Bipartisan momentum is building for a comprehensive health care package that could bring much-needed reforms and funding to crucial areas of the health system.
Senate Democrats are working together to revive a bipartisan package that was excised from a December funding bill.
The proposal includes key items benefiting providers and patients, notably:
- Reforms of pharmacy benefit manager practices to reduce drug cost
- Extension of Medicare telehealth flexibilities and hospital-at-home model
- Mitigation for physician pay cuts
- Funding for additional cancer screenings
- Support for rare pediatric disease drug development
- Reauthorization for a program fighting opioid overdose
PBM Reforms and Medicare Changes Gain Traction
Among the most anticipated provisions in the bill are new limits on pharmacy benefit managers, after a federal report found they “wield enormous power” in determining prescription costs. Congressional hearings have also raised serious concerns about PBMs using vertical integration to maximize profits, driving up prices for patients and insurance plans.
Physicians and other care providers would also benefit from the bill, which adjusts chronically low reimbursements for Medicare patients. The boost in payments will allow many practices and rural hospitals to continue providing care for the nation’s 65 million Medicare enrollees.
Telehealth and Cancer Screening Get a Boost
The proposed package would also extend the availability of telehealth options, allowing more patients to receive care. These flexible arrangements to connect doctors with patients remotely were introduced during the COVID-19 pandemic but are scheduled to expire at the end of March, leaving many patients with fewer options. Congress now has the chance to act, ensuring continuity of care for those who rely on these services.
Spurred by evidence showing the importance of early cancer detection in improving survival rates, the bill would also increase funding for cancer screenings. About half of cancers are not detected until their advanced stages, when the chance of recovery is lower and the cost of treatment higher.
A Path Forward for Rare Disease Treatment
One especially crucial provision promises to extend the priority review voucher program, which encourages drug development for rare pediatric diseases. The incentive program is set to expire if Congress does not act, potentially slowing the pace of innovation for rare diseases, 95% of which currently have no approved treatment options.
Congress Must Act
The health package, which has broad bipartisan support and was nearly included in a funding bill at the end of last year, should once again receive bipartisan support for these commonsense reforms. The introduction of the package is meant to open a path for Republicans and Democrats to work together.
The various provisions are relatively uncontroversial, and there is hope that the House will follow the Senate’s lead to take up these much-needed reforms. The most expedient strategy to pass the package, or the exact legislation to which it might be attached, is still being determined. Lawmakers must seize this opportunity to pass meaningful reforms that improve health care access, affordability and quality.
