by Jane Anderson
The Senate Health,
Education, Labor and Pensions (HELP) Committee on June 26 advanced wide-ranging
bipartisan legislation aimed at lowering health care costs by protecting
patients against surprise medical bills and targeting drug prices by clamping
down on PBMs.
"This [Senate] bill
seems to have strong momentum and will keep moving before the election,"
says Caroline Pearson, a senior fellow at NORC at the University of Chicago.
Still, "it's impossible to know whether it will actually pass," Pearson
tells AIS Health.
"The debate over
surprise bills continues to be complicated, as health plans and providers do
not agree on what the payment should be for out-of-network charges,"
Pearson explains. "As the bill has progressed, providers and payers remain
split on appropriate reimbursement."
Generally speaking,
providers favor an arbitration model to resolve the payment question, Pearson
says, noting, "providers are concerned that any other fixed payment amount
constitutes rate-setting." Meanwhile,
"for health plans, individual arbitration with many different providers
has the potential to be very burdensome. These payers would prefer a fixed
reimbursement benchmark."
Overall, America's Health
Insurance Plans President and CEO Matt Eyles said in a statement that the bill
would hinder competitive negotiations by stripping insurers and PBMs of
leverage to lower costs "without addressing the root cause: high drug
prices set and controlled by manufacturers who enjoy government-granted
monopolies through the patent system."
It's too soon to tell how
the bill’s provisions might affect consumers, Pearson says. "Efforts to
increase transparency about which providers are in-network are helpful for
consumers, but only if that information is easy to use," she says. "The
real consumer impact will depend on the final details of the bill and how it is
implemented through regulation."
From Health Plan Weekly
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