| Good morning from the nation's capital, where it could hit 100 degrees today for the first time in seven years. Send tips and tricks to beat the heat to: mckenzie.beard@washpost.com. Not a subscriber? Sign up here. Today's edition: A powerful Senate panel advances legislation targeting pharmacy middlemen, and abortion rights groups press lawmakers to get rid of a provision in the FDA funding bill that would reimpose tighter restrictions on mifepristone. But first … | This year's bipartisan trends: Expanding the workforce and mental health care and lowering drug costs |  Like on Capitol Hill, state legislatures across the country targeted permacy middlemen this session in an effort to reign in high prescription drug costs. (Elise Amendola/AP) | | | We've spent a lot of time in this newsletter tracking health policy moves through state legislatures over the last seven months. Much of it fell along predictably partisan lines, with the United States increasingly splintered by deep blue or deep red states led by Democratic or Republican supermajorities. But not all health measures were partisan. Today, we're taking a look at initiatives that won bipartisan support in a mix of blue and red states this legislative season. | Strengthening the health-care workforce | | State lawmakers passed a flurry of bills aimed at bolstering the health-care workforce, as Republicans and Democrats alike acknowledge that the national shortage of providers was approaching a crisis level even before the pandemic. Zooming out: In places where a health workforce shortage has been identified, the United States needs more than 17,200 physicians, 12,200 dental health practitioners and 8,200 mental health providers, according to data from the Health Resources and Services Administration. Proposals to recruit and train new workers to fill those gaps won bipartisan support in several red and blue statehouses. Michigan, Kentucky and Washington are among the states where lawmakers approved billions of dollars in new grant funding to recruit, train and retain additional nurses, physicians and behavioral health providers. | | | | | | | | Prescriptions are too expensive and managing your care can be complicated. We're finding ways to make it better ever step along the way. Learn how we're working to "Optumize" pharmacy care. | | | |  | | | | | But the tangible impact of that legislation won't be felt for years to come, prompting many lawmakers to reach across the aisle to find a more immediate solution. At least 10 states passed bipartisan legislation to join various interstate compacts that facilitate a streamlined licensing process for providers seeking to practice in multiple states. For example: Missouri, Iowa and Vermont adopted the Counseling Compact, while Louisiana and Nevada joined the interstate compact for occupational therapy. | | Michigan Lt. Gov. Garlin Gilchrist II (D): |  | | | | Expanding mental health services | | Passing behavioral health legislation was among lawmakers' top priorities this season, as the lingering impact of the coronavirus pandemic continues to exacerbate existing mental health and substance use challenges in the United States. Proposals to increase mental health awareness among educators and public servants in particular won bipartisan support. Colorado, Connecticut and Arkansas are among the states that passed legislation requiring school workers to receive mental health first-aid training, which teaches people how to identify and respond to signs of mental illnesses or substance abuse in others. New York and Mississippi enacted similar requirements for law enforcement. Another major area of focus this session was expanding access to behavioral health care. Some states embraced certified community behavioral health clinics (CCBHC), which provide outpatient mental health and substance use disorder treatment, case management and primary health screening. Notably, the federally backed model stipulates that no one be denied services, regardless of their ability to pay. | - Lawmakers in Indiana, Maryland and Nebraska passed bipartisan legislation directing their respective health departments to submit plans to establish CCBHCs in their states.
| | Nebraska Gov. Jim Pillen (R): |  | | | | Lowering prescription drug prices | | Reining in the sky-high cost of prescription drugs was another key health policy area ripe for bipartisanship this session. | | Like on Capitol Hill, pharmacy benefit managers were dragged into the hot seat in statehouses across the country, with both Democrats and Republicans arguing that they drive up the cost of medicine — a characterization the industry's main lobby denies. | - In Florida, a bill prohibiting spread pricing, clawbacks, mail-order rebates and more sailed through the state legislature with near unanimous support.
- Meanwhile, lawmakers in Alabama, Arizona and Idaho approved legislation tightening regulations and transparency requirements for pharmacy middlemen.
| | Some states also targeted pharmaceutical companies to curtail drug prices. Montana, New Jersey, North Dakota and Washington enacted new price caps on insulin, a lifesaving drug used by over 7 million Americans with diabetes to manage their blood sugar levels. Those caps range from $25 to $35 a month. In a new trend we highlighted earlier this year, New Jersey and West Virginia also passed laws limiting monthly out-of-pocket costs for diabetic supplies, such as continuous glucose monitors or insulin pumps. | | West Virginia Gov. Jim Justice (R): |  | | | | | |  | On the Hill | | Senate Finance Committee advances legislation targeting pharmacy middlemen |  Senate Finance Chairman Sen. Ron Wyden (D-Ore.), left, and Sen. Mike Crapo (R-Idaho), center, crafted a bipartisan deal to target pharmacy middlemen. (Photo by Ricky Carioti/The Washington Post) | | | Another powerful health panel has put down a marker on an array of proposals aimed at cracking down on pharmacy benefit managers (PBMs). In a 26-1 vote, the Senate Finance Committee advanced bipartisan legislation targeting prescription drug middlemen, and the panel's Democratic and Republican leaders pledged to continue to work on further proposals. | | The bill includes measures to impose transparency requirements on PBMs; delink certain payments that pharmacy middlemen receive from the price of a drug; ban spread pricing in the Medicaid program and more. Sen. Ron Johnson (R-Wis.) was the sole committee member to vote against the legislation, per Stat's John Wilkerson. The effort comes as multiple committees have lobbed fresh attacks at PBMs, accusing the industry of contributing to the high cost of medicines; meanwhile, the main PBM lobby has maintained the industry helps lower costs for patients. | On the other side of the Capitol … | | The House Ways and Means Committee advanced legislation yesterday that Republicans say increases transparency into the opaque health-care system. But Democrats and other outside groups are adamant the legislation doesn't go far enough to ensure companies disclose details about their ownership, Stat's Rachel Cohrs writes. The package advanced along party lines yesterday. Among the policies, the legislation would require parity in Medicare payments for certain hospital outpatient department services furnished off-campus; establish requirements for private Medicare plans using prior authorization for medical care; and more. | | |  | Reproductive wars | | | First in The Health 202: More than 100 groups supporting abortion rights want a policy rider related to a key abortion pill stripped out of House Republicans' bill to fund the Food and Drug Administration and other agencies. The spending bill includes a provision to reinstate tighter restrictions around mifepristone, one of two drugs commonly used in a medication abortion, such as halting the mail delivery of the drug. GOP leadership had been targeting putting the legislation on the floor this week, but Punchbowl News reports this morning that Republican leaders are considering kicking consideration of the broader bill to September, amid demands from moderate Republicans rebelling over the mifepristone language and another unrelated issue. The provision "is imperiling critical legislation by attaching ideological policy provisions that have no place in annual appropriations bills," the over 100 groups wrote in a letter to House lawmakers led by Planned Parenthood Federation of America and Physicians for Reproductive Health. The organizations expressed support for an amendment filed by Rep. Rosa DeLauro (Conn.), the ranking Democrat on the House Appropriations Committee, which would strip out the language related to mifepristone. But it's not yet clear if her amendment will get a vote before the full House chamber. Bear in mind: This spending bill is just one part of a major abortion showdown looming on Capitol Hill. House Republicans have tucked antiabortion provisions into the majority of their appropriations bills, as well as the annual defense policy bill. That sets up a high-stakes clash with the Democratic-controlled Senate, which has pledged to be a firewall against such policies. | | John Bresnahan, Punchbowl News, on the status of the FDA funding bill: |  | | | | | |  | Dispatches from the Hill | | McConnell freezes mid-sentence, escorted away at news conference | | Senate Minority Leader Mitch McConnell (R-Ky.) abruptly froze and appeared unable to speak during a news conference yesterday, prompting his colleagues to usher him away from the podium, The Post's Amy B Wang, Paul Kane and Maegan Vazquez report. The details: McConnell, 81, had kicked off the GOP's leadership weekly news conference by saying lawmakers were on a path to finishing a major defense budget bill this week. Then the Kentucky Republican was silent for about 20 seconds, staring straight ahead, before other members of GOP leadership intervened. Several minutes later, McConnell returned to the podium, telling reporters "I'm fine" when asked about the incident. A McConnell aide later said that the senator had been feeling lightheaded and stepped away for a moment. The incident comes about four months after McConnell fell and suffered a concussion and a broken rib in early March. He was absent from the Senate for nearly six weeks as he recovered from his injuries. McConnell — who overcame polio as a child — also tripped and fell embarking from a plane earlier this month, NBC News reported last night, though noted he wasn't seriously hurt by the incident. In the past two months, McConnell has struggled at times. On multiple occasions, he has not been able to hear questions that reporters have asked him. At one point during a news conference early in June, Sen. John Thune (R-S.D.) had to lean in and explain to McConnell what the question was, Amy, Paul and Maegan note. | | |  | In other health news | | - North Carolina Democratic Gov. Roy Cooper's administration announced yesterday that the state will expand Medicaid on Oct. 1, though the Republican-controlled legislature hasn't yet approved the funding to do so, Politico's Megan Messerly writes.
- Oxycodone maker Mallinckrodt is in talks with hedge funds about filing for bankruptcy and avoiding paying out more than $1 billion in settlement payments meant to help victims of the opioid crisis, Alexander Saeedy, Alexander Gladstone and Akiko Matsuda report for the Wall Street Journal.
- A shortage of penicillin to treat a surge in syphilis cases in the United States is so severe that federal health officials are considering declaring a public health emergency, Bloomberg's Ike Swetlitz, Riley Griffin, and Matthew Griffin report, citing people familiar with the matter.
| | |  | Health reads | | | |  | Sugar rush | |  (Pia Guerra and Ian Boothby/The Washington Post) | | | Thanks for reading! See y'all tomorrow. | |
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