The Lower Costs, More Transparency bill has been introduced by the House Energy and Commerce Committee to address healthcare cost transparency. The bill’s purpose is to enhance price transparency within the healthcare system.
According to survey, over 60% of Americans are living paycheck to paycheck. This implies that they are at risk of facing a financial emergency with just one medical bill or doctor visit, which could prevent them from being able to afford their rent, groceries, or gas.
The new bill mandates hospitals, insurance companies, labs, ambulatory surgical centers, and imaging providers to make healthcare price information publicly available. Additionally, it requires health insurers and pharmacy benefit managers to disclose negotiated drug rebates and discounts. The bill seeks to expand access to generic drugs and lower drug costs.
The Federal Group’s president stated that the full House of Representatives will probably deliberate on this bill this month.
Several bills have been introduced in both the House and the Senate over the last two legislative sessions to address PBM business practices. These bills, originating from different committees, share common themes such as addressing drug and PBM pricing transparency, pharmacy clawbacks, spread pricing, and drug rebates.
The latest bill combines elements of previous bills and focuses on transparency related to hospital services, laboratory tests, healthcare coverage, and PBMs. It includes H.R. 2679, which mandates PBMs to provide employers with data on drug acquisition costs, total out-of-pocket spending, formulary placement rationale, and rebate information. The bill also requires the Government Accountability Office to submit a report on the practices of pharmacy networks of group health plans.
The bill also incorporates the following provisions:
- R. 4508, which mandates PBMs and third-party administrators to reveal their compensation to plan fiduciaries
- R. 4507, which prohibits gag clauses that prevent pharmacists from informing patients about lower-priced drugs
- R. 1613, which prohibits spread pricing in Medicaid and requires states to pay an administrative fee to PBMs. It also encourages the use of National Average Drug Acquisition Cost (NADAC) in Medicaid.
- The push for transparency in pharmacy benefits originates from employers’ demand for access to their data. “This has united Congress,” remarked the Vice President of Government Relations for the Healthcare Industry during a session at the recent annual conference held in Orlando. A survey conducted last year found that around 79% of voters support a bill that would mandate health insurance companies to disclose prices.
The push for transparency in pharmacy benefits originates from employers’ demand for access to their data. “This has united Congress,” remarked the Vice President of Government Relations for the Healthcare Industry during a session at the recent annual conference held in Orlando. A survey conducted last year found that around 79% of voters support a bill that would mandate health insurance companies to disclose prices.