Final opioid bill may come by Friday Presented by

With help from Brianna Ehley, Sarah Owermohle and Aaron Lorenzo.

The Gates Foundation is out with a new report on global efforts to fight poverty and disease. Spoiler: They're worried that the world's progress could backslide.

But first: An update on the long-germinating opioid package.

FINAL OPIOID BILL TARGET IS FRIDAY — Congressional leaders are aiming to have a final package (scored by the CBO) before lawmakers leave town ahead of the midterms, Senate HELP Chairman Lamar Alexander said Monday. The House would vote next week, the Senate would vote quickly thereafter, and the deal would move to Trump’s desk before the elections.

… But both chambers are still working to reconcile differences between the three-month-old House bill, and the Senate’s bill, which was approved 99-1 last night, POLITICO’s Brianna Ehley reports. For instance, the Senate package doesn’t include new spending; the House version does.

A message from PhRMA: Today, there are several promising vaccine candidates in stage three clinical trials. These trials have tens of thousands of participants, from every walk of life. From development to robust clinical trials, and throughout manufacturing, these vaccine candidates follow the same rigorous process of other vaccines that have saved millions of lives. More.

WHAT WE’RE WATCHING IN THE FINAL DEAL — Among the unresolved policy fights are

— Partial repeal of the IMD exclusion, a policy which limits Medicaid payment for certain inpatient rehab treatment. It’s partially lifted in the House bill. (States would submit state plan amendments to get Medicaid to reimburse for inpatient opioid and cocaine addiction treatment at certain facilities.) That’s not in the Senate bill, but Senate aides say they expect a final deal to include some form of the provision.

— More sharing of addiction patients’ medical information, which is allowed in the House bill but not in the Senate package. It’s unclear it will be included in the final deal.

— More Medicare payments for non-opioid alternatives, which is included in the House package but not the Senate bill.

— Language tweak to bill benefiting Addiction Policy Forum. Senate Republicans committed to changing several provisions in the bill to appease Democrats, including tweaking one provision in the Senate-passed measure that Democrats said specifically benefited the PHRMA-backed Addiction Policy Forum. New language broadening who can qualify for DOJ-administered grants is expected to appear in the final bill.

AND THE OPIOID PROBLEM IS FAR FROM SOLVED — Public health experts and first responders say the massive bipartisan legislation takes important steps toward better access to treatment but lacks the urgency, breadth and steady long-term funding required to quell the emergency that takes 115 lives in the United States a day. More here.

MEANWHILE: ‘MINIBUS’ FUNDING PACKAGE COULD MOVE TODAY — The Senate is poised to approve a mammoth funding bill for the Pentagon and a spate of domestic agencies, and Senate Appropriations chief Richard Shelby (R-Ala.) said the vote could come today.

The package, H.R. 6157 (115), takes in the fiscal 2019 Defense and Labor-HHS-Education titles. It also includes stopgap funding for all other federal agencies that don't have a full-year budget by Oct. 1— which would avoid a dreaded fall shutdown, POLITICO’s Sarah Ferris and Anthony Adragna report. That continuing resolution would last through Dec. 7.

With the Senate's green light, the bill would then go to the House, where Democrats and GOP defense hawks are expected to help carry enough votes for passage.

IT’S TUESDAY PULSE — Where Roseanne (the TV character, not the actress) will soon be declared dead ... because of an opioid overdose. Or so says the actress who formerly played her. It's the latest turn in the show's prominent storyline about opioids.

PULSE hasn't seen the data, but he's confident opioid overdoses in TV and movies exploded in the past few years. Got evidence of that? (Or anything else?) Tips to [email protected].

BILL GATES TALKS TRUMP’s GAG RULE, ATTEMPTED AID CUTS — The philanthropist told reporters that the Trump administration’s broad application of the Mexico City Policy — the so-called gag rule that blocks U.S. funding for foreign organizations that discuss or provide abortion services — has complicated unrelated aid efforts.

For instance, Gates noted that condoms have played a vital role in curbing HIV but that the breadth of the gag rule has created new challenges for reproductive health groups to get funding, POLITICO’s Sarah Owermohle reports.

… Africa’s booming population growth also could be better managed if more women were empowered to plan their pregnancies, Gates said. The annual Goalkeepers report by the Bill and Melinda Gates Foundation projects that Africa’s population will surpass 4 billion by the year 2100, although access to family planning could reduce the projected population by 30 percent.

“Although it’s not a direct goal in our case, it does reduce the amount of abortions if you have great access to these family planning tools,” Gates said, commending Congress for preserving funding for global health efforts.

FIRST IN PULSE: Health Care Voter launches guide for midterms. The pro-ACA group is rolling out a new interactive that lets voters see how GOP incumbents voted on health care legislation. See the tool.

Feds approve Cigna-Express Scripts mega-merger. The combination represents a major reshuffling of the health care industry as companies try to constrain costs and gird for the long-expected entrance of Amazon into the sector. More.

… The Justice Department reportedly is also close to approving CVS Health’s blockbuster acquisition of Aetna, which would create one of the country’s biggest health care companies.

Drugmakers still benefit from dodging taxes, Oxfam says. Pfizer, Abbott, J&J and Merck averaged profits of 7 percent in eight advanced economies but their margins soared to 31 percent in four countries that charge low or no corporate tax rates, a study found.

It’s a sign that even after the U.S. slashed its corporate tax rate this year, the new law hasn’t eliminated incentives to shift profits abroad, said Oxfam’s Robert Silverman. See the study. PhRMA didn’t immediately respond to POLITICO with comment.

FIRST IN PULSE: Charlene MacDonald joins FTI Consulting. MacDonald, who served as senior policy adviser to House Democratic Whip Steny Hoyer, will lead the health care and life sciences team for FTI’s strategic communications division. MacDonald played a key role as lawmakers crafted legislation like the 21st Century Cures and the Medicare and CHIP Reauthorization Act (MACRA).

By Rachel Roubein

Bundled payments could be a key to saving Medicare money, but more rigorous analysis is needed, Austin Frakt writes in The New York Times. More.

The health implications of Hurricane Florence — such as bacterial infections and contaminated water — will linger long after the storm subsides, The Washington Post reports. More.

Coca-Cola is “closely watching” the growing trend of cannabis-infused drinks, Associated Press reports. More.

The National Institute on Alcohol Abuse and Alcoholism updated its website to indicate a stronger link between cancer risk and drinking alcohol, in response to criticism from a Boston University researcher, writes Stat’s Sharon Begley. More.

HHS leaders want the department’s agencies to share more data with each other, but a barrier exists: there isn’t any department-wide guidance on how to do so, Nextgov reports, citing a new report from the HHS chief technology officer. More.

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