All year, lawmakers have debated contentious policies impacting payers, including Medicare Advantage and the future of pharmacy benefit managers.
Some policy wishes and proposals, backed by some of Washington’s most influential lobbying groups, culminated in bipartisan bills. But most of this legislation has stagnated, either in a committee or a chamber of Congress. These priorities are under a cloud of uncertainty before what could be the closest election in recent memory, with each potential administration likely to tackle pressing health issues differently. We wanted to better understand how major industry players are attempting to create or modify policy in their interest, as well as the roadmap going forward.
Will any legislation surrounding prior authorization, price transparency or individual coverage health reimbursement arrangements (ICHRAs), for example, make it in an end-of-year package? Movement on new electronic prior auth standards may be possible, we learned.
“What I’m hearing is that an end-of-the-year package will be extenders, plus some little things,” said Peggy Tighe, a healthcare lobbyist for Powers Pyles Sutter & Verville. “I hope these elections don’t go so weird that legislators can’t talk to each other and do the things they need to do.”
The must-pass legislation refers to existing programs that are set to expire by the end of the year or have already expired. These pieces of legislation will form the spine of the end-of-year package. Depending on the politics of the lame-duck session, legislators may be able to push through additional priorities.
In this special report, Fierce Healthcare talked to lobbyists and trade group associations, and reviewed federal disclosure statements and data compiled by campaign finance watchdog OpenSecrets for calendar year 2024.
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