The U.S. House of Representatives on Monday passed a health-care package that includes pharmacy benefit manager reform.
The Lower Costs, More Transparency Act would ban PBMs from spread pricing, or charging Medicaid more than they pay pharmacies for drugs, and codify Trump-era rules that require hospitals and insurers to publicly post their prices. PBMs, clinical lab test providers, imaging providers and ambulatory surgical centers also would have to be more transparent about their pricing. Although the bill passed the House on a bipartisan vote of 320 to 71, it is unlikely to be taken up in the Senate, where committees have written their own legislation.
In addition to mandating that providers and PBMs publicly list prices before they charge patients, hospitals would be required to publish charges through machine-readable files. The bill also calls for the elimination of $16 billion in disproportionate share hospital program cuts through 2025 and $7 billion in funds for the Medicaid Improvement Fund, while allocating $15 billion in funds toward community health centers and programs to address physician shortages in underserved communities.
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