Health industry under bipartisan fire on Capitol Hill
Sens. Patty Murray and Lamar Alexander. Photo: Mark Wilson/Getty Images
A new Senate bill would tackle an array of health industry tactics that are costing patients a lot of money, but have largely fallen under politicians' radar until now.
The big picture: This is one of the most ambitious bipartisan health care bills in a long time.
Details: The bill, written by Sens. Lamar Alexander and Patty Murray, pitches 3 options for ending surprise hospital billing, including a new one that could coax more doctors into accepting the same insurance plans as the hospitals they practice in.
It would also:
- Create a nonprofit entity to collect and review claims data, to help illuminate what care actually costs.
- Ban hospitals from including anticompetitive clauses in their contracts with insurers.
- Ban pharmacy benefit managers from charging more for a drug than the PBM paid for it, and would require PBMs to pass 100% of rebates or discounts along to insurers and employers that hire them.
- Prohibit some of the "gaming" practices that drugmakers use to keep competition off of the market.
The backdrop: A bipartisan House proposal released yesterday would restructure Medicare’s drug benefit and cap seniors’ out-of-pocket costs.
The other side: House Speaker Nancy Pelosi this week presented ideas for "Dems' forthcoming prescription drug negotiation bill," according to a senior Democratic aide and first reported by Politico.
- HHS would negotiate prices for at least 25 drugs every year, which would apply to all payers.
- Drugs covered by Medicare couldn't have price hikes higher than inflation, or the manufacturer would have to rebate the difference to Medicare.