House Passes Health Package With PBM Reforms, Site-Neutral Policy
The Lower Costs More Transparency Act of 2023, passed by the House 320-71 on Monday, would institute new transparency and pricing rules on PBMs and hospitals, and spare hospitals from some funding cuts while likely imposing others. The measure is unlikely to pass the Senate as currently written but signals bipartisan openness to the policies.
Stat:
House Passes Site-Neutral Policy, PBM Reform Package
The House passed a relatively major health care package late Monday, an end-of-year victory after the same policies had to be yanked from consideration in September because they lacked bipartisan support. Though the package is unlikely to pass the Senate and become law as-is, its advancing through the House does make each included policy more attractive for a potential government funding deal, as lawmakers draw closer to the Jan. 19 deadline to fund the government and extend funding for certain health programs in particular. (Cohrs, 12/11)
Modern Healthcare:
House Passes Bill Covering PBMs, DSH Cuts, Site-Neutral Payments
The Lower Costs More Transparency Act of 2023, which passed 320 to 71, would require extensive new disclosures of prices and costs by hospitals, insurers, imaging services, diagnostic laboratories and PBMs. It also bans PBMs from the practice of spread pricing in Medicaid, requiring them to pass on savings they negotiate with drug companies and instead get paid a set administrative fee. (McAuliff, 12/11)
Fierce Healthcare:
House Price Transparency Legislation Passes With Bipartisan Support
In addition to mandating providers and PBMs publicly list prices before they charge patients, hospitals will be required to publish charges through machine-readable files. The bill also calls for the elimination of $16 billion in disproportionate share hospital (DSH) program cuts through 2025, $7 billion in funds for the Medicaid Improvement Fund while allocating $15 billion in funds toward community health centers and programs to address physician shortages in underserved communities. Leading House members argue the bill will help patients and employers get the best deal possible for patients and employers by codifying price transparency protections, allowing consumers to compare health insurers’ rates and prices hospitals charge. This means insurers will have to disclose all billing codes and modifiers. (Tong, 12/11)
In related news —
Fierce Healthcare:
Seniors Would Have Reaped Benefits Of IRA In 2021: Report
A new analysis shows that if Medicare had negotiated the price of 10 of the most expensive Part D drugs in 2021, seniors’ out-of-pocket drug costs would have decreased by 23% from $1,250 to $967. (Tong, 12/11)
In other legislative news from Capitol Hill —
Stat:
Addiction Doctors Spar With Methadone Clinics Over Legislation
Lawmakers on Tuesday will debate an addiction medicine proposal that would have been considered unthinkable just years ago: giving a select group of doctors the power to prescribe methadone directly to patients. (Facher, 12/12)
NPR:
Senators Push Bureau Of Prisons To Address Reports Of Inadequate Health Care
Two key senators on the committee tasked with overseeing the nation's federal prisons are now urging the Bureau of Prisons to fix a medical care system that has allowed people in its care to die preventable deaths. Sens. Dick Durbin, D-Ill., and Chuck Grassley, R-Iowa, were responding to reporting from NPR showing that federal prisoners die from treatable conditions that are not diagnosed or treated in a timely way within the prison system. (Anderson, 12/12)
Military.com:
US Military To Screen All New Recruits For Heart Conditions Under Must-Pass Annual Defense Bill
Beginning next year, the U.S. military is expected to screen all potential recruits for cardiac anomalies under a new program designed to reduce deaths at boot camp and beyond. The current version of the fiscal 2024 National Defense Authorization Act, expected to pass Congress this month, requires the Defense Department to launch a pilot program by next October to give electrocardiograms, also known as ECGs or EKGs, to anyone who undergoes a military accession screening. (Kime, 12/11)
