Lower Costs, More Transparency
In the ongoing effort to control rising costs and provide individuals better tools to make informed decisions about their medical care, the House has passed a new bill (H.R. 5378). If passed in the Senate, this would be a complement to the Transparency in Coverage regulations currently being phased in for group health plans, and would increase disclosure obligations for pharmacy pricing.
On the House floor this month, the Chair of the Energy and Commerce Committee noted:
“....we’ve heard countless stories about real patients who were victims of an opaque system and were on the hook for staggering amounts of money for seeing a doctor, going to a hospital, or getting medicine. We heard about a patient that tried to shop for her care and was billed thousands of dollars more than what she was quoted.”
The core components of the bill include price transparency requirements in hospitals, laboratory testing, imaging, ambulatory surgical centers, and oversight of pharmacy benefit managers (which have been largely immune to existing transparency laws). Specifically, PBMs would be required to disclose all compensation to employers. With pharmacy spending accounting for a significant percentage of total spending and cost increase each year, this is an area in need of regulatory scrutiny. As 2024 approaches, the industry anxiously awaits progress on this bill.