New Legislation Aims to Increase Healthcare Price Transparency and Lower Costs

In a move to provide patients and employers with more accurate information about the cost of healthcare procedures and services, a new bipartisan legislation called the Lower Costs, More Transparency Act was recently introduced in the U.S. House of Representatives. The bill aims to increase healthcare price transparency and lower overall costs for patients and employers.

The bill, introduced by House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Ranking Member Frank Pallone, Jr. (D-NJ), House Ways and Means Committee Chair Jason Smith (R-MO), and House Education and the Workforce Committee Chair Virginia Foxx (R-NC), brings attention to the need for healthcare entities to improve transparency.

One proposed requirement of the bill is for hospitals, insurance companies, labs, imaging providers, and ambulatory surgical centers to publicly list the prices they charge patients in machine-readable files. This provision would compel healthcare organizations to provide price information, thereby increasing transparency.

Additionally, the bill aims to lower costs by mandating that health insurers and pharmacy benefit managers (PBMs) disclose negotiated drug rebates and discounts. By shedding light on these financial aspects, the bill intends to empower patients and employers to make more informed decisions about their healthcare.

Another area of focus for the legislation is prescription drug costs. The bill seeks to lower out-of-pocket costs for seniors who receive medication at hospital-owned outpatient facilities or doctor’s offices. It also aims to expand access to more affordable generic drugs and equips employers with drug price information that could help negotiate better deals for their employees.

Moreover, the bill emphasizes investments into programs that strengthen the healthcare system. It proposes funding community health centers and supporting training programs for doctors who are new to their communities. Additionally, the legislation ensures that Medicaid funding for hospitals that serve uninsured and low-income patients is preserved.

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Pushback from Pharmaceutical Care Management Association

Despite its potential benefits, the Lower Costs, More Transparency Act has faced criticism from the Pharmaceutical Care Management Association (PCMA). PCMA argues that the legislation does not address the root causes of high drug prices and instead gives more power to pharmaceutical companies. The association specifically warns against targeting PBMs, which it believes could hamper efforts to lower drug costs.

In response to PCMA’s stance, proponents of the bill maintain that it will promote honesty and clarity in healthcare pricing. They argue that by requiring transparency from health insurers, hospitals, and PBMs, the legislation will enable patients to make more informed decisions and foster competition in the prescription drug marketplace.

The Road to Price Transparency

The push for price transparency in healthcare has been ongoing. In April, the Centers for Medicare and Medicaid Services announced stricter enforcement of price transparency rules, imposing fines on non-compliant hospitals. The final rule, which became effective in January 2021, mandates that hospitals establish and publicly disclose a list of their standard charges.

Despite these efforts, a 2022 survey revealed that less than 20% of hospitals were in compliance with the transparency rule. This underscores the need for legislation like the Lower Costs, More Transparency Act to push for greater accountability and transparency in healthcare pricing.

In conclusion, the Lower Costs, More Transparency Act represents a significant step towards increasing healthcare price transparency and lowering costs for patients and employers. With the assistance of AI legalese decoder, individuals can better navigate the complexities of the bill and engage in meaningful discussions about the future of healthcare pricing.

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