News & Press: Advocacy News

CCTS MEMORANDUM | March 29, 2019

Friday, May 31, 2019   (0 Comments)
Posted by: Andres Bachelet
Share |

May 29, 2019




TO:     Coalition for Clinical and Translational Science


FR:     Dale Dirks & Dane Christiansen


RE:     Lower Health Care Costs Act Summary


Just prior to adjourning for the Memorial Day congressional recess, the Senate’s Committee on Health, Education, Labor, and Pensions (HELP) released a discussion draft of the bipartisan Lower Health Care Costs Act. This legislation represents a comprehensive proposal to address drug pricing, health system transparency, affordability, and related hot-button topics. The HELP Committee is currently accepting community feedback on the proposal in an effort to craft and introduce a final bill.


Congress is expected to tackle a variety of high-profile healthcare issues, including “must-pass” items, prior to the end of the current fiscal year (October 1st) and this package will likely form the foundation of Senate efforts (the House is expected to take a different approach and emphasize patient access and protections for those with pre-existing conditions). We will continue to provide updates as legislative efforts to reform healthcare delivery move forward.


The Lower Health Care Costs Act includes the provisions of interest listed below. A copy of the current draft of the bill is attached.


Title I- Ending Surprise Medical Bills


·         Advances patient protections for emergency services to ensure patient out of pocket costs are counted towards “in network” deductibles and that patients are billed appropriate amounts consistent with standard in network care. 


·         Includes requirements to provide pricing and related charges to patients up front as well as subsequent options to mediate billing disputes.


Title II- Reducing the Price of Prescription Drugs


·         Advances reforms to the patent and trademark system to promote and facilitate the entry of generic products into the market.


·         Closes a loophole to ensure that any products (such as insulin) that are reclassified as biologics or biosimilars after March of 2020 do not receive any additional patent exclusivity.


·         Reforms the citizen petition process to allow for proper grievances while preventing the system from being used to simply stymie or delay market entry for products. 


Title III- Improving Transparency in Health Care


·         Bans “gag clauses” in contracting that might otherwise prevent health plans from seeing cost and quality data on providers or that might prevent access to de-identified claims data that could be used for quality improvement. 


·         Restricts the use of “anti-tiering” and “anti-steering” clauses in contracts between providers and health plans, which could restrict the plan from directing or incentivizing patients to use specific providers and facilities with higher quality and lower prices.


·         Creates a non-governmental and non-profit entity for the purposes of improving the transparency of healthcare costs and establishes an advisory committee comprised of federal and non-federal members to advance the activities of this new entity.


·         Prohibits Pharmacy Benefit Managers (PBMs) from charging a plan sponsor, plan, or patient more for a drug than the PBM paid to acquire the drug while also requiring PBMs to pass on all savings and rebates they receive to the plan sponsor.


·         Initiates a study by the Government Accountability Office (GAO) on profit-sharing relationships between hospitals, contract management groups, and physician and ancillary services while making recommendations to improve oversight in this area.


Title IV- Improving Public Health


·         Initiates new public health activities focused on obesity, vaccinations, training of health professionals, and maternal and child health.


Title V- Improving the Exchange of Health Information


·         Seeks to enhance patient access to commercial health insurance information by facilitating the availability of claims data, in-network practitioners, and expected out-of-pocket costs.