Illustration: Natalie Peeples/Axios
The Energy and Commerce telehealth bill didn't get marked up last week (thanks to tech bill drama), but the payfors have a good chance of coming back in an end-of-year health package.
Why it matters: The PBM and hospital outpatient department offsets are becoming more familiar to lawmakers, and they show signs of becoming go-to ways to pay for health priorities ahead of the lame duck session.
What's inside: The E&C bill extends telehealth flexibilities for two years, and pays for that through:
- PBM transparency measures, as well as "delinking" in Medicare Part D, meaning paying PBMs a flat fee instead of based off the price of a drug.
- Requiring hospital outpatient departments to have unique identifier numbers to ensure they are not overcharging.
What they're saying: "Now we're in a position where they have such strong bipartisan agreement on the need to make these reforms that they're seen as obvious and acceptable payfors for legislation," said Jen Taylor, senior director of federal relations at Families USA. "[That] is a really good sign."
Yes, but: It is still not an easy lift to get these provisions into law, given opposition from the PBM and hospital industries.
- PBMs take particular issue with the delinking provision, arguing it has not been sufficiently scrutinized and would actually cost money.
- "We do not believe the Congressional Budget Office has evaluated the policy independent of separate PBM provisions," said Greg Lopes, a spokesman for the Pharmaceutical Care Management Association.
- "We urge CBO to do a specific analysis of delinking to understand that it will not save taxpayer money," he added.
- Mark Miller, executive vice president of health care at Arnold Ventures, also said he had questions about delinking and wanted to see further analysis. "I'd like to see the score," he said.
The bottom line: The unique identifier provision for hospitals has wide support among experts, though it faces pushback from hospitals.
- The American Hospital Association called it an "unnecessary and onerous administrative burden."
