Congress appears likely to exclude PBMs, other health priorities from spending package

Congress is unlikely to include many major health priorities in the next government funding package, according to multiple sources. 

It is increasingly likely that only a handful of programs facing imminent deadlines could be included in legislation needed to fund the government by March 8, such as community health center funding, a reversal of Medicaid cuts to hospitals serving low-income and uninsured patients, and at least a partial rollback of Medicare physician payment cuts. 

A reauthorization of a federal pandemic preparedness program and a sweeping bill to address opioid and substance use disorder are among the policies likely to be left on the cutting room floor, sources said. The authorizations for those bills expired at the end of September.

Potential reforms to the business practices of pharmacy benefit managers (PBMs) also seem unlikely to make it into the funding package, though sources stressed no final decisions have been made. 

PBM reform has been a bipartisan priority for both chambers, including legislation that advanced through the Senate Finance Committee and Senate Health Committee. But competing priorities in the House and Senate have led to complications, and the two sides have been unable to hammer out any agreement. 

A partial government shutdown is looming as congressional negotiators failed to come to an agreement this past weekend on the first four appropriations bills set to expire on March 1, including legislation to fund the Food and Drug Administration.  

Funding for other agencies is set to expire March 8. House Speaker Mike Johnson (R-La.) is facing pressure from his right flank to hold the line for lower spending in ongoing bipartisan talks and to push for a laundry list of policy riders related to abortion, diversity initiatives, border issues and other GOP priorities. 

It’s unclear what the path forward would be if PBM reforms and other reauthorizations are not included, though sources speculated that legislation in the lame duck session after the November election would be a likely outcome.