Spending Patch Averts Shutdown, Has No PBM Measures

The temporary spending bill that the House and Senate approved last night will keep the federal government operating through March and provide $100 billion in disaster relief and aid to farmers does not include measures to regulate pharmacy benefit managers (PBM) and other healthcare-related provisions.

A week of political drama and President-elect Donald Trump and Elon Musk using their social media platforms to kill a much larger bill of more than 1,500 pages ended shortly after Friday midnight with the Senate voting 85-11 in favor of the stopgap spending measure. Earlier, the House voted 366-34 in favor of the spending legislation averted a federal government shutdown just before the winter holidays.

The scaled-back version of the spending package, called a continuing resolution, includes extension of more liberal rules for telehealth that were adopted during the COVID-19 public health emergency and set the stage for telehealth becoming a common way to patients to interact with clinicians.

Congress has been investigating and debating new rules and regulations for PBM industry for years. On Wednesday it looked like that tortuous process would finally result in legislation and new ground rules for a segment of the healthcare industry that has come under increasing scrutiny.

The PBM-related provisions in the first version of the continuing resolution included a ban on spread pricing in the Medicaid program, delinking of PBM remuneration from drug prices in the Medicare Part D program and transparency and rules governing PBM remuneration in the commercial market.

The Pharmaceutical Care Management Association (PCMA), the trade group for the large established PBMs, was ardently opposed to those provisions while Transparency-Rx,a new group of smaller PBMs that are vying for business with what they say are more transparent business practices, was just as strongly in favor of them.

The large spending bill, which had many unrelated provisions tacked on to it to satisfy dozens of different constituencies and interest groups and win bipartisan support, seemed headed for passage until Musk and then Trump attacked it as ungainly and expensive and an example of the politics-as-usual that they say they want to disrupt. Democrats defended it as a negotiated compromise and important vehicle for addressing important needs. On Thursday, the House voted down a second, stripped-down version of the continuing resolution that jettisoned the PBM and many other provisions. That version, however, included a lifting of the debt ceiling favored by Trump that some Republicans and Democrats opposed.

The third, successful version of the continuing resolution that passed last night was also a vastly reduced version of the first continuing resolution but didn’t have debt ceiling provisions.

On X, the social media platform that he owns, Musk congratulated House Speaker Mike Johnson yesterday. “Your actions turned a bill that weighed pounds into a bill that weighed ounces.”