BILL: Lower Costs, More Transparency Act

H.R. 5378 - Lower Costs, More Transparency Act

Bill Overview

• Title: Lower Costs, More Transparency Act
• Sponsored by: Rep. Cathy McMorris Rodgers (R-Wash.)
• Purpose: To enhance transparency and regulate costs in the healthcare sector.

Current Status

• The bill was introduced in the House of Representatives on Sept. 8, and passed on a bipartisan basis with 320-71 votes on Dec. 11. 

Key Elements of the Bill

• Price Disclosures:
  • Requires Medicare-participating hospitals, clinics, labs, imaging service providers, and other healthcare facilities to publish prices, including discounts and negotiated charges, annually.
• Pharmacy Benefit Managers (PBMs):
  • Mandates semiannual reporting by PBMs on claims for covered drugs types and costs. 
  • Requires contracts with PBMs for employer-sponsored health plans to permit audits of costs and claims. 
• Medicaid and Medicare Adjustments:
  • Implements pass-through pricing models and bans spread-pricing — a pricing model where PBMs charge health insurance plans a higher price for prescription drugs than what they pay pharmacies to dispense the drugs — in Medicaid.
  • Standardizes Medicare payments for drug administration services in different settings. 
• Extends Funding and Furthers Public Health Programs:
  • Allocates funding and resources to the Department of Health.
  • Extends the Teaching Health Center Graduate Medical Education Program and National Health Service Corps. 

Supports and Critiques

• Supporting Views:
  • Rep. Rick W. Allen (R-G.A.) expressed his support for the bill, emphasizing its role in restoring patient-centered, cost-effective healthcare solutions, reducing unexpected medical bills and hidden fees, and ensuring price transparency.
• Opposition and Concerns:
  • Rep. Richard Neal (D-Mass.) and other Democratic lawmakers shared concern that the bill lacks ownership transparency requirements for private equity purchases of healthcare facilities. 
  • Hospitals and PBMs have expressed opposition as well, specifically to the site-neutral payment policies.

Tell your reps to support or oppose the bill.