd said ahead of his scheduled meeting.

Even those who might have been expected to have concerns about RFK Jr.’s stances on vaccines and abortion have had positive things to say after meeting with him. For example, Sen. John Barrasso (R-Wyo.), an orthopedic surgeon-turned-senator who’s in line to be the No. 2 official in the Senate GOP caucus next year, said Wednesday that RFK Jr. has his support.

It’s unclear whether RFK Jr. could peel off any Democratic votes. A clip of Sen. John Fetterman (D-Pa.) giving RFK Jr. an impromptu handshake circulated on social media, and the senator told Punchbowl News that they’re working on setting up a meeting. Sen. Cory Booker (D-N.J.) told Rachel he hasn’t heard from RFK Jr.’s team, but he’d be open to meeting with any of President-elect Trump’s nominees. Sen. Bernie Sanders (I-Vt.) said it’s “too early to say” whether he could support RFK Jr.

No crystal ball is that good

Elizabeth Cooney and Isabella Cueto remind us that at this time last year we were eager to see how blockbuster obesity drugs would actually perform, and whether they had staying power. But how could we have predicted that then-Democrat Robert F. Kennedy Jr. would be nominated to run HHS in a Trump administration as part of a new “Make America Healthy Again” movement?

Elizabeth and Isa don’t attempt MAHA divination, but they pose three big-picture questions to help us make sense of what could come next: Is primary care at an inflection point? Will RFK Jr. put his stamp on the national dietary guidelines? What will be Enemy No. 1 for the Trump commission on chronic disease? Read more here.

Prisoners often can’t get addiction drugs

STAT’s Lev Facher gives us his sixth installment of the War on Recovery investigative series on how the U.S. denies lifesaving medications to people with opioid addiction.

Lev tells the story of an inmate with opioid use disorder who pleaded for buprenorphine to curb his cravings. He didn’t receive treatment and wound up dead of an overdose from opioids he obtained from another inmate.

The story highlights a lingering crisis in the prison system, where law enforcement officials remain hostile to addiction medications.

FDA deputy commissioner to leave agency

The deputy commissioner is often primed for the commissioner role; if Kamala Harris had won the election, Namandjé Bumpus likely would have been a key contender to lead the FDA, STAT’s Lizzy Lawrence reports

Instead, she’s leaving the agency.

Bumpus replaced recently retired Janet Woodcock, and she oversaw a recent FDA reorganization. Previously, she had been FDA’s chief scientist.