Rep. Sheila Cherfilus-McCormick

Maddy summaryHR 7142 (Alternatives to PAIN Act) requires Medicare Part D plans to cover non-opioid pain management drugs with no deductible and at the lowest copay level starting in 2025. It defines "qualifying non-opioid drugs" as FDA-approved medications that don’t act on opioid receptors (like certain NSAIDs or nerve pain treatments), excluding opioids and schedule I-III drugs. The bill prohibits Medicare plans from forcing patients to try opioids first (step therapy) or requiring prior approval for these non-opioid options. It directly affects Medicare beneficiaries needing pain management, especially those seeking alternatives to opioids for post-surgical or acute pain. The policy change aims to improve access to non-addictive pain treatments while preserving doctors' authority to prescribe medically appropriate care.

Maddy summaryThis bill, HR 6860, protects patients with end-stage kidney disease (ESRD) who require dialysis by preventing health insurance plans from discriminating against them. It amends Medicare rules to prohibit plans from treating dialysis coverage differently than other medical services based on a patient’s ESRD diagnosis, need for dialysis, or any other factor. The bill clarifies that plans can still choose which dialysis providers to include in their networks but cannot deny or limit coverage for dialysis services solely because of the patient’s condition. It ensures Medicare remains the secondary payer for these services as intended, without forcing plans to cover specific providers.

Maddy summaryHR 6801, the RPM Cost Sharing Elimination Study Act of 2023, eliminates cost-sharing (like copays) for remote physiologic monitoring (RPM) services under Medicare. It directly affects Medicare beneficiaries who use RPM devices (e.g., for heart or diabetes monitoring) by making these services 100% covered under both Original Medicare and Medicare Advantage plans starting January 1, 2024. The bill requires the Health and Human Services Secretary to report by June 2026 on how eliminating cost-sharing impacted patient health outcomes and Medicare costs. This is a temporary measure (2024-2025) designed to study the effects before potential permanent changes.

Maddy summaryThis bill updates Medicare physician payment rules to improve stability and accuracy. It raises the budget neutrality threshold from $20 million (pre-2025) to $53 million in 2025, with annual indexing after 2026, to prevent excessive payment adjustments. The bill requires the Medicare program to correct budget neutrality payments based on actual service utilization data (not estimates) starting in 2025, and mandates updating direct cost inputs (like staff wages and equipment prices) every 5 years. It also caps annual changes to the physician payment conversion factor at 2.5% to limit sudden payment shifts, directly affecting Medicare physicians and healthcare providers receiving these payments.

Maddy summaryHR 6283, the DRUG Act, regulates pharmacy benefit managers (PBMs) to prevent practices that may increase prescription drug costs for consumers. The bill prohibits PBMs from earning revenue based on drug prices or discounts, requiring them to charge flat dollar service fees instead of fees tied to drug costs. It bans PBMs from steering patients to pharmacies they own or control, mandates equal reimbursement for affiliated and non-affiliated pharmacies, and prohibits charging different fees for the same drug. These provisions apply to group health plans, health insurance issuers, and PBMs, with enforcement beginning for plan years starting January 1, 2026. Violations would result in $10,000 daily penalties and require disgorgement of improperly received payments.

Maddy summaryThe WEAR IT Act (HR 6279) allows individuals to use funds from tax-advantaged health savings accounts (HSAs), Archer MSAs, and flexible spending accounts (FSAs) to cover the cost of medical wearable devices, up to $375 annually. It defines "wearable devices" as body-worn tools that collect physiological data for diagnosing, treating, or preventing disease. The bill amends tax code provisions to include these devices as qualified medical expenses, effective for purchases after December 31, 2023. This directly affects people using medical wearables who rely on tax-advantaged health accounts for out-of-pocket costs.

Maddy summaryThis bill creates a framework for states to develop their own universal health care systems by applying for waivers from certain federal health care requirements. States must demonstrate they can provide comprehensive coverage meeting or exceeding current federal standards (like Medicaid, Medicare, and CHIP) for at least 95% of residents within 5 years, with the federal government redirecting funds that would have gone to federal programs to support state systems. States must include specific protections like reproductive health care coverage and submit regular reports on coverage rates, affordability, and quality. The bill includes special provisions to protect Indian health care services and ensure they remain accessible under state plans. States that fail to meet coverage goals may face consequences, including potential termination of their waiver.

Maddy summaryThis bill amends Medicare, Medicaid, and private insurance rules to improve coverage for drugs treating rare diseases (defined as conditions affecting 200,000 or fewer people in the U.S.). It requires coverage for rare disease drug uses supported by peer-reviewed medical literature and not listed as contraindicated in FDA labeling or medical reference guides. Private insurers must provide expedited review processes for denials of such drugs. The changes apply 30 days after enactment, affecting insurers and patients seeking coverage for rare disease treatments.

Maddy summaryThe Medicare Advantage Consumer Protection and Transparency Act requires Medicare Advantage plans to submit detailed, standardized data about supplemental benefits, healthcare services provided (encounter data), coverage denials, prior authorization requirements, quality measures, and provider networks. Plans must submit this information annually in standardized formats, with penalties of up to 10% in reduced payments for incomplete submissions. The data will be publicly reported, increasing transparency for beneficiaries and oversight officials. This law directly affects Medicare Advantage plans and beneficiaries by providing clearer information about plan offerings and performance. It focuses on concrete data collection and reporting requirements rather than altering benefit structures.

Maddy summaryHR 5614 extends duty-free treatment for Haitian apparel imports under the Caribbean Basin Economic Recovery Act until September 30, 2035. It modifies the quantitative limit for eligible apparel imports to cap at 1.25% of the U.S. market for the most recent 12-month period, replacing the previous fixed annual period structure. This bill directly affects Haitian apparel exporters and U.S. importers of Haitian-made clothing by maintaining tariff preferences. The extension also requires the President to adjust the Harmonized Tariff Schedule to restore lost benefits for eligible items affected by prior tariff schedule changes.