Monday, March 13, 2023

Podcast Episode Recommendation: Politico Pulse Check, Episode 398

My followers may recall that I have previously shared a particular podcast (the episode I shared was about Mark Cuban Cost Plus Drug Company), specifically a podcast known as Politico Pulse Check. For a quick refresher, Politico describes its Pulse Check podcast this way: "Politico Pulse Check delivers the latest news in healthcare with sharp policy analysis and a dose of real-world perspective". In other words, "Pulse Check" is about healthcare and healthcare policy emanating from Washington, DC.

Anyway, on February 23, 2023, Politico Pulse Check had a rather interesting episode entitled "PBM reform effort intensifies on Capitol Hill" which was worth a listen. The episode is only about 10 minutes long, and yet they covered a few things which may be of interest to those with Type 1 diabetes interested in politics surrounding healthcare policy. Of particular note is how Politico now seems to be hinting that not only could we still potentially see legislation on PBM reform in spite of a divided Congress. Ordinarily, divided legislatures accomplish next to nothing, but this time could be different, at least when it comes to PBM reform.

It is still relevant to acknowledge that while Republicans managed to gain control of the House of Representatives during the midterm elections, they had the smallest gain in seats for any opposing party in midterm elections in recent memory. That led to some fake drama in naming a House Majority leader at the beginning of 2023. The reality is that Republicans currently have just an 8-seat majority in the House, which is a razor-thin majority which has important  implications which may not be readily apparent for casual observers on how the Congress operates (see also Politico's "The red wave that wasn't" at for more). 

For example, there are some important implications that House Republicans' tiny majority has on what Republicans in the House can accomplish by themselves. The reason is because under parliamentary rules, the House Republicans enjoy such a small majority that it means that all House committees are required to be composed of BIPARTISAN membership; and that reality means there remains a moderating force on whatever those committees in the House can actually do without bipartisan collaboration. And, in general, that also forces committees to consist of members from both parties.

Meanwhile, on the Senate side, we saw Senator Ted Cruz (R-TX) try to use parliamentary procedures to try and delay any progress on PBM reform for some peculiar reason (considering Texas voters are as impacted by the games PBM's pay as any other state). Under Senate rules, Committee chairs must still follow parliamentary procedures. Currently, Maria Cantwell (D-WA) controls the Senate Commerce Committee, not Ted Cruz. On Thursday, February 2, 2023, the Senate held a formal hearing on a bipartisan bill (meaning it has sponsors in both political parties, including Senator Charles Grassley (R-IA) that aims to get the drug middlemen to reveal to the FTC how much money they make through pharmacy fees and "spread pricing," a practice of charging insurers more for drugs than the PBM's actually pay pharmacies for the drug, and pocketing the difference for themselves.

That said, Ted Cruz remains on the Senate Commerce Committee as a ranking minority member, so his recent role on the Senate Commerce Committee was basically to try and delay the Senate from getting more information which the committee needed to get any proposed legislation out of committee and brought to the floor for a vote of the full Senate (a STAT News article kind of addressed that nonsense at, although the article may be behind a paywall). It really was mostly just dumb tactics used to try and delay things, because the Republican minority does not actually have the ability to prevent a bill from leaving committee or being brought to the floor by current Senate Majority Leader Charles Schumer. So the best a Senator who no one really likes (Ted Cruz) could do is to delay things. (The man is a real @$$#0l3.)

And yet ironically, today, neither political party is exactly enamored with PBM's right now, hence there DOES appear to be some bipartisan support for PBM reforms of some kind. Just what those end up looking like remains to be seen. In the Politico Pulse podcast, host Ruth Reader held a conversation with Megan R. Wilson. In the podcast, Ms. Wilson mentioned specifically that since Democrats took full control of the Senate, Ron Wyden (D-OR) now chairs the Senate Finance Committee. 

Polly Webster

Ms. Wilson says that as part of that new Senate leadership role, in January 2023, Senator Ron Wyden hired a former lobbyist for the generic drug industry named Polly Webster (image courtesy of, see her LinkedIn profile at to handle his drug policy. 

Ms. Wilson also says that the idea is that people who are working on the prospect of reforms to how PBM's are allowed to operate actually have people with knowledge about what really happens in the drug industry on staff which could be a big deal. 

But Megan Wilson also noted that it's currently unclear whether there's sufficient momentum for a standalone bill to be passed, hence she posits that it could potentially be included in some larger bill which has yet to be determined. However, the point is that there seems to be growing momentum on Capitol Hill to do something, and PBM's likely have targets on them.

That also explains why Megan Wilson acknowledged that exactly which bill PBM legislation gets attached to remains to be seen. But it is important to acknowledge that we could still see SOMETHING happen in 2023. To listen to the full Politico Pulse podcast episode, listen below or by visiting

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