July 13, 2022

Congress Continues Focus on Appropriations & Drug Pricing

The House Appropriations Labor, Health and Human Services, Education, and Related Agencies (Labor-H) Subcommittee marked up its Fiscal Year 2023 bill that includes HIV-related funding. Readers will recall that the Biden-Harris administration requested greater investments in HIV prevention, treatment, and research and the Subcommittee largely kept pace, even exceeding the White House budget in several areas.

• Centers for Disease Control and Prevention (CDC): Increases in STD Prevention, TB Elimination, and Opioid Related Infectious Diseases. Reductions in total funding to the Division of HIV prevention by $60 million.
• The rider that bans the use of federal dollars for the purchase of syringes was again listed, but an amendment to the bill added a ban on federal funds used for the purchase of other harm reduction methods.
• Appropriators added “report language” (language that offers more detailed guidance to departments and agencies than just the spending bill alone) on access to PrEP. “The Committee notes the importance of expanding HIV pre-exposure prophylaxis (PrEP) nationally to improve access to medications and essential support services, community and provider outreach, to make progress towards ending the HIV epidemic.”
• Health Resources and Services Administration (HRSA): The House bill calls for an increase of $200 million in the Ryan White Program, increasing funding in Part A by $20.5 million, Part B – Care by $41 million, Part C by $6.4 million, Part D by $2.3 million, and Part F (AETCs $1.1 million, Dental $400k, Special Projects of National Significance $3 million).
• National Institutes of Health (NIH): The House bill requests another $200 million for the NIH-sponsored Centers for AIDS Research, increasing that funding to $3.394 billion.
• Housing and Urban Development (HUD): The House Transportation, Housing and Urban Development Appropriations Subcommittee bill requested $600 million for the Housing Opportunities for Persons With AIDS (HOPWA) program. Appropriators have recommended an overall increase of $170 million over last fiscal year.

The full committee is expected to take up some of the bills next week, though Labor-H is not on that list and a specific timeline is not yet known. Nevertheless, the Academy will continue to advocate for robust funding across federal HIV prevention, treatment, care, and research funding streams.

Also unclear is when the Senate will take up its spending bills, though it’s perhaps not until December. One related issue that is back in the news, however, is drug pricing reform and the budget reconciliation tactic. Readers may recall the effort that was underway last year with Build Back Better until things fell apart after Sen. Joe Manchin pulled out of negotiations.

The revived bill would require Medicare to negotiate prices on certain drugs using a phased-in approach. Negotiations on drug pricing would begin next year, but reform on pricing wouldn’t be implemented until 2026. Medicare redesigns to shield patient costs would move to 2025, with a cap on out-of-pocket costs going into effect in 2024. The pharmaceutical industry strongly opposes this plan.