November 02,2023

Wyden, Crapo Release Discussion Draft of Mental Health, PBMs Package Ahead of November 8 Markup

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., and Ranking Member Mike Crapo, R-Idaho, today released a discussion draft including policies aimed at expanding mental health care under Medicaid and Medicare and reducing prescription drug costs for seniors at the pharmacy counter. The package also includes essential Medicaid and Medicare provisions that will expire this year, as well as changes to Medicare payment to support physicians and other professionals. 

The committee intends to advance these legislative proposals, in addition to pharmacy benefit manager (PBM) reforms previously passed out of Committee in July, and pursue full Senate passage and enactment. As part of that process, the Committee intends to hold a markup on Wednesday, November 8 at 10 a.m. In keeping with Finance Committee rules, the Chairman’s Mark will be released 48 hours in advance of the markup.

“Every American should have access to the mental health care they need when they need it. And sticker shock at the pharmacy counter must become a thing of the past,” Wyden said. “I am proud that once again this Committee is coming together on a bipartisan basis to expand access to mental health care, further rein in damaging actions by PBM middlemen, and lower prescription drug costs for American families and seniors. I look forward to a constructive, bipartisan markup next week.”

“In July, the Finance Committee took crucial steps toward improving health care access and affordability for Americans from all walks of life, and committed to continue our work on prescription drug benefits,” said Crapo. “With this markup, we are building on that success by taking up additional commonsense, comprehensive proposals championed by members across the dais to strengthen our federal health programs. I thank Senator Wyden and my colleagues for their meaningful contributions to what has become a patient-focused, fiscally sound and evidence-driven product.”

Proposed policies in the discussion draft include:

  • Expanding the number of mental health and substance use providers participating in Medicare–including psychologists, clinical social workers, marriage and family therapists, and mental health counselors–in rural and underserved communities. 
  • Expanding the use of licensed clinical social workers (LCSWs) and occupational therapists under Medicare. 
  • Funding primary care physicians to deliver behavioral health and primary care to Medicare beneficiaries in the same setting. 
  • Improving access to Medicare mental health services delivered through telehealth.
  • Requiring Medicare Advantage plans to have up-to-date and accurate provider directories and protecting beneficiaries from paying higher out-of-pocket costs when relying on an incorrect directory (Requiring Enhanced & Accurate Lists of Health Providers Act).
  • Improving mental health services and substance use disorder care for youth enrolled in Medicaid and CHIP. 
  • Improving integration of mental health services and substance use disorder care with primary care for youth enrolled in Medicaid and CHIP.
  • Assuring pharmacy access and choice for Medicare beneficiaries.
  • Protecting seniors from paying higher copays on certain prescription medicines. 
  • Increasing access to more affordable biosimilar medicines in Medicare Part D.
  • Supporting physicians and professionals by mitigating predicted Medicare payment cuts.  
  • Extending essential Medicaid and Medicare provisions that will expire this year to avert harmful Medicaid cuts to safety-net hospitals and protect rural providers and patients, among others.

The full text of the discussion draft is available here.

The Committee discussion draft and next week’s markup build on Wyden and Crapo’s bipartisan commitment to expand mental health services and lower drug costs for America’s seniors and families. The Committee earlier this year passed the Modernizing and Ensuring PBM Accountability Act (MEPA), legislation that would bring more transparency, accountability and competition to pharmacy benefit manager practices in the drug supply chain, helping to lower out-of-pocket costs for patients. Additionally, in 2022, the Committee completed its bipartisan mental health initiative, releasing a series of legislative proposals that can be found here.