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Congress reaches final deal on opioid package. Congressional leaders have finalized a deal on a wide-ranging bill to help reduce addictions and deaths from opioids. The bill, which spans 660 pages, was announced late Tuesday evening and marks a significant bipartisan victory ahead of the midterm elections. The death toll from opioids reached 40,000 people in 2017, and the legislation changes regulations, gives more tools to medical research entities and law enforcement, and uses funding from various spending bills advanced earlier this year. Congressional leaders did not release a timeline for a vote, but said they expected the deal to pass “swiftly” and head to President Trump’s desk.

Key provisions in opioid bill:

• The STOP Act, which gives the U.S. postal service more tools to identify suspicious shipments of illicit fentanyl from overseas;
• The CRIB Act intended to help newborns suffering from addiction. The bill would allow Medicaid to cover residential pediatric recovery providers in addition to hospitals;
• A measure to give the Food and Drug Administration authority to limit opioid packaging to blister packs that provide only a three to five-day supply. The goal is to limit overuse; and
• The INFO Act that creates a database that can be used by local law enforcement, governments, pharmacists and healthcare providers that has information on how to fight the epidemic. The database will also have information on federal funding opportunities.

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Pharmaceutical lobby fails again to advance ‘doughnut hole’ fix. The legislative package designed to help address the opioid crisis will not include the “doughnut hole” fix, a key provision sought by the pharmaceutical lobby to lower the portion of the cost of a drug the industry must cover under Medicare. The Pharmaceutical Research and Manufacturers of America was trying to insert a measure into the bill, expected to be finalized as early as Tuesday evening, to overturn a provision included in a February government spending bill that will force the drug industry in 2019 to begin to cover 70 percent of the price of treatments offered in the Medicare Part D program. The influential lobbying group was trying to lower that discount for enrollees to 63 percent and sought to pair it with a proposal the industry previously opposed that would make it more difficult for pharmaceutical manufacturers to abuse a safety program at the Food and Drug Administration to prevent generic competitors from reaching the market. Barring any last minute deal, the package pushed by PhRMA is not expected to be added to the opioids legislation.

IMD exclusion makes it into the opioid package. Sen. Rob Portman, R-Ohio, told the Washington Examiner that the final package would include a repeal of some sort of a decades-old rule that prevented hospitals from caring for more people with mental illness or substance abuse issues. The Institution for Mental Disease, or IMD, rule prevents Medicaid from reimbursing a hospital that allows more than 16 people suffering from mental illness or addiction to staying at the hospital. The House passed a partial repeal of the rule, but the Senate’s version of the legislation that passed last week did not include any repeal of the rule.

Portman and several other senators introduced a bill last week that would completely repeal the rule. Democratic Sens. Dick Durbin of Illinois, Ben Cardin of Maryland, and Sherrod Brown of Ohio were also co-sponsors of the Improving Coverage for Addiction Recovery Expansion Act.

Portman said that a version of his bill made it into the final package, but did not elaborate.

House votes to ban ‘gag clauses’ that prevent pharmacies from lowering customers’ drug costs. The House has passed two measures blocking insurers from enforcing “gag clauses” that forbid pharmacies from telling customers about how they can pay less for drugs.

The Patient Right to Know Drug Prices Act and the Know the Lowest Price Act passed through voice vote Tuesday and are intended to help patients find out whether a prescription would cost less if they were to pay for it out of pocket rather than through their health plan.

House reauthorizes pandemic control program, without Trump’s requested change.  The House has reauthorized a bill intended to tackle pandemics and other threats to public safety, while leaving out a previously drafted change to emergency supplies that had the support of President Trump. The final version of the legislation, passed through a voice vote, ultimately did not include a provision that would have moved a massive stockpile of drugs, vaccines, and medical supplies from the authority of the Centers for Disease Control and Prevention to the Department of Health and Human Services’ Assistant Secretary for Preparedness and Response. The change to the stockpiles, kept in warehouses at undisclosed locations around the U.S., had been requested by the White House, but lawmakers ultimately decided not to include it in the bill in order to keep it bipartisan, according to a senior Republican aide. The administration may still decide to make the change, and the House added provisions to the bill to encourage better reporting. The Senate version of the bill, which advanced almost unanimously out of the Senate Health, Education, Labor and Pensions Committee, did not contain the stockpile change. Congress has until the end of September to send the bill to Trump to sign it into law before it expires. Its provisions last for five years.

Kevin Brady sees vote to nix Obamacare mandates slipping past midterm elections. House Ways & Means Chairman Kevin Brady suggested Tuesday that the House won’t have enough time this week to vote on a bill that delays or repeals key parts of Obamacare, meaning that the legislation won’t be passed until after the midterm elections. Brady told reporters at the Capitol that a recess in the House due to Hurricane Florence could mean the Save American Workers Act of 2018 will not be considered until a lame duck session of Congress after the 2018 midterm elections. The House is expected to recess after this week for the whole month of October to give members more time to campaign before the elections in early November. “I think with Hurricane Florence knocking some days of the calendar I think timing got the better of the process,” Brady said. “I expect those bills to come to the floor if not this week then when we return.” He said that he hopes to have the bill to President Trump’s desk before the end of the year.

Chuck Grassley sets up possible Kavanaugh vote for Friday. The Senate Judiciary Committee has scheduled a possible Friday vote on Supreme Court nominee Brett Kavanaugh, panel Chairman Chuck Grassley, R-Iowa, announced Tuesday. Grassley tweeted Tuesday that a vote on Kavanaugh is possible that day, but will depend on the results of Thursday’s hearing with the nominee and the woman who accused him of sexual assault, Christine Blasey Ford. “After hrg Dr Ford & Judge Kavanaugh’s testimony — if we’re ready to vote, we will vote,” he tweeted. “If we aren’t ready, we won’t.”

CDC: Congenital syphilis cases have more than doubled since 2013. Cases of congenital syphilis — syphilis passed from mother to baby during pregnancy — have more than doubled since 2013, according to the annual Sexually Transmitted Disease Surveillance Report released Tuesday by the CDC.

Insurers, drug pricing reform groups implore Congress to keep discount. A collection of 16 insurer and hospital lobbyists and drug pricing reform groups don’t want to take any chances with the “donut hole” fix. They wrote a letter to House and Senate leadership late Tuesday calling for Congress to keep the discount. “We’re urging you to thwart any efforts by the pharmaceutical industry to lower the drug manufacturer discount in the Part D program,” the letter said. Drug pricing reform groups Campaign for Sustainable Rx Pricing and Patients for Affordable Drugs were among the groups that signed on to the letter. The pro-Obamacare group Families USA, AARP, insurance lobby America’s Health Insurance Plans, and the American Hospital Association were also signatories on the letter.

RUNDOWN

Citylab Is your local coffee shop a low-key opioid clinic?

Axios Healthcare data hacks are on the rise

The Hill GOP ad uses shark to hit Dem over government takeover

NPR Will Congress bring sky-high air ambulance bills back down to Earth?

New York Times Cancer center switches focus on fundraising as problems mount

Kaiser Health News Obamacare emerging as a central issue in state attorney general races

CNN Health crisis turned this Trump voter into an Obamacare supporter

Politico GOP ground game focuses on abortion to turn out base