Senate to focus on PBMs and nursing shortage in 2023

The Senate will still have an extremely narrow majority in 2023, but with some new curveballs, like HELP Chairman Bernie Sanders, and a Republican House on Capitol Hill.

  • It may not sound like a recipe for tons of health policy action, but here’s what we’re hearing about the areas where the senators are at least going to try.

1. PBM. Action on PBMs is perhaps the issue with the best chance, given the bipartisan and bicameral interest in targeting any role they may play in high drug costs for patients.

  • Finance Committee Chairman Ron Wyden told Axios before lawmakers left for vacation that “middlemen and cost containment” will be healthcare priorities in 2023, using the somewhat derogatory term for PBM.
  • “I know of people in the House that I think will work with us,” Wyden said.
  • He did not go into details of what he wants to do, but in the past he has proposed the C-THRU Actwhich includes transparency requirements on reimbursements that PBMs receive and would require PBMs to pass along a minimum percentage of reimbursements to health plans.

2. Nursing shortage. Incoming Ranking Member of the HELP Committee, Bill Cassidy, formerly told Axios wants to work with Sanders on the nursing shortage. Now, Sanders is reciprocating the interest.

what are they saying: Sanders told Axios that he can “absolutely” work with Cassidy on the nursing “catastrophic crisis.”

  • “State after state is spending enormous amounts of money on roaming nurses instead of creating their own workforce,” Sanders said. “I look forward to working with Senator Cassidy, among many other things, to greatly expand our nursing [workforce].”
  • The details of any deal are less clear. sanders has proposed increased funding for nursing education through the Nurse Corps program, but Cassidy would not commit to more money, saying she wants to look into the issue first.

Sanders wasn’t ready to talk about the great progressive causes for which he is known. We asked him if he plans to try to call pharmaceutical executives to testify, for example, but he declined to talk further about his schedule.

  • “It’s a little too early to talk about that,” he said.

3. Parity in mental health. Wyden says he will do his best to make sure insurers cover mental health at the same level as physical health, but it has been harder get bipartisan interest on this issue.

  • Some lobbyists previously thought that a bipartisan Finance Committee task force on the issue would not release any recommendations, but actually did in early December.
  • The recommendations were modest, such as requesting GAO studies, and did not include larger measures opposed by the insurance industry, such as financial penalties on insurers that violated parity laws.

  • Asked if he would push financial sanctions again, Wyden said he would “keep all our options open” but insisted that what he called “ghost nets” without enough mental health providers is “outrageous.”

4. Costs. “Next year I think there is an opportunity to make real reforms in the cost containment space,” Wyden said. He mentioned that limiting out-of-pocket costs of insulin for people with private insurance is “at the top of the list.”

  • Reality check: That idea has fought to get a lot of support from the Republican Party, and supporters failed to get him on the bus last month.

We asked if the prices of hospitalswhat are they getting growing scrutiny aside from drug prices, they’re on his target list: “There’s not a part of healthcare where you can’t get more efficiency out of the area,” Wyden replied.

  • Cassidy told reporters that the “cost of prescription drugs” is a priority for him, but did not elaborate. Have generally proposed Smaller-scale bipartisan ideas, such as speeding up generic drug approvals, compared to the Democrats’ broader new drug pricing law.

The bottom line: There are many unknowns about the new year, such as how chaotic the House will be and how much Sanders will prioritize bipartisanship over progressive causes.

  • But it’s at least possible that Congress will find somewhat narrower areas of health policy to work on, now that high-profile partisan items like repealing Obamacare and the Medicare drug deal are either dead for now or gone. they approved.

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