congress

A flurry of health care bills

This is the last week that the House and Senate will be in session together until Sept. 14. Lawmakers are scrambling to get a lot done, including on health care. (Each chamber will be in session alone during a portion of that time.)

The work by committees in the Senate and House sets the stage for a potential health care package later in the year, possibly during the lame duck session, though it remains to be seen whether the two parties will work together following the midterm elections.

“People say Congress is not functioning well,” Senate health committee Chair Bill Cassidy (R-La.) said at the end of markup of several health care bills. “This was a long morning because Congress is functioning well.”

Here are some key bills gaining traction in Congress:

Hospital price transparency. The Senate and House are working on separate versions of this legislation.

The Senate health committee on Wednesday passed the Patients Deserve Price Tags Act, which would apply to hospitals and insurance companies. The legislation would require hospitals to publish rates negotiated with insurers, discounts for cash payments, and billing codes. Insurance plans would be required to provide a tool for consumers to search the in-network and out-of-network charges for covered items and services and the negotiated prices for covered prescription drugs.

The House Energy and Commerce Committee on Tuesday passed the Lower Costs, More Transparency Act, following passage of that bill by the House Ways and Means Committee a week earlier. The legislation applies to a broader range of health care facilities, including hospitals, diagnostic labs, imaging centers, and ambulatory surgical facilities. It would require those facilities to post all gross charges, payer-specific negotiated charges, and discounted cash prices in a consumer-friendly format for at least 300 shoppable services, with updates annually.

Prior authorization. Both the Energy and Commerce and Ways and Means committees have passed legislation to rein in prior authorization in Medicare Advantage and require private MA plans to report their approval and denial rates to government regulators.

However, Senate Republicans last week blocked a separate Democratic bill to halt a Trump administration pilot testing prior authorization in original Medicare.

Drug prices. The Senate health committee passed legislation that would cap the cost of insulin at $35 per month for those with private insurance and create a pilot program to make insulin more accessible for those without insurance.

The bill also would authorize the Food and Drug Administration to reject petitions filed solely to delay generic or biosimilar competition. On Tuesday, the Senate passed a bill aimed at preventing brands from delaying generic and biosimilar competition with a practice often referred to as “patent thicketing.”

Committees in the Senate and House have passed legislation making it easier to get biosimilars approved.

On Wednesday, the House Oversight Committee passed a bipartisan bill restricting the business practices of pharmacy benefit managers participating in federal health care plans. It mandates minimum reimbursement rates for pharmacies and prohibits PBMs from steering patients toward affiliated pharmacies.

Although not a drug pricing measure, the health committee passed legislation that would add country-of-origin labeling requirements to the U.S.’s prescription drug supply chain.