by Christine Stuart CTNewsJunkie
At a time when partisan gridlock is the norm, the U.S. House passed a healthcare package with bipartisan support Monday even though the likelihood it passes the Senate in its current form is low.
The House voted 320-71 for a health care package that equalizes payment between hospital outpatient departments and doctors’ offices for the administration of medicine under Medicare. It also addresses practices by pharmacy benefit managers and establishes price transparency rules. It also aims to prevent pay cuts for safety-net hospitals and allocates more funding to community health centers.
U.S. Rep. Joe Courtney was responsible for drafting the portion that addresses the pharmacy benefit managers (PBMs) and ensures they disclose their compensation and business practices to health care plan fiduciaries.
“As Supreme Court Justice Louis Brandeis said, ‘sunlight is the best disinfectant’ to fight corruption. This bipartisan legislation takes an important step to achieving that goal by improving the transparency of the middlemen, or PBMs, who set prescription drug costs,” said Courtney. “I am pleased the House took decisive action to pass Rep. Houchin’s and my bill, and ensure employer sponsored insurance gives patients access to care and treatment that is valuable to them, not to commercial entities.”
Furthermore, the package includes provisions to prohibit pharmacy benefit managers from engaging in spread pricing, which involves charging Medicaid more than the amounts paid to pharmacies for medications. It also formalizes rules introduced during the Trump era, mandating that hospitals and insurers publicly disclose their pricing. The legislation extends the requirement for greater pricing transparency to pharmacy benefit managers, clinical lab test providers, imaging providers, and ambulatory surgical centers as well.
One of the most contentious aspects of the bill, known as the “Lower Costs, More Transparency Act,” led by House Energy & Commerce Chair Cathy McMorris Rodgers R-Wash., revolved around “site-neutral” payments for administering medicines. While the financial impact on hospitals for this policy is estimated at $3 billion, concerns have been raised about the potential for a broader application of this philosophy throughout Medicare, which could result in a significant cost of $150 billion, according to recent estimates.
The American Hospital Association in a Dec. 6 letter said “There is nothing neutral about site-neutral payment policies — not the level or quality of care, not the patient complexity, and not the enhanced regulatory oversight of hospitals.”
The Senate committee with jurisdiction over these matters has drafted its own proposals to address these health care issues, which means it’s unlikely they will take up this legislation.
However, it does give some hope to lawmakers that some of the proposal will be funded as part of the Jan. 19, 2024 package to fund the government.