Rep. H. Morgan Griffith

Maddy summaryHR 5400, the NO PBMs Act, requires Medicare Part D prescription drug plans (PDP sponsors) and pharmacy benefit managers (PBMs) to allow any pharmacy meeting basic contract terms to join their networks. This directly affects Medicare beneficiaries by expanding their choice of pharmacies, as current networks often restrict access to specific locations. Key provisions mandate that PDP sponsors and PBMs must accept all eligible pharmacies and establish standardized "reasonable and relevant" contract terms by January 1, 2026. The bill aims to increase pharmacy access without altering drug pricing or plan benefits.

Maddy summaryHR 5393 requires Medicare Part D plans and Medicare Advantage plans with Part D to use standardized, evidence-based performance measures when determining financial incentives or fees for pharmacies. These measures must be tailored to pharmacy types (like retail, mail order, or specialty) and will be maintained in a public list by the government. The bill also mandates that plans provide pharmacies with clear, standardized payment information for each claim, including fees and discounts. Additionally, the government must conduct a study on current practices and report findings to Congress by 2025.

Maddy summaryHR 5371, the Choices for Increased Mobility Act of 2023, updates Medicare payment rules for manual wheelchairs. It clarifies that Medicare Part B will not cover the extra cost of titanium or carbon fiber materials in a wheelchair's base, effective January 1, 2023. This specifically affects Medicare beneficiaries who use manual wheelchairs with these materials, as payments will now be calculated without including those component costs. The bill directly changes how Medicare reimburses providers for such wheelchairs by excluding these materials from the standard payment amount. This is a technical adjustment to Medicare's fee schedule, not a new benefit or eligibility change.

Maddy summaryHR 3285, the Fairness for Patient Medications Act, requires health insurance plans and pharmacy benefit managers to limit patient cost-sharing for "highly rebated drugs" (drugs where manufacturers rebate over 50% of annual spending). Starting January 2025, plans must cap out-of-pocket costs per 30-day supply at 1/12 of the drug’s net price (after rebates), calculated annually. The bill also prohibits hidden discounts from drug manufacturers when plans add previously excluded drugs to coverage, requiring price reductions to be visible at checkout or limited to flat service fees. This directly affects health insurance plans, insurers, and pharmacy benefit managers managing prescription drug coverage.

Maddy summaryThis bill repeals the tax on Social Security benefits for seniors, making those benefits fully tax-free. It directly affects seniors who receive Social Security benefits and are currently subject to income tax on a portion of those payments. The key provision removes Section 86 of the tax code that previously included benefits in gross income, while a separate funding mechanism appropriates money to Social Security trust funds to replace the lost revenue. The bill ensures Social Security trust funds remain fully funded without requiring new tax increases.

Maddy summaryHR 2707, the MADE in America Act, creates a 25-30% federal tax credit for manufacturers producing specific health products (including drugs, medical devices, personal protective equipment, and diagnostic tools) in designated "distressed zones." These zones are census tracts with over 30% poverty rates that are also designated as qualified opportunity zones. The credit applies to wages paid to employees working in these zones and qualified production costs (like equipment and materials), increasing to 30% if most employees reside locally. It directly affects pharmaceutical and medical device manufacturers operating in eligible low-income areas, aiming to incentivize domestic production of critical health products.

Maddy summaryThis bill would require Medicare to cover FDA-approved blood tests that screen for multiple cancers simultaneously (like breast, lung, or colorectal cancer) for beneficiaries. It directly affects Medicare recipients aged 65+ who could access these new screenings once per year, without prior authorization. The key provision adds "multi-cancer early detection screening tests" to Medicare's covered services under Part B, defining them as blood tests analyzing cell-free DNA, while maintaining existing coverage for standard screenings like mammograms. The bill does not change current coverage for individual cancer screenings but ensures Medicare keeps pace with new medical technology.

Maddy summaryThis bill expands Medicare Part B coverage to include specific pharmacist services, directly affecting Medicare beneficiaries and pharmacists who provide these services. It adds new coverage for pharmacist evaluations and treatments related to certain illnesses (like COVID-19, flu, or strep throat) and public health emergencies, requiring payment at 80% of the lesser of actual charge or 85% of physician payment rates (100% during emergencies). The bill also prohibits balance billing for these services, ensuring beneficiaries pay only the standard Medicare copayment. These changes aim to improve access to pharmacist care during health crises while aligning payment with existing physician service frameworks.

Maddy summaryThe Prevent Interruptions in Physical Therapy Act of 2023 amends Medicare rules to allow physical therapists to use temporary replacement providers (locum tenens) for outpatient physical therapy services, aligning with existing provisions for physicians. This directly affects Medicare beneficiaries receiving physical therapy and physical therapy practices needing temporary staffing solutions during provider shortages. The bill updates the Social Security Act to extend the current physician locum tenens rule to physical therapists, ensuring continuity of care without requiring separate approval for temporary coverage. It applies to services furnished after the bill's enactment date.

Maddy summaryThis bill repeals specific provisions from the Affordable Care Act and its 2010 amendment that restricted certain physician referrals to hospitals under Medicare. It directly affects hospitals and physicians who previously faced limitations on referring Medicare patients to facilities they owned or had financial ties with. The key mechanism restores the original rules that allowed such referrals without the prior restrictions, effectively undoing the 2010 changes. This is a procedural change to existing law, not a new policy.