Congress returns to Washington this month in a race to fund the government, a race that they have lost regularly year after year. It doesn’t seem to matter which party is in control, and they just can’t get their work done on time.
We discuss that in this month’s update, as well as the newly released lower prices for ten commonly used drugs that are part of the Inflation Reduction Act that President Biden signed into law in August of 2022.
Plus, we give you a tip on what to do with an unexpectedly high medical bill – and more.
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Congress Begins Race They Already Know They’ll Lose
For the last several years, at this same time, we have warned that the specter of a government shutdown looms because Congress hasn’t finished one of the most important things they are supposed to do: fund the federal government for the coming fiscal year, which begins October 1.
Instead of the usual Democrat versus Republican fight, Republicans are also preparing for a showdown against their fellow Republicans ahead of the September 30 government funding deadline, with a possible shutdown hanging in the balance.
Since members of both parties already know they won’t pass the legislation needed to fund the government for the fiscal year 2025, they are planning to pass a bill called a Continuing Resolution, referred to as a CR, that will temporarily fund the government at the same level as it had been in the 2024 fiscal year. The CR has a deadline, and the purpose is to give them more time to reach an agreement.
However, like last year, the GOP is split over the length of a continuing resolution and whether other GOP priorities should be attached. Those differences will need to be resolved to pass the funding in the House, where Republicans only narrowly have control.
The outcome will determine whether federal agencies close down on October 1 or receive temporary funding until new fiscal 2025 spending is worked out.
They will have little time to resolve their differences because Congress is only in session 13 days this month before the deadline.
Democrats, meanwhile, are mostly united behind a short-term CR lasting into the lame-duck session that will occur after the November elections. They have the votes in the Senate to block any broader deal that the House Republican majority may end up passing, and Senate Democrats have sought to blame Republicans for veering toward a shutdown.
The hard-right House Freedom Caucus has called for a continuing resolution that would stretch into early next year “to avoid a lame duck omnibus that preserves Democrat spending and policies well into the next administration.” They hope to see former President Donald Trump back in office in January, when he could push conservative spending priorities.
However, despite conservative resistance, there is good reason to believe Congress will be able to avoid a government shutdown, mainly because the upcoming election means a shutdown could hurt Republicans politically in their battle to keep the House.
In addition to a handful of other important measures, Congress also needs to address an almost $15 billion shortfall at the Department of Veterans Affairs by September 20 to avoid missed benefits for veterans and their families.
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Last month, the Center for Medicare and Medicaid Services released this statement:
In August 2022, President Biden signed the Inflation Reduction Act of 2022 into law. The law improves Medicare by expanding benefits, lowering drug costs, and improving the sustainability of the Medicare program for generations to come.
The law provides meaningful financial relief for millions of people with Medicare by improving access to affordable treatments and strengthening Medicare, both now and in the long run. For the first time, the law provides Medicare the ability to directly negotiate the prices of certain high-expenditure, single-source drugs without generic or biosimilar competition.
The Centers for Medicare & Medicaid Services (CMS) selected ten drugs covered under Medicare Part D for the first cycle of negotiations for initial price applicability year 2026. They engaged in voluntary negotiations with the drug companies for the selected drugs. Below is the list of negotiated prices, which the statute refers to as Maximum Fair Prices (MFPs), for ten drugs covered under Medicare Part D that will go into effect beginning January 1, 2026, based on negotiations and agreements between CMS and participating drug companies.
The following drugs are included:
Drug Name List price (monthly) Negotiated price (monthly)
Januvia $527.00 $113.00
Fiasp $495.00 $119.00
Farxiga $556.00 $178.50
Enbrel $7,106.00 $2,355.00
Jardiance $573.00 $197.00
Stelara $13,836.00 $4, 695.00
Xarelto $517.00 $197.00
Eliquis $521.00 $231.00
Entresto $628.00 $295.00
Imbruvica $14,934.00 $9,319.00
These prices will go into effect on January 1, 2026.
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Pharmacy Benefit Managers (PBMs) Accused of False Testimony
Drug middlemen, also known as PBMs, are accused of making false statements during congressional testimony last month as part of an investigation into the practices of these entities.
House Oversight Chair James Comer (R-Ky.) wrote to CVS, UnitedHealth, and Cigna late last month asking them to correct remarks they made during a July hearing that they don’t steer patients to their own pharmacies or pay them more favorable rates.
Comer said those statements contradicted evidence unearthed by his committee and the Federal Trade Commission, which is independently investigating PBMs.
A Cigna’s Express Scripts unit spokesperson said the company stands behind the testimony and rebuts the letter’s allegations.
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Think your Medical Bill isn’t quite Right? It Might Pay to Ask Some Questions
According to an article in Statnews:
If you get a medical bill that you’re worried about, you should probably try to fight it, according to new survey data published Friday. Researchers used nationally representative data from more than 1,100 respondents, about 1 in 5 of whom reported receiving a medical bill that they disagreed with or couldn’t afford. About 61% of those people contacted the billing office to address the concern.
Ask and, often, you shall receive: For those with an unaffordable bill, 75% received financial relief through bill cancellation, assistance, payment plans, or price reductions. Almost 62% got a price drop among those who negotiated the price.
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