House introduces bill focused on health care price transparency, PBMs and spread pricing
Three House committees have introduced the Lower Costs, More Transparency Act, which would require hospitals, payers, labs, imaging providers and surgical centers to use machine-readable files to list prices they'll charge patients.
Congress continues to seek ways to reduce costs and increase price transparency for health-care consumers.
Late last week, three House committees – Energy and Commerce, Ways and Means, and Education and Workforce – introduced the Lower Costs, More Transparency Act. The proposed legislation would require hospitals, payers, labs, imaging providers and ambulatory surgical centers to use machine-readable files to list prices they will charge patients. It also mandates that insurers and pharmacy benefit managers disclose drug rebates and discounts.
House members hope the bill will lower out-of-pocket costs for seniors who receive medicine at a hospital-owned outpatient facility; expand access to generic drugs; and help employers give workers the best information possible.
“Our bipartisan legislation meets this moment by giving patients what they are rightfully demanding — the ability to get the right care, at the right time, at a price they know and can afford,” said Rep. Cathy McMorris Rodgers, R-Wash., chair of the Energy and Commerce Committee. “It will lower costs by giving patients the health-care price information they need to make the decisions that are best for them and their families, something 95% of Americans support.”
This is the latest example of PBMs drawing the ire of legislators. In July, the Senate Finance Committee voted to support bipartisan efforts to rein in practices that allow PBMs to operate in the shadows, particularly through spread pricing. The Pharmaceutical Care Management Association released a statement countering that the legislation does nothing to reduce the cost of prescription drugs for patients.
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“Instead of focusing on legislation that risks increasing drug costs, Congress should refocus on enacting policies that promote more competition in the prescription drug marketplace, including policies that eliminate common and egregious drug company practices aimed at extending patents in highly anticompetitive ways,” said J.C. Scott, president and CEO of the association.
Several ranking members added a provision that prohibit PBMs that contract with Medicaid managed care organizations from using spread pricing. States instead would have to reimburse PBMs with an administrative fee for managing the pharmacy benefit for Medicaid beneficiaries.
Along with price transparency, the package extends investments in the Community Health Center Fund, the National Health Service Corps and the Special Diabetes Program for research, as well as health workforce training programs.
At the same time, the bill proposes cutting $7 billion from the Medicaid Improvement Fund, which specifically seeks to improve the parts of Medicaid that provide hospital and medical insurance, as well as $8 billion for the next two years from Medicaid Disproportionate Share Hospital payments going to hospitals that serve large portions of those who are on Medicaid or uninsured.