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May 25, 2023 - Health

House panel advances transparency and PBM bills

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Illustration: Gabriella Turrisi/Axios

The House Energy and Commerce Committee on Wednesday advanced a series of health care measures to promote price transparency and overhaul regulation of pharmacy benefit managers (PBMs) in a mostly bipartisan markup.

Driving the news: The measures advanced on a unanimous 49-0 vote addressed:

  • Codifying and strengthening Trump-era rules to require hospitals and insurers to make negotiated prices more easily available.
  • Imposing new transparency requirements on PBMs and banning PBMs' ability to charge more than they pay for a drug and keep the difference in Medicaid.
  • Providing funding for community health centers and graduate medical education, as well as putting off cuts in disproportionate share hospital payments that offset some facilities' uncompensated care costs.

Yes, but: Two bills advanced on largely party-line votes, with one to increase hospital reporting requirements in the 340B drug discount program adopted 29-22.

  • The split between top Democratic Reps. Anna Eshoo (Calif.) and Frank Pallone (N.J.) over a bill to facilitate value-based arrangements in Medicaid for high-cost drugs continued, with most Democrats siding with Pallone against the measure. It still passed 31-19 due to GOP support.

What we're watching: Even the more modest site-neutral policies that were considered, like equalizing payment for physician-administered drugs, drew concerns from New York Democratic Reps. Paul Tonko and Yvette Clarke, who warned of the effects on hospitals.

  • That highlights the even tougher lift facing the bigger site-neutral payment policies that were left out for now and address the way hospitals charge more for the same services private doctors deliver in their offices.

A version of this story was published first on Axios Pro. Get news like this by subscribing. Use code POLICY100 which gives you $100 off.

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