AHA decries site neutral payments in Lower Cost More Transparency Act

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The U.S. House of Representatives has passed H.R. 5378, the Lower Costs, More Transparency Act, a bill aimed at mandating greater hospital price transparency that would curb pharmacy benefit manager spread pricing.

The bill passed the House by a vote of 320 to 71 and now heads to the Senate for consideration. Congress is scheduled to recess for the year at the end of this week.

It also provides price transparency for clinical lab tests so that patients will get more clarity into the prices they'll pay for these tests.

The bill spares hospitals $16 billion in cuts to disproportionate share hospital payments for two years.

WHY THIS MATTERS

Site neutral payments are included in the bill.

Rick Pollack, president and CEO of the American Hospital Association, said, "While the AHA appreciates inclusion of a two-year delay on DSH cuts, we have been very clear regarding the harm that would be done to our nation's hospitals if so-called site-neutral cuts to Medicare were adopted. We have strongly urged that those cuts be eliminated from this legislation. If Medicare site-neutral cuts remain part of this package, we ask that Congress oppose H.R. 5378 (The Lower Costs, More Transparency Act) until such changes are made."

The Catholic Health Association has also called for lawmakers to reject site neutral provisions in the Lower Costs, More Transparency bill.

Merith Basey, executive director of Patients for Affordable Drugs Now, said, "The House's decisive bipartisan action tonight in passing the 'Lower Costs, More Transparency Act' including measures to increase transparency and further tackle high drug prices by improving the generic drug approval process, is highly encouraging and moves the Congress in the right direction."

But the Pharmaceutical Care Management Association said the bill would fail to achieve the objective of lowering drug costs.

"America's pharmacy benefit companies are extremely disappointed by the passage of H.R. 5378 by the U.S. House of Representatives," the organization said. "The legislation undermines the work of PBMs to reduce prescription drug costs for patients and employers. The bill's intrusion into private market contracting for pharmacy benefits undermines and weakens the ability of PBMs to offer health plans, employers, and unions the choice of the most cost-effective pharmacy benefits to meet their needs."

THE LARGER TREND

Another bill introduced in the House would avert a pending 3.37% physician pay cut to Medicare payments, according to the American Medical Association.

These cuts threaten healthcare access for seniors as well as the viability of physician practices, including many in rural and underserved areas, said the AMA.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org