This week, Congress unveiled a stopgap funding bill that encompasses a noteworthy healthcare package. The reaction from provider groups has been largely positive, with specific praise directed at initiatives targeting pharmacy benefit managers (PBMs), the extension of telehealth flexibilities, and increased payment provisions for hospitals and physicians.
Reforms in Pharmacy Benefit Management
The proposed legislation aims to regulate the business practices of PBMs. Key measures include a mandate for PBMs to transfer 100% of drug rebates and discounts to employers or health plans, and a prohibition on PBMs linking their fees to a drug’s Medicare list price. Additionally, the bill seeks to abolish spread pricing in Medicaid, a practice where PBMs retain a cut of the payment they receive for drugs. These changes, expected to take effect in 2028, have been well-received by the American Pharmacists Association. According to CEO Michael Hogue, PharmD, this marks a significant step in limiting PBMs’ practices that have adversely affected healthcare access in many communities.
Telehealth Flexibility Expansion
The legislative package includes an extension of Medicare telehealth flexibilities through 2026. This provision allows patients to continue accessing telehealth services from their homes, supports the use of audio-only communications for certain services, and facilitates virtual care in rural health clinics and federally qualified health centers. The Federation of American Hospitals CEO, Chip Kahn, has lauded these measures for safeguarding rural healthcare and ensuring seniors’ access to telehealth services, while also preventing funding cuts to hospitals tasked with serving the vulnerable.
Updates on Payment and Reimbursement
The package proposes a delay to the Medicaid disproportionate hospital share payment cuts slated for next year, alongside a temporary 2.5% boost to the Medicare physician fee schedule for 2025. This increase aims to counteract the 2.83% payment reduction recently finalized by the Centers for Medicare & Medicaid Services (CMS) for next year. Stacey Hughes, executive vice president of the American Hospital Association, has expressed her support, highlighting the legislative effort as a testament to bipartisan collaboration. This, she notes, will allow hospitals and health systems to maintain care for patients and communities.
For a detailed analysis, visit MedCity News.