Legislation Seeks to Increase Healthcare Price Transparency
The Lower Costs, More Transparency Act (H.R. 5378) was introduced by the U.S. House of Representatives, primarily seeking to provide patients with accurate information regarding the cost of procedures and services. Specifically, the bill requires healthcare price information from hospitals, insurance companies, labs, imaging providers, and ambulatory surgical centers, which would be obligated to publicly list the prices they charge patients in machine-readable files. It would also require health insurers and pharmacy benefit managers (PBMs) to disclose negotiated drug rebates and discounts.
In addition, it aims to lower out-of-pocket prescription costs for seniors; expand access to more affordable generic drugs; and Pharmacy Benefit Managers (PBMs) to provide employers with drug price information that could allow them to get a better deal for their employees.
Other items include suspension of the Medicaid disproportionate share hospital (DSH) reductions for 2 years; and permanently implement reductions to Medicare payments for drug administration services in off-campus hospital outpatient departments (HOPDs).
While there is some congressional support, the bill is facing opposition from the healthcare industry and some members of the House. The American Hospital Association (AHA) sent a letter to House leadership expressing concerns regarding the new regulations. Some House members say the proposed legislation falls short, and is missing components to improve transparency with private Medicare plans and private ownership of healthcare facilities. Earlier this year, CMS updated their process to enforce compliance with the hospital price transparency update requirements to include giving specific deadlines in which hospitals should be in full compliance, automatically imposing civil monetary penalties and streamlining the compliance process, ultimately shortening the time that hospitals must come into compliance. The Fifth Semi-Annual survey performed and published by PatientRightsAdvocate.org (PRA) found that 36% of hospitals were fully in compliance with the transparency rule.
