Medicare PBM Accountability Act

H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package) H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5526 Seniors Access to Critical Medications Act of 2024 H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act H.R. 7623 Telehealth Modernization Act of 2024 H.R. 9096 Pharmacists Fight Back Act H.R. 10545 CR - The American Relief Act, 2025 S. 1038Drug Price Transparency in Medicaid Act S. 1339Pharmacy Benefit Manager Reform Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act) S. 3458Seniors Access to Critical Medications Act of 2024

Client expense: $620,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lower healthcare costs and bring transparency to pharmacy benefit managers (PBMs) through meaningful PBM reforms. H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2534 Protect 340B Act of 2023 H.R. 2816 The PBM Sunshine and Accountability Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package) H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act H.R. 5526 Seniors Access to Critical Medications Act of 2024 H.R. 7623 Telehealth Modernization Act of 2024 H.R. 7635 The 340B Patients Act of 2024 H.R. 8574 340B Affording Care for Communities and Ensuring a Strong Safety-Net Act H.R. 9096 Pharmacists Fight Back Act H.R. 10362 - A bill to prohibit pharmacy benefit managers and pharmacies from being under common ownership, and for other purposes. H.R. 10545 CR - The American Relief Act, 2025 S. 1038Drug Price Transparency in Medicaid Act S. 113Prescription Pricing for the People Act S. 127Pharmacy Benefit Manager Transparency Act S. 1339Pharmacy Benefit Manager Reform Act S. 1491Pharmacy and Medically Underserved Areas Enhancement Act S. 2052Protect Patient Access to Pharmacies Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3393The SUPPORT Act S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act) S. 3458Seniors Access to Critical Medications Act of 2024 S. 5021The 340B Patients Act of 2024 S. 5503 A bill to prohibit pharmacy benefit managers and pharmacies from being under common ownership, and for other purposes.

Client expense: $620,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Economic Council (NEC), SENATE, White House Office

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Urged Congress to support year-end Continuing Resolution (CR) that contained PBM reform, averting Medicare physician payment cuts by 2.5%, provided bonus payment to physicians participating in APMs, and extended telehealth flexibilities adopted during the COVID-19 pandemic for 2 years. Also advocated that streamlined prior authorization process for Medicare Advantage plans be included in the CR. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Client expense: $242,106 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Urged Congress to support year-end Continuing Resolution (CR) that contained PBM reform, averting Medicare physician payment cuts by 2.5%, provided bonus payment to physicians participating in APMs, and extended telehealth flexibilities adopted during the COVID-19 pandemic for 2 years. Also advocated that streamlined prior authorization process for Medicare Advantage plans be included in the CR. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Client expense: $124,919 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Medicare Advantage (MA) & ME Rate Notice; prescriptions and PBMs H.R. 2880 - Protecting Patients Against PBM Abuses Act To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under Part D of the Medicare program. H.R. 5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D. Discussions regarding utilizing AI to combat fraud. Discussions regarding Dual Eligible Special Needs Plans (D-SNP 101).

Client expense: $760,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 1613 - Drug Price Transparency in Medicaid Act of 2023 - Rep. Carter, Earl - spread-pricing by PBMs for Medicaid H.R. 2880 - Protecting Patients Against PBM Abuses Act - Rep. Carter, Earl - PBM transparency H.R. 4818 - Treat and Reduce Obesity Act - Rep. Wenstrup, Brad - weight loss coverage H.R. 5372 - Expanding Seniors Access to Lower Cost Medicines Act of 2023 - Rep. Joyce, John - generic drugs, biosimilars cost H.R. 5378 - Lower Costs, More Transparency Act - Rep. McMorris Rodgers, Cathy - PBM transparency H.R. 5385 - Medicare PBM Accountability Act - Rep. Landsman, Greg McMorris - PBM transparency H.R. 6283 - DRUG Act - Rep. Miller-Meeks, Mariannette - PBM contracts H.R. 6963 - Pediatric Cancer Drug Supply Act of 2024 - Rep. Eshoo, Anna - establishes agreements with drug manufacturers to establish reserve supplies of covered pediatric cancer drugs H.R. 7635 - The 340B PATIENTS Act of 2024- Rep. Matsui, Doris - ensures accessibility of drugs under 340B drug discount program S. 79 - Interagency Patent Coordination and Improvement Act of 2023 - Sen. Durbin, Richard - prescription drug patenting S. 113 - Prescription Pricing for the People Act of 2023 - Sen. Grassley, Chuck - PBM transparency S. 127 - Pharmacy Benefit Manager Transparency Act of 2023 - Sen. Cantwell, Maria - PBM transparency S. 142 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy - pharmacy and biosimilar prescription drugs S. 148 - Stop STALLING Act - Sen. Klobuchar, Amy - pharmacy market approval processes S. 150 - Affordable Prescriptions for Patients Act of 2023 - Sen. Cornyn, John - pharmacy and prescription drug prices, prevent patent thickets S. 574 - Increasing Prescription Drug Competition Act - Sen. Hassan, Maggie - closure of pharmaceutical patent loophole S. 652 - Safe Step Act - Sen. Murkowski, Lisa - medication step therapy protocol S. 954 - Affordable Insulin Now Act of 2023 - Sen. Warnock, Raphael - insulin pricing and cost sharing S. 1038 - Drug Price Transparency in Medicaid Act of 2023 - Sen. Welch, Peter - drug pricing transparency S. 1269 - INSULIN Act of 2023 - Sen. Shaheen, Jeanne - insulin pricing S. 1339 - Pharmacy Benefit Manager Reform Act - Sen. Sanders, Bernie - PBM transparency S. 1542 - DRUG Act - Sen. Marshall, Roger - PBM regulation S. 2973 - Modernizing and Ensuring PBM Accountability Act - Sen. Wyden, Ron - Plan implementation S. 3934 - Increasing Access to Biosimilars Act of 2023- Sen. Cornyn, John - Medicare drug access Issues related to the implementation of Inflation Reduction Act - Medicare negotiation; coverage of weight loss drugs; high priced drugs; patent reforms; Pharmacy Benefit Managers; and copay coupons.

Client expense: $2,560,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

S. 1967, the Patients Before Middlemen (PBM) Act, establishing new requirements relating to the responsibility of pharmacy benefit managers under Medicare part D; H.R. 3282, Promoting Transparency and Healthy Competition in Medicare Act; H.R. 3284, Providers and Payers COMPETE Act, To require the Secretary of Health and Human Services to consider, within the annual rulemaking process, the effect of regulatory changes to certain Medicare payment systems on provider and payer consolidation, and for other purposes; H.R. 2880, the Protecting Patients Against PBM Abuses Act; H.R. 5376, the Share the Savings with Seniors Act; H.R. 5385, the Medicare PBM Accountability Act; H.R.4881, To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program. Including issues related to point-of-sale rebates in Part D Low-Income Subsidy under the Medicare program; H.R. 5393, the Transparency and Fairness for Pharmacies Act; H.R. 5372, the Expanding Seniors Access to Lower Cost Medicines Act of 2023; H.R. 1352, the Increasing Access to Biosimilars Act; H.R. 5386, the Cutting Copays Act; Issues related to the Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies; Medicare Program; Contract Year (CY) 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications; Issues related to Pharmacy Direct and Indirect Remuneration (DIR), including the Contract Year (CY) 2023 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit (Part D) Programs proposed rule; H.R. 7623, Telehealth Modernization Act of 2024; H.R. 8702/ S.4532, Improving Seniors' Timely Access to Care Act.

Client expense: $1,720,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid; Medicaid Redeterminations; Medicare Advantage; Prior Authorization H.R.5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor: Rep. Landsman, Greg [D-OH-1] (Introduced 09/12/2023) H.R. 7623 - Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] (Introduced 03/12/2024) H.R.8702 - Improving Seniors Timely Access to Care Act of 2024 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] (Introduced 06/12/2024)

Client expense: $20,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to prescription drug coverage and pharmacy benefits Issues related to the prescription drug marketplace, patents, and competition Regulatory and proposed legislative changes to Medicare Part D and Medicaid prescription drug benefits S.113 - Prescription Pricing for the People Act S.127 - Pharmacy Benefit Manager Transparency Act S.142 - Preserve Access to Affordable Generics and Biosimilars Act S.148 - Stop STALLING Act S.652 - Safe Step Act S.775 - Increasing Transparency in Generic Drug Applications Act S.1067 - Ensuring Timely Access to Generics Act S.1114 - Expanding Access to Low-Cost Generics Act S.1120 - Improved Access to Affordable Medications Act S.1128 - Ensuring Access to Generic Medications Act S.1339 - Pharmacy Benefit Manager Reform Act S.1542/H.R.6283 - Delinking Revenue from Unfair Gouging (DRUG) Act S.2973 - Modernizing and Ensuring PBM Accountability Act S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act S.150 - Affordable Prescriptions for Patients Act of 2023 H.R.1352 - Increasing Access to Biosimilars Act H.R.1790 - Biologics Competition Act H.R.2880 - Protecting Patients Against PBM Abuses Act H.R.4881 - To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program H.R.5378 - Lower Costs More Transparency Act H.R.5385 - Medicare PBM Accountability Act H.R. 8261- Preserving Telehealth, Hospital, and Ambulance Access Act, Sec. 302 H.R.7623- Telehealth Modernization Act of 2024 H.R.4758- Accelerating Kids Access to Care Act AINS Sec. 3 H.R.9096- Pharmacists Fight Back Act Implementation of the Inflation Reduction Act of 2022, P.L. 169- Provisions on Medicare Part D modernization and drug price negotiation

Client expense: $4,165,073 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Issues related to prescription drug coverage and pharmacy benefits Regulatory and proposed legislative changes to Medicare Part D prescription drug benefits S.652 - Safe Step Act S.2973 - Modernizing and Ensuring PBM Accountability Act S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act H.R.2880 - Protecting Patients Against PBM Abuses Act H.R.4881 - To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program H.R.5378 - Lower Costs More Transparency Act H.R.5385 - Medicare PBM Accountability Act H.R. 8261- Preserving Telehealth, Hospital, and Ambulance Access Act, Sec. 302 H.R.7623- Telehealth Modernization Act of 2024 H.R.4758- Accelerating Kids Access to Care Act AINS Sec. 3 H.R.9096- Pharmacists Fight Back Act Implementation of the Inflation Reduction Act of 2022, P.L. 169- Provisions on Medicare Part D modernization and drug price negotiation

Client expense: $4,165,073 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Issues related to pharmacy contracting with respect to drug pricing and pharmacy networks Regulatory and proposed legislative changes to Medicare Part D pharmacy contracting, pharmacy networks, and mail-service pharmacy S.113 - Prescription Pricing for the People Act S.127 - Pharmacy Benefit Manager Transparency Act S.1339 - Pharmacy Benefit Manager Reform Act S.2973 - Modernizing and Ensuring PBM Accountability Act S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act H.R.2880 - Protecting Patients Against PBM Abuses Act H.R.5378 - Lower Costs More Transparency Act H.R.5385 - Medicare PBM Accountability Act S.1542/H.R.6283 - Delinking Revenue from Unfair Gouging (DRUG) Act H.R. 8261- Preserving Telehealth, Hospital, and Ambulance Access Act, Sec. 302 H.R.7623- Telehealth Modernization Act of 2024 H.R.4758 - Accelerating Kids Access to Care Act AINS Sec. 3 H.R. 9096 - Pharmacists Fight Back Act Implementation of the Inflation Reduction Act of 2022, P.L. 169- Provisions on Medicare Part D modernization and drug price negotiation

Client expense: $4,165,073 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Advantage (MA) H.R.5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor: Rep. Landsman, Greg [D-OH-1] S.1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act) To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Sen. Cortez Masto, Catherine [D-NV] H.R.5819 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care Act To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Rep. Steel, Michelle [R-CA-45] S.2254 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor: Sen. Cortez Masto, Catherine [D-NV] H.R. 5394, Expanding Remote Monitoring Access Act (House only) To ensure appropriate access to remote monitoring services furnished under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R. 7149, Equal Access to Specialty Care Everywhere (EASE) Act of 2024 To amend title XI of the Social Security Act to require the Center for Medicare and Medicaid Innovation to test a model to improve access to specialty health services for certain Medicare and Medicaid beneficiaries. Sponsor: Rep. Steel, Michelle [R-CA-45] H.R. 8532, Connected MOM Act (House only) To identify and address barriers to coverage of remote physiologic devices under State Medicaid programs to improve maternal and child health outcomes for pregnant and postpartum women Sponsor: Sen. Cassidy, Bill [R-LA] H.R.8702 - Improving Seniors Timely Access to Care Act of 2024 To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.4758 - Accelerating Kids Access to Care Act To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. Sponsor: Rep. Trahan, Lori [D-MA-3] H.R. 4605, Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 6860, Restore Protections for Dialysis Patients Act To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 7996, Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2]

Client expense: $1,910,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

Lower healthcare costs and bring transparency to pharmacy benefit managers (PBMs) through meaningful PBM reforms. H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2534 Protect 340B Act of 2023 H.R. 2816 The PBM Sunshine and Accountability Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package) H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act H.R. 5526 Seniors Access to Critical Medications Act of 2024 H.R. 7623 Telehealth Modernization Act of 2024 H.R. 7635 The 340B Patients Act of 2024 H.R. 8574 340B Affording Care for Communities and Ensuring a Strong Safety-Net Act H.R. 9096 Pharmacists Fight Back Act S. 1038Drug Price Transparency in Medicaid Act S. 113Prescription Pricing for the People Act S. 127Pharmacy Benefit Manager Transparency Act S. 1339Pharmacy Benefit Manager Reform Act S. 1491Pharmacy and Medically Underserved Areas Enhancement Act S. 2052Protect Patient Access to Pharmacies Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3393The SUPPORT Act S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act) S. 3458Seniors Access to Critical Medications Act of 2024 S. 5021The 340B Patients Act of 2024

Client expense: $760,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Economic Council (NEC), SENATE, White House Office

H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package) H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5526 Seniors Access to Critical Medications Act of 2024 H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act H.R. 7623 Telehealth Modernization Act of 2024 H.R. 9096 Pharmacists Fight Back Act S. 1038Drug Price Transparency in Medicaid Act S. 1339Pharmacy Benefit Manager Reform Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act) S. 3458Seniors Access to Critical Medications Act of 2024

Client expense: $760,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1613 / S. 1038, the Drug Price Transparency in Medicaid Act; S. 2052, the Protect Patient Access to Pharmacies Act; H.R. 2880, the Protecting Patients Against PBM Abuses Act; H.R. 1770 / S. 2477, the Equitable Community Access to Pharmacist Services Act; S. 1491, the Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 2816, the PBM Sunshine and Accountability Act; H.R. 3281, the Transparent PRICE Act; H.R. 3282, the Promoting Transparency and Healthy Competition in Medicare Act; H.R. 3561, the PATIENT Act; S. 1967, the Patients Before Middlemen (PBM) Act; S. 2129, the Ensuring Access to Lower-Cost Medicines for Seniors Act; S. 2405, the Strengthening Pharmacy Access for Seniors Act; S. 2973, the Modernizing and Ensuring PBM Accountability Act; H.R. 5378, the Lower Costs, More Transparency Act; H.R.5385, the Medicare PBM Accountability Act; H.R. 5393, to amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes; H.R. 5400 / S. 2436, the NO PBMs Act; S.3430,the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023; Request for Information for "Medicare Transaction Facilitator (MTF) for the Medicare Drug Price Negotiation Program in the Inflation Reduction Act" (IRA; P.L. 117-169); Comments for "Medicare Prescription Payment Plan: Draft Part Two Guidance on Select Topics, Implementation of Section 1860D-2 of the Social Security Act for 2025" (IRA, P.L. 117-169); Comments for Final Rule Document 2022-09375, "Medicare Program, Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs..." (87 FR 27704); Comments for "Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies" (CMS-2024-0006); Request for Information for Bipartisan 340B Senate Working Group SUSTAIN 340B Act Discussion Draft; H.R.4366, the Consolidated Appropriations Act, 2024 H.R.2882, the Further Consolidated Appropriations Act, 2024 Cybersecurity protocols and policies in health care system and the impact on claims processing and reimbursement; Comments to CMS on the implementation of Medicare Part D vaccine coverage under the Inflation Reduction Act (IRA; P.L. 117-169); Comments to CMMI on the Importance of Implementing Reasonable Reimbursement Guardrails for Pharmacies in the Medicare $2 Drug List Model based on the Executive Order on Lowering Prescription Drug Costs for Americans; Comments to HHS and CMS on 2024 NADAC Methodology Changes; Comment to CMS on "Medicare Drug Price Negotiation Program: Draft Guidance, Implementation of Sections 1191 - 1198 of the Social Security Act for Initial Price Applicability Year 2027 and Manufacturer Effectuation of the Maximum Fair Price (MFP) in 2026 and 2027."; H.R. 9096, the Pharmacists Fight Back Act; Long Term Care at Home Pharmacy Services in Medicare; Regulating fair and common-sense contracting guardrails between Part D plans/PBMs, and pharmacies; Comments to CMS on Proposed Rule Re: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments [CMS-1807-P]; H.R.4758, the Accelerating Kids Access to Care Act; H.R. 8107, the Ensuring Access to Medicaid Buy-in Programs Act of 2024; Comments to CMS on Draft Guidance Re: Medicare Drug Price Negotiation Program: Draft Guidance, Implementation of Sections 1191 - 1198 of the Social Security Act for Initial Price Applicability Year 2027 and Manufacturer Effectuation of the Maximum Fair Price (MFP) in 2026 and 2027;

Client expense: $380,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Small Business Administration (SBA), White House Office

Medicare Advantage Advance Rate Notice; MA Health Equity Index Reward Factor Methodology H.R. 7623 Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. H.R. 5385 - Medicare PBM Accountability Act To amend title XVIII of the SSA to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D

Client expense: $160,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported the Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries.

Client expense: $243,888 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported the Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries.

Client expense: $124,919 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Medicaid Redeterminations & renewals; Same-day billing restrictions in Medicaid; Medicare Advantage; 340B Program H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.5380 -To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVlll of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R.2880 - Protecting Patients Against PBM Abuses Act To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under part D of the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R.5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish phannacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor:Rep. Landsman, Greg [D-OH-1] H.R.5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12]

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Same-day billing restrictions in Medicaid; Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R.2880 - Protecting Patients Against PBM Abuses Act To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under part D of the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R.5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor: Rep. Landsman, Greg [D-OH-1] H.R.5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R.4758 - Accelerating Kids Access to Care Act To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. Sponsor: Rep. Trahan, Lori [D-MA-3] S.1378 - Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act) To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program. Sponsor: Sen. Cortez Masto, Catherine [D-NV] H.R. 4605, Healthy Moms and Babies Act To amend titles XIX and XXI of the Social Security Act to improve maternal health coverage under Medicaid and CHIP, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 6860, Restore Protections for Dialysis Patients Act To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. Sponsor: Rep. Kelly, Mike [R-PA-16] H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R. 7996, Improving CARE for Youth Act To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. Sponsor: Rep. Dunn, Neal P. [R-FL-2] H.R. 8561, to amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification Sponsor: Rep. Tenney, Claudia [R-NY-24]

Client expense: $1,430,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

Issues related to prescription drug coverage and pharmacy benefits Issues related to the prescription drug marketplace, patents, and competition Regulatory and proposed legislative changes to Medicare Part D and Medicaid prescription drug benefits S.113 - Prescription Pricing for the People Act S.127 - Pharmacy Benefit Manager Transparency Act S.142 - Preserve Access to Affordable Generics and Biosimilars Act S.148 - Stop STALLING Act S.652 - Safe Step Act S.775 - Increasing Transparency in Generic Drug Applications Act S.1067 - Ensuring Timely Access to Generics Act S.1114 - Expanding Access to Low-Cost Generics Act S.1120 - Improved Access to Affordable Medications Act S.1128 - Ensuring Access to Generic Medications Act S.1339 - Pharmacy Benefit Manager Reform Act S.1542/H.R.6283 - Delinking Revenue from Unfair Gouging (DRUG) Act S.2973 - Modernizing and Ensuring PBM Accountability Act S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act S.150 - Affordable Prescriptions for Patients Act of 2023 H.R.1352 - Increasing Access to Biosimilars Act H.R.1790 - Biologics Competition Act H.R.2880 - Protecting Patients Against PBM Abuses Act H.R.4881 - To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program H.R.5378 - Lower Costs More Transparency Act H.R.5385 - Medicare PBM Accountability Act H.R. 8261- Preserving Telehealth, Hospital, and Ambulance Access Act, Sec. 302 H.R.7623- Telehealth Modernization Act of 2024 H.R.4758 - Accelerating Kids Access to Care Act AINS Sec. 3 Implementation of the Inflation Reduction Act of 2022, P.L. 169- Provisions on Medicare Part D modernization and drug price negotiation

Client expense: $3,581,756 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Economic Council (NEC), SENATE

Issues related to prescription drug coverage and pharmacy benefits Regulatory and proposed legislative changes to Medicare Part D prescription drug benefits S.652 - Safe Step Act S.2973 - Modernizing and Ensuring PBM Accountability Act S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act H.R.2880 - Protecting Patients Against PBM Abuses Act H.R.4881 - To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program H.R.5378 - Lower Costs More Transparency Act H.R.5385 - Medicare PBM Accountability Act H.R. 8261- Preserving Telehealth, Hospital, and Ambulance Access Act, Sec. 302 H.R.7623- Telehealth Modernization Act of 2024 H.R.4758- Accelerating Kids Access to Care Act AINS Sec. 3 Implementation of the Inflation Reduction Act of 2022, P.L. 169- Provisions on Medicare Part D modernization and drug price negotiation

Client expense: $3,581,756 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Issues related to pharmacy contracting with respect to drug pricing and pharmacy networks Regulatory and proposed legislative changes to Medicare Part D pharmacy contracting, pharmacy networks, and mail-service pharmacy S.113 - Prescription Pricing for the People Act S.127 - Pharmacy Benefit Manager Transparency Act S.1339 - Pharmacy Benefit Manager Reform Act S.2973 - Modernizing and Ensuring PBM Accountability Act S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act H.R.2880 - Protecting Patients Against PBM Abuses Act H.R.5378 - Lower Costs More Transparency Act H.R.5385 - Medicare PBM Accountability Act S.1542/H.R.6283 - Delinking Revenue from Unfair Gouging (DRUG) Act H.R. 8261- Preserving Telehealth, Hospital, and Ambulance Access Act, Sec. 302 H.R.7623- Telehealth Modernization Act of 2024 H.R.4758 - Accelerating Kids Access to Care Act AINS Sec. 3 Implementation of the Inflation Reduction Act of 2022, P.L. 169- Provisions on Medicare Part D modernization and drug price negotiation

Client expense: $3,581,756 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Economic Council (NEC), SENATE

S. 1967, the Patients Before Middlemen (PBM) Act, establishing new requirements relating to the responsibility of pharmacy benefit managers under Medicare part D; H.R. 3282, Promoting Transparency and Healthy Competition in Medicare Act; H.R. 3284, Providers and Payers COMPETE Act, To require the Secretary of Health and Human Services to consider, within the annual rulemaking process, the effect of regulatory changes to certain Medicare payment systems on provider and payer consolidation, and for other purposes; H.R. 2880, the Protecting Patients Against PBM Abuses Act; H.R. 5376, the Share the Savings with Seniors Act; H.R. 5385, the Medicare PBM Accountability Act; H.R.4881, To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program. Including issues related to point-of-sale rebates in Part D Low-Income Subsidy under the Medicare program; H.R. 5380, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage; H.R. 5393, the Transparency and Fairness for Pharmacies Act; H.R. 5372, the Expanding Seniors Access to Lower Cost Medicines Act of 2023; H.R. 1352, the Increasing Access to Biosimilars Act; H.R. 5386, the Cutting Copays Act; Issues related to the Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies; Medicare Program; Contract Year (CY) 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications; Issues related to Pharmacy Direct and Indirect Remuneration (DIR), including the Contract Year (CY) 2023 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit (Part D) Programs proposed rule; H.R. 7623, Telehealth Modernization Act of 2024; H.R./ S. Improving Seniors' Timely Access to Care Act.

Client expense: $2,200,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1613 - Drug Price Transparency in Medicaid Act of 2023 - Rep. Carter, Earl - spread-pricing by PBMs for Medicaid H.R. 2880 - Protecting Patients Against PBM Abuses Act - Rep. Carter, Earl - PBM transparency H.R. 5372 - Expanding Seniors Access to Lower Cost Medicines Act of 2023 - Rep. Joyce, John - generic drugs, biosimilars cost H.R. 5378 - Lower Costs, More Transparency Act - Rep. McMorris Rodgers, Cathy - PBM transparency H.R. 5385 - Medicare PBM Accountability Act - Rep. Landsman, Greg McMorris - PBM transparency H.R. 6283 - DRUG Act - Rep. Miller-Meeks, Mariannette - PBM contracts H.R. 6963 - Pediatric Cancer Drug Supply Act of 2024 - Rep. Eshoo, Anna - establishes agreements with drug manufacturers to establish reserve supplies of covered pediatric cancer drugs H.R. 7635 - The 340B PATIENTS Act of 2024- Rep. Matsui, Doris - ensures accessibility of drugs under 340B drug discount program S. 79 - Interagency Patent Coordination and Improvement Act of 2023 - Sen. Durbin, Richard - prescription drug patenting S. 113 - Prescription Pricing for the People Act of 2023 - Sen. Grassley, Chuck - PBM transparency S. 127 - Pharmacy Benefit Manager Transparency Act of 2023 - Sen. Cantwell, Maria - PBM transparency S. 142 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy - pharmacy and biosimilar prescription drugs S. 148 - Stop STALLING Act - Sen. Klobuchar, Amy - pharmacy market approval processes S. 150 - Affordable Prescriptions for Patients Act of 2023 - Sen. Cornyn, John - pharmacy and prescription drug prices, prevent patent thickets S. 574 - Increasing Prescription Drug Competition Act - Sen. Hassan, Maggie - closure of pharmaceutical patent loophole S. 652 - Safe Step Act - Sen. Murkowski, Lisa - medication step therapy protocol S. 954 - Affordable Insulin Now Act of 2023 - Sen. Warnock, Raphael - insulin pricing and cost sharing S. 1038 - Drug Price Transparency in Medicaid Act of 2023 - Sen. Welch, Peter - drug pricing transparency S. 1269 - INSULIN Act of 2023 - Sen. Shaheen, Jeanne - insulin pricing S. 1339 - Pharmacy Benefit Manager Reform Act - Sen. Sanders, Bernie - PBM transparency S. 2973 - Modernizing and Ensuring PBM Accountability Act - Sen. Wyden, Ron - Plan implementation S. 3934 - Increasing Access to Biosimilars Act of 2023- Sen. Cornyn, John - Medicare drug access Issues related to the implementation of Inflation Reduction Act - Medicare negotiation; coverage of weight loss drugs; patent reforms; Pharmacy Benefit Managers; and copay coupons.

Client expense: $2,390,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, SENATE

H.R. 1613 / S. 1038, the Drug Price Transparency in Medicaid Act; S. 2052, the Protect Patient Access to Pharmacies Act; H.R. 2880, the Protecting Patients Against PBM Abuses Act; H.R. 1770 / S. 2477, the Equitable Community Access to Pharmacist Services Act; S. 1491, the Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 2816, the PBM Sunshine and Accountability Act; H.R. 3281, the Transparent PRICE Act; H.R. 3282, the Promoting Transparency and Healthy Competition in Medicare Act; H.R. 3561, the PATIENT Act; S. 1967, the Patients Before Middlemen (PBM) Act; S. 2129, the Ensuring Access to Lower-Cost Medicines for Seniors Act; S. 2405, the Strengthening Pharmacy Access for Seniors Act; S. 2973, the Modernizing and Ensuring PBM Accountability Act; H.R. 5378, the Lower Costs, More Transparency Act; H.R.5385, the Medicare PBM Accountability Act; H.R. 5393, to amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes; H.R. 5400 / S. 2436, the NO PBMs Act; S.3430,the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023; Request for Information for "Medicare Transaction Facilitator (MTF) for the Medicare Drug Price Negotiation Program in the Inflation Reduction Act" (IRA; P.L. 117-169); Comments for "Medicare Prescription Payment Plan: Draft Part Two Guidance on Select Topics, Implementation of Section 1860D-2 of the Social Security Act for 2025" (IRA, P.L. 117-169); Comments for Final Rule Document 2022-09375, "Medicare Program, Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs..." (87 FR 27704); Comments for "Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies" (CMS-2024-0006); Request for Information for Bipartisan 340B Senate Working Group SUSTAIN 340B Act Discussion Draft; H.R.4366, the Consolidated Appropriations Act, 2024 H.R.2882, the Further Consolidated Appropriations Act, 2024 Cybersecurity protocols and policies in health care system and the impact on claims processing and reimbursement; Comments to CMS on the implementation of Medicare Part D vaccine coverage under the Inflation Reduction Act (IRA; P.L. 117-169); Comments to CMMI on the Importance of Implementing Reasonable Reimbursement Guardrails for Pharmacies in the Medicare $2 Drug List Model based on the Executive Order on Lowering Prescription Drug Costs for Americans; Comments to HHS and CMS on 2024 NADAC Methodology Changes; Comment on "Medicare Drug Price Negotiation Program: Draft Guidance, Implementation of Sections 1191 - 1198 of the Social Security Act for Initial Price Applicability Year 2027 and Manufacturer Effectuation of the Maximum Fair Price (MFP) in 2026 and 2027.";

Client expense: $340,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Small Business Administration (SBA), White House Office

Medicaid; Medicaid Redeterminations; Medicare Advantage; Prior Authorization H.R.5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor: Rep. Landsman, Greg [D-OH-1] (Introduced 09/12/2023) H.R. 2880-Protecting Patients Against PBM Abuses Act To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under part D of the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] (Introduced 04/26/2023) H.R. 7623, Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] (Introduced 03/12/2024)

Client expense: $20,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (MA) & ME Rate Notice; prescriptions and PBMs H.R. 2880 - Protecting Patients Against PBM Abuses Act To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under Part D of the Medicare program. H.R. 5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D.

Client expense: $830,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Medicare Advantage Advance Rate Notice; MA Health Equity Index Reward Factor Methodology H.R. 7623 Telehealth Modernization Act To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. H.R. 5385 - Medicare PBM Accountability Act To amend title XVIII of the SSA to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D

Client expense: $150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency HR 2880, Protecting Patients Against PBM Abuses Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under Part D of the Medicare program. HR 5380, by Rep. John Sarbanes (D-MD). To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. HR 5385, Medicare PBM Accountability Act, by Rep. Greg Landsman (D-OH). To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D. HR 5386, Cutting Copays Act, by Rep. Morgan McGarvey (D-KY). To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare Part D cost-sharing reductions for low-income individuals. HR 5388, Supporting Innovation for Seniors Act, by Rep. Troy Balderson (R-OH). To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. HR 5663, ALS Better Care Act, by Rep. Janice Schakowsky (D-IL). To amend title XVIII of the Social Security Act to provide coverage of ALS-related services under the Medicare program for individuals diagnosed with amyotrophic lateral sclerosis. HR 5746, Addressing Whole Health in Medicare Advantage Act, by Rep. Gus Bilirakis (R-FL). To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. HR 6860, Restore Protections for Dialysis Patients Act, by Rep. Mike Kelly (R-PA). To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. HR 7623, Telehealth Modernization Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. HR 7996, Improving CARE for Youth Act, by Rep. Neal Dunn (R-FL). To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. HR 8561, by Rep. Claudia Tenney (R-NY). To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. S 1378, Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act), by Sen. Catherine Cortez Masto (D-NV). To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program.

Client expense: $10,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency HR 2880, Protecting Patients Against PBM Abuses Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under Part D of the Medicare program. HR 5380, by Rep. John Sarbanes (D-MD). To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. HR 5385, Medicare PBM Accountability Act, by Rep. Greg Landsman (D-OH). To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare Part D. HR 5386, Cutting Copays Act, by Rep. Morgan McGarvey (D-KY). To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare Part D cost-sharing reductions for low-income individuals. HR 5388, Supporting Innovation for Seniors Act, by Rep. Troy Balderson (R-OH). To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. HR 5663, ALS Better Care Act, by Rep. Janice Schakowsky (D-IL). To amend title XVIII of the Social Security Act to provide coverage of ALS-related services under the Medicare program for individuals diagnosed with amyotrophic lateral sclerosis. HR 5746, Addressing Whole Health in Medicare Advantage Act, by Rep. Gus Bilirakis (R-FL). To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. HR 6860, Restore Protections for Dialysis Patients Act, by Rep. Mike Kelly (R-PA). To amend title XVIII of the Social Security Act to clarify and preserve the breadth of the protections under the Medicare Secondary Payer Act. HR 7623, Telehealth Modernization Act, by Rep. Earl Carter (R-GA). To amend title XVIII of the Social Security Act to make permanent certain telehealth flexibilities under the Medicare program. HR 7996, Improving CARE for Youth Act, by Rep. Neal Dunn (R-FL). To amend title XIX of the Social Security Act to ensure Medicaid coverage of mental health services and primary care services furnished on the same day. HR 8561, by Rep. Claudia Tenney (R-NY). To amend title XVIII of the Social Security Act to address significant under projection of MA local area growth due to wage index reclassification. S 1378, Connecting Our Medical Providers with Links to Expand Tailored and Effective Care (COMPLETE Care Act), by Sen. Catherine Cortez Masto (D-NV). To amend title XVIII of the Social Security Act to provide incentives for behavioral health integration under the Medicare program.

Client expense: $240,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported the Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vil, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usuage. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process by reintroducing and passing the Improving Seniors' Timely Access to Care Act. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries.

Client expense: $485,577 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported the Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vil, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usuage. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process by reintroducing and passing the Improving Seniors' Timely Access to Care Act. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries.

Client expense: $122,264 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported the Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vil, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usuage. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process by reintroducing and passing the Improving Seniors' Timely Access to Care Act. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries.

Client expense: $82,388 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported the Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vil, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usuage. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process by reintroducing and passing the Improving Seniors' Timely Access to Care Act. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries.

Client expense: $327,208 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package) H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act H.R. 7623 Telehealth Modernization Act of 2024 S. 1038Drug Price Transparency in Medicaid Act S. 1339Pharmacy Benefit Manager Reform Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act)

Client expense: $1,800,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lower healthcare costs and bring transparency to pharmacy benefit managers (PBMs) through meaningful PBM reforms. H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2534 Protect 340B Act of 2023 H.R. 2816 The PBM Sunshine and Accountability Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act H.R. 7623 Telehealth Modernization Act of 2024 H.R. 7635 The 340B Patients Act of 2024 H.R. 8574 340B Affording Care for Communities and Ensuring a Strong Safety-Net Act S. 1038Drug Price Transparency in Medicaid Act S. 113Prescription Pricing for the People Act S. 127Pharmacy Benefit Manager Transparency Act S. 1339Pharmacy Benefit Manager Reform Act S. 1491Pharmacy and Medically Underserved Areas Enhancement Act S. 2052Protect Patient Access to Pharmacies Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3393The SUPPORT Act S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act)

Client expense: $1,800,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Economic Council (NEC), SENATE, White House Office

Issues related to prescription drug coverage and pharmacy benefits Issues related to the prescription drug marketplace, patents, and competition Regulatory and proposed legislative changes to Medicare Part D and Medicaid prescription drug benefits S.113 - Prescription Pricing for the People Act S.127 - Pharmacy Benefit Manager Transparency Act S.142 - Preserve Access to Affordable Generics and Biosimilars Act S.148 - Stop STALLING Act S.150 - Affordable Prescriptions for Patients Act S.652 - Safe Step Act S.655 - Chronic Disease Management Act S.727 - Insulin for All Act S.775 - Increasing Transparency in Generic Drug Applications Act S.954 - Affordable Insulin Now Act S.1038 - Drug Price Transparency in Medicaid Act S.1067 - Ensuring Timely Access to Generics Act S.1114 - Expanding Access to Low-Cost Generics Act S.1120 - Improved Access to Affordable Medications Act S.1128 - Ensuring Access to Generic Medications Act S.1130 - Health Care PRICE Transparency Act S.1131 - Drug Price Transparency Act S.1217 - Ending the Prescription Drug Kickback Act S.1218 - Fair Prescription Drug Prices for Americans Act S.1269 - INSULIN Act S.1339 - Pharmacy Benefit Manager Reform Act S.1375 - HELP Copays Act S.1497 - Emergency Access to Insulin Act S.1491 - Pharmacy and Medically Underserved Areas Enhancement Act S.1542 - Delinking Revenue from Unfair Gouging (DRUG) Act S.1543 - A bill to require regulations concerning the disclosure of direct and indirect compensation from entities providing pharmacy benefit management services or third party administration services S.1967 - Patients Before Middlemen (PBM) Act S.2052 - Protect Patient Access to Pharmacies Act S.2129 - Ensuring Access to Lower-Cost Medicines for Seniors Act S.2254 - Medicare PBM Accountability Act S.2405 - Strengthening Pharmacy Access for Seniors Act S.2406 - PBM Oversight Act S.2408 - IMPROVE Part D Regulations Act S.2436 - Neighborhood Options for Patients Buying Medicines (NO PBM) Act S.2456 - Protecting Seniors from High Drug Costs Act S.2474 - Share the Savings with Seniors Act S.2477 - Equitable Community Access to Pharmacist Services Act S.2493 - PBM Reporting Transparency Act S.2666 - EPCS 2.0 Act S.2840 - Bipartisan Primary Care and Health Workforce Act (Bruan Amendment #3 - Price Transparency Requirements) S.2939 - Pharmacy Access Oversight and Reporting Act S.2973 - Modernizing and Ensuring PBM Accountability Act S.3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act H.R.830 - HELP Copays Act H.R.1352 - Increasing Access to Biosimilars Act H.R.1488 - Affordable Insulin Now Act H.R.1587 - Making Insulin Affordable for All Children Act H.R.1613 - Drug Price Transparency in Medicaid Act H.R.1770 - Equitable Community Access to Pharmacists Act H.R.1790 - Biologics Competition Act H.R.2630 - Safe Step Act H.R.2666 - Medicaid VBPs for Patients (MVP) Act H.R.2670 - PBM Accountability Act H.R.2691 - Transparent PRICE Act H.R.2880 - Protecting Patients Against PBM Abuses Act H.R.3030 - Stop the Overuse of Petitions and Get Affordable Medicines to Enter Soon (STOP GAMES) Act H.R.3134 - Emergency Access to Insulin Act H.R.3262 - to amend title XI of the Social Security Act to increase transparency of certain health-related ownership information H.R.3281 - Transparent PRICE Act H.R.3282 - Promoting Transparency and Health Competition in Medicare Act H.R.3285 - Fairness for Patient Medications H.R.3561- Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act H.R.3800 - Chronic Disease Flexible Coverage Act H.R.4011 - Timely Access to Clinical Treatment Act H.R.4507 - Transparency in Coverage Act H.R.4508 - Hidden Fee Disclosure Act H.R.4509 - Transparency in Billing Act H.R.4527 - Health Data Act H.R.4712 - Patient Right to Shop Act H.R.4822 - Health Care Price Transparency Act H.R.4846 - To amend the Internal Revenue Code of 1986, title XXVII of the Public Health Service Act, and the Employee Retirement Income Security Act of 1974 to provide for oversight of pharmacy benefit manager services H.R.4881 - To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program H.R.4883 - Medicare Common Ownership Transparency Act H.R.5372 - Expanding Seniors Access to Lower Cost Medicines Act H.R.5376 - Share the Savings with Seniors Act H.R.5378 - Lower Costs More Transparency Act H.R.5384 - Advancing Enrollment and Reducing Drug Costs Act H.R.5385 - Medicare PBM Accountability Act H.R.5386 - Cutting Copays Act H.R.5393 -Transparency and Fairness for Pharmacies Act H.R.5400 - Neighborhood Options for Patients Buying Medicines (NO PBM) Act H.R.5461 - Ensuring Access to Lower-Cost Medicines for Seniors Act Implementation of the Inflation Reduction Act of 2022, P.L. 169- Provisions on Medicare Part D modernization and drug price negotiation

Client expense: $4,803,802 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

H.R. 1613 - Drug Price Transparency in Medicaid Act of 2023 - Rep. Carter, Earl - spread-pricing by PBMs for Medicaid H.R. 2880 - Protecting Patients Against PBM Abuses Act - Rep. Carter, Earl - PBM transparency H.R. 5372 - Expanding Seniors Access to Lower Cost Medicines Act of 2023 - Rep. Joyce, John - generic drugs, biosimilars cost H.R. 5378 - Lower Costs, More Transparency Act - Rep. McMorris Rodgers, Cathy - PBM transparency H.R. 5385 - Medicare PBM Accountability Act - Rep. Landsman, Greg McMorris - PBM transparency H.R. 6283 - DRUG Act - Rep. Miller-Meeks, Mariannette - PBM contracts H.R. 6963 - Pediatric Cancer Drug Supply Act of 2024 - Rep. Eshoo, Anna - establishes agreements with drug manufacturers to establish reserve supplies of covered pediatric cancer drugs H.R. 7635- The 340B PATIENTS Act of 2024- Rep. Matsui, Doris - ensures accessibility of drugs under 340B drug discount program S. 79 - Interagency Patent Coordination and Improvement Act of 2023 - Sen. Durbin, Richard - prescription drug patenting S. 113 - Prescription Pricing for the People Act of 2023 - Sen. Grassley, Chuck - PBM transparency S. 127 - Pharmacy Benefit Manager Transparency Act of 2023 - Sen. Cantwell, Maria - PBM transparency S. 142 - Preserve Access to Affordable Generics and Biosimilars Act - Sen. Klobuchar, Amy - pharmacy and biosimilar prescription drugs S. 148 - Stop STALLING Act - Sen. Klobuchar, Amy - pharmacy market approval processes S. 150 - Affordable Prescriptions for Patients Act of 2023 - Sen. Cornyn, John - pharmacy and prescription drug prices S. 574 - Increasing Prescription Drug Competition Act - Sen. Hassan, Maggie - closure of pharmaceutical patent loophole S. 652 - Safe Step Act - Sen. Murkowski, Lisa - medication step therapy protocol S. 954 - Affordable Insulin Now Act of 2023 - Sen. Warnock, Raphael - insulin pricing and cost sharing S. 1038 - Drug Price Transparency in Medicaid Act of 2023 - Sen. Welch, Peter - drug pricing transparency S. 1269 - INSULIN Act of 2023 - Sen. Shaheen, Jeanne - insulin pricing S. 1339 - Pharmacy Benefit Manager Reform Act - Sen. Sanders, Bernie - PBM transparency S. 3934- Increasing Access to Biosimilars Act of 2023- Sen. Cornyn, John - Medicare drug access Regulatory Issues: Issues relating to long term safety and effectiveness of medical devices and drugs, including registries; issues relating to post-market surveillance of drugs and medical devices; issues relating to price of drugs and biologics and proposals to limit high prices; issues related to prescription drug coupons and discount programs; contraceptive coverage; issues relating to vaccines; issues related to health equity; issues related to vaccination; potential Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; issues related to coverage of EUA drugs under Medicare Part D; issues related to drug patents and market exclusivity; issues related to pharmacy benefit managers; issues related to biosimilars; issues related to approval of drugs and biologics; issues relating to opioids; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to health care price transparency; issues relating to prescription drug rebates; direct-to-consumer advertising for prescription drugs; issues relating to access for investigational drugs; issues related to comparative effectiveness research and quality-adjusted life years; issues related to health plan step-therapy; and other issues relating to health care reform implementation.

Client expense: $4,210,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 1967, the Patients Before Middlemen (PBM) Act, establishing new requirements relating to the responsibility of pharmacy benefit managers under Medicare part D; H.R. 3282, Promoting Transparency and Healthy Competition in Medicare Act; H.R. 3284, Providers and Payers COMPETE Act, To require the Secretary of Health and Human Services to consider, within the annual rulemaking process, the effect of regulatory changes to certain Medicare payment systems on provider and payer consolidation, and for other purposes; H.R. 2880, the Protecting Patients Against PBM Abuses Act; H.R. 5376, the Share the Savings with Seniors Act; H.R. 5385, the Medicare PBM Accountability Act; H.R.4881, To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program. Including issues related to point-of-sale rebates in Part D Low-Income Subsidy under the Medicare program; S. 2129, the Ensuring Access to Lower-Cost Medicines for Seniors Act; H.R. 5380, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage; H.R. 5393, the Transparency and Fairness for Pharmacies Act; H.R. 5372, the Expanding Seniors Access to Lower Cost Medicines Act of 2023; H.R. 1352, the Increasing Access to Biosimilars Act; H.R. 5386, the Cutting Copays Act; S. 3059, the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act; S. 3430, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (the Better Act); Issues related to the Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies; Medicare Program; Contract Year (CY) 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications; Issues related to Pharmacy Direct and Indirect Remuneration (DIR), including the Contract Year (CY) 2023 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit (Part D) Programs proposed rule.

Client expense: $2,910,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1613 / S. 1038, the Drug Price Transparency in Medicaid Act; S. 2052, the Protect Patient Access to Pharmacies Act; H.R. 2880, the Protecting Patients Against PBM Abuses Act; H.R. 1770 / S. 2477, the Equitable Community Access to Pharmacist Services Act; S. 1491, the Pharmacy and Medically Underserved Areas Enhancement Act; H.R. 2816, the PBM Sunshine and Accountability Act; H.R. 3281, the Transparent PRICE Act; H.R. 3282, the Promoting Transparency and Healthy Competition in Medicare Act; H.R. 3561, the PATIENT Act; S. 1967, the Patients Before Middlemen (PBM) Act; S. 2129, the Ensuring Access to Lower-Cost Medicines for Seniors Act; S. 2405, the Strengthening Pharmacy Access for Seniors Act; S. 2973, the Modernizing and Ensuring PBM Accountability Act; H.R. 5378, the Lower Costs, More Transparency Act; H.R.5385, the Medicare PBM Accountability Act; H.R. 5393, to amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes; H.R. 5400 / S. 2436, the NO PBMs Act; S.3430,the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023; Request for Information for "Medicare Transaction Facilitator (MTF) for the Medicare Drug Price Negotiation Program in the Inflation Reduction Act" (IRA; P.L. 117-169); Comments for "Medicare Prescription Payment Plan: Draft Part Two Guidance on Select Topics, Implementation of Section 1860D-2 of the Social Security Act for 2025" (IRA, P.L. 117-169); Comments for Final Rule Document 2022-09375, "Medicare Program, Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs..." (87 FR 27704); Comments for "Advance Notice of Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies" (CMS-2024-0006); Request for Information for Bipartisan 340B Senate Working Group SUSTAIN 340B Act Discussion Draft; H.R.4366, the Consolidated Appropriations Act, 2024 H.R.2882, the Further Consolidated Appropriations Act, 2024

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Small Business Administration (SBA), White House Office

H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package) H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 1038Drug Price Transparency in Medicaid Act S. 1339Pharmacy Benefit Manager Reform Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act)

Client expense: $740,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lower healthcare costs and bring transparency to pharmacy benefit managers (PBMs) through meaningful PBM reforms. H.R. 1613 Drug Price Transparency in Medicaid Act H.R. 1770 Equitable Community Access to Pharmacist Services Act H.R. 2534 Protect 340B Act of 2023 H.R. 2816 The PBM Sunshine and Accountability Act H.R. 2880 Protecting Patients Against PBM Abuses Act H.R. 2882 Fiscal 2024 Further Consolidated Appropriations Act (3-22 package) H.R. 3561 The Patient Act H.R. 4366 Consolidated Appropriations Act, 2024 (3-8 package H.R. 5378 Lower Costs, More Transparency Act H.R. 5385 The Medicare PBM Accountability H.R. 5393 To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes. H.R. 5400 TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act H.R. 7635 The 340B Patients Act of 2024 S. 1038Drug Price Transparency in Medicaid Act S. 113Prescription Pricing for the People Act S. 127Pharmacy Benefit Manager Transparency Act S. 1339Pharmacy Benefit Manager Reform Act S. 1491Pharmacy and Medically Underserved Areas Enhancement Act S. 2052Protect Patient Access to Pharmacies Act S. 2436TheNeighborhood Options for Patients Buying Medicines (NO PBMs) Act S. 2477Equitable Community Access to Pharmacist Services Act S. 2666ECAPS 2.0 Act S. 2973Modernizing and Ensuring PBM Accountability Act (MEPA) S. 3393The SUPPORT Act S. 3430Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023 (Better Act)

Client expense: $740,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Economic Council (NEC), SENATE, White House Office

Medicaid Redeterminations & renewals; Same-day billing restrictions in Medicaid; Medicare Advantage (MA) & MA Rate Notice; 340B Program/Transparency; Managed Care Organizations; Draft duals legislation H.R.5746 - Addressing Whole Health in Medicare Advantage Act To amend title XVIII of the Social Security Act to expand the availability of supplemental benefits to certain Medicare Advantage enrollees. Sponsor: Rep. Bilirakis, Gus M. [R-FL-12] H.R.5386 - Cutting Copays Act To amend title XVIII of the Social Security Act to provide for adjustments to the Medicare part D cost-sharing reductions for low-income individuals. Sponsor: Rep. McGarvey, Morgan [D-KY-3] H.R.5380 - To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage. Sponsor: Rep. Sarbanes, John P. [D-MD-3] H.R.2880 - Protecting Patients Against PBM Abuses Act To amend title XVIII of the Social Security Act to establish certain requirements for pharmacy benefit managers under part D of the Medicare program. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R.5385 - Medicare PBM Accountability Act To amend title XVIII of the Social Security Act to establish pharmacy benefit manager reporting requirements with respect to prescription drug plans and MA-PD plans under Medicare part D. Sponsor:Rep. Landsman, Greg [D-OH-1] H.R.5388 - Supporting Innovation for Seniors Act To amend title XVIII of the Social Security Act to provide coverage of certain technologies and medical devices under the Medicare program. Sponsor: Rep. Balderson, Troy [R-OH-12] H.R.5663 - ALS Better Care Act To amend title XVIII of the Social Security Act to provide coverage of ALS-related services under the Medicare program for individuals diagnosed with amyotrophic lateral sclerosis, and for other purposes. Sponsor: Rep. Schakowsky, Janice D. [D-IL-9] H.R.4758 - Accelerating Kids Access to Care Act To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. Sponsor: Rep. Trahan, Lori [D-MA-3] S.2973 - Modernizing and Ensuring PBM Accountability Act To amend titles XVIII and XIX of the Social Security Act to establish requirements relating to pharmacy benefit managers under the Medicare and Medicaid programs, and for other purposes. Sponsor: Sen. Wyden, Ron [D-OR] HR 5663 ALS Better Care Act To amend title XVIII of the Social Security Act to provide coverage of ALS-related services under the Medicare program for individuals diagnosed with amyotrophic lateral sclerosis, and for other purposes. Sponsor: Rep. Schakowsky, Janice D. [D-IL-9] HR 4758 Accelerating Kids Access to Care Act To amend title XIX of the Social Security Act to streamline enrollment under the Medicaid program of certain providers across State lines, and for other purposes. Sponsor: Rep. Trahan, Lori [D-MA-3]

Client expense: $1,940,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE