Now that most provisions of the 2021 CAA’s transparency in coverage (TiC) law have taken effect, Congress remains committed to increased measures designed to lower health care costs. As we reported in late 2023, the House passed the ‘Lower costs, More Transparency Act’ which requires health care providers and insurers to disclose certain information about care costs. It also establishes requirements for certain payment methodologies under Medicare and Medicaid (which includes prohibiting spread-pricing for payment arrangements with pharmacy benefit managers (PBMs) under Medicaid)  and extends several public health programs. There is bipartisan support for the bill, and members of the House Committee on Energy And Commerce are currently negotiating with members of the Senate to align key provisions of their agenda. Congress hopes to include the final price transparency provisions  in the upcoming spending bill.

Senator  James Lankford from Oklahoma, along with several other members of Congress, authored a letter to the FTC urging an investigation into the ‘anti-competitive’ PBM business practices. At the same time, New York joins the growing list of states attempting to reform the PBM industry as the Department of Financial Services Superintendent announced a proposed market conduct regulation that would govern PBMS operating in the state. While the question of ERISA preemption still looms large in the state level PBM reform attempts, the activity here shows no sign of slowing down.