国会预算办公室监督听证会后的记录问题答复

Following a Hearing onOversight of the Congressional Budget Office Conducted by the On November 18, 2025, the House Committee on theBudget convened a hearing at which Phillip L. Swagel,Director of the Congressional Budget Office, testified about savings that would be generated by such therapies even ifthey have high up-front costs? Answer.CBO is building its capacity to analyzeproposals involving durable or curative therapies over various time spans. In the past, CBO has providedbudgetary information—both within and beyond thestandard 10-year period covered by cost estimates—forproposals related to anti-obesity medications and excisetaxes on cigarettes.2The agency has also described how itapproaches longer-term analyses of other health inter- After the hearing, Representatives Buddy Carter, Ben Cline,Andrew Clyde, Randy Feenstra, Brandon Gill, GlennGrothman, Addison McDowell, and Lloyd Smucker submit-ted questions for the record. This document provides CBO’sanswers to those questions. It is available atwww.cbo.gov/ Representative Carter’s QuestionsAbout Innovative Medical Therapiesand Prescription Drug Spending Although such interventions differ in the timing andsize of their costs and potential savings, CBO uses aconsistent approach to analyze them: The net budgetaryeffect reflects the federal government’s share of treatmentcosts, any reductions in federal health care spendingfrom improved health outcomes, and any changes infederal revenues or spending associated with increasedlongevity. If requested, and as practicable, CBO can usepresent-value estimates to assess the budgetary effects ofsuch interventions beyond the standard 10-year period. Question.Can you commit to prioritize a CBO scoreof H.R. 4299 [the Protecting Patient Access to Cancerand Complex Therapies Act]? I would appreciate your Answer.CBO expects to be able to provide a range ofthe bill’s estimated effects by late spring. Current law specifies that beginning in 2028, the pricesnegotiated for prescription drugs covered under Part B ofMedicare are supposed to be charged at the point of sale andserve as the basis for reimbursing physicians and other pro-viders. H.R. 4299 would instead have drug manufacturers Completing a preliminary analysis of the bill’s effectspresents several analytical challenges. The analysisinvolves estimating effects on Medicare and possiblyeffects related to other entities that pay for health care.In addition, 2026 is the first year for negotiated prices inPart D of Medicare. The experience of that program will Question.Over the next 5-10 years, how does CBOforecast the trajectory of 340B spending absent reform,and what are the implications for the federal budget? Answer.CBO expects that in the absence of legislativeor administrative changes, spending through the 340BDrug Pricing Program—which requires pharmaceutical Question.How is CBO adapting its modeling to account for the next generation of innovative therapieslike cell therapies and gene therapies that are durable 3.Congressional Budget Office,How Increased Use of Gene TherapyTreatment for Sickle Cell Disease Could Affect the Federal Budget(December 2024),www.cbo.gov/publication/60775,BudgetaryEffects of Policies That Would Increase Hepatitis C Treatment(June 2024),www.cbo.gov/publication/60237, andHow CBOAnalyzes Approaches to Improve Health Through Disease Prevention(June 2020),www.cbo.gov/publication/56345. to participating health care facilities at discountedprices—will almost certainly grow faster than overalldrug spending. Part of the reason for that expectationis ongoing growth in the number of off-site outpatientclinics that become eligible for the program when theyare established or acquired by hospitals that participatein the program. (For reference, the Centers for Medicareand Medicaid Services project that national spending onprescription drugs will grow by an average of 5.6 percenta year in 2026 and 2027 and 4.7 percent a year over the of the Balanced Budget and Emergency Deficit ControlAct of 1985? When CBO prepares a cost estimate that implicatesthese deviations from a true current law baseline, canCBO include supplementary information estimating thecost of the legislation relative to a baseline without those Answer.The Deficit Control Act’s instructions forpreparing the baseline, including the required differencesfrom current law, are described in detail in several CBOpublications.5For mandatory spending and revenues,CBO is required to assume that certain expiring pro-grams will continue, that entitlement authority will befully funded, and that expiring excise taxes dedicated totrust funds will continue. In CBO’s most recent baseline,published in January 2025, those assumptions account The conclusion that spending through the 340B pro-gram is likely to grow faster than overall drug spendingis based on CBO’s recent analysis of the program.4 That analysis found that drug spending by facilitiesparticipating in the 340B Prime V