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House passes site-neutral policy, transparency, 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. The bill passed the House on a bipartisan 320-71 vote.


The health care package would equalize payment between hospital outpatient departments and doctors’ offices for administering medicines in Medicare, rein in some practices by pharmacy benefit managers, and codify health care price transparency rules. It would also stave off pay cuts for safety-net hospitals and fund community health centers.


The most controversial part of the bill, called the Lower Costs, More Transparency Act, led by House Energy & Commerce Chair Cathy McMorris Rodgers (R-Wash.), is the so-called “site-neutral” payments for administering medicines. While the financial hit to hospitals would only be $3 billion for this policy, hospitals fear that it could be the beginning of a slippery slope to expanding the philosophy of paying the same for care in both inpatient and outpatient settings. If that’s ever broadly applied throughout Medicare, it could cost them $150 billion, according to recent estimates.


“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 American Hospital Association wrote in a Dec. 6 letter opposing the policy.


The package would also ban pharmacy benefit managers from spread pricing, or charging Medicaid more than they pay pharmacies for drugs, and codify Trump-era rules that require hospitals and insurers to publicly post their prices. Pharmacy benefit managers, clinical lab test providers, imaging providers, ambulatory surgical centers would have to be more transparent about their pricing, too.


It also includes a provision that requires the Food and Drug Administration to provide generic drugmakers more guidance about how to ensure their formulations are similar enough to brand counterparts’.


Pharmacies and consumer advocacy organizations supported passage of the legislation.


The package is unlikely to be taken up in the Senate, where committees have crafted their own legislative packages to address pharmacy middlemen and pay safety-net hospitals.

House Ways & Means Committee ranking member Richard Neal (D-Mass.) opposed the legislation over the fact that it doesn’t require more disclosure from private equity-owned hospitals and physician groups, a policy he has advocated for. House Energy & Commerce and Education & Workforce committee ranking Democrats Frank Pallone (D-N.J.) and Bobby Scott (D-Va.) supported the bill.


Reporter: Rachel Cohrs, Washington Correspondent

2 comments

2 Comments


Let Indy pharmacists write the bill

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It has been YEARS, I gave up all hope a LONG time ago.

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