This week, Congress released a stopgap funding bill that included a significant healthcare package.
Provider groups are reacting favorably to the package, mainly due to provisions that go after pharmacy benefit managers, extend telehealth flexibilities and increase payments to hospitals and physicians.
PBM reform
The legislation proposes changes that would reign in pharmacy benefit managers’ business practices. Specifically, it would require PBMs to pass through 100% of drug rebates and discounts to employers or health plans, as well as prohibit PBMs from linking their compensation to a drug’s Medicare list price. The package also seeks to eliminate spread pricing in Medicaid — which occurs when PBMs keep a portion of the amount paid to them for drugs.
These proposed changes — which are slated to take effect in 2028 — have been received well by the American Pharmacists Association.
“For years, APhA has advocated for these long overdue reforms to begin to stop PBMs’ harmful business practices that have robbed many communities of the necessary health care services they have come to rely upon,” APhA CEO Michael Hogue, PharmD, said in a statement.
Extended telehealth flexibilities
Congress is seeking to extend Medicare telehealth flexibilities through the end of 2026.
This extension would allow patients to continue receiving telehealth services from their homes, permit the use of audio-only communication for certain services, and enable rural health clinics and federally qualified health centers in providing virtual care.
Chip Kahn, CEO of the Federation of American Hospitals, released a statement applauding these measures.
“Congress’ health package hits the spot — it protects rural health care and assures seniors continued telehealth services while preventing cuts to hospitals serving the most vulnerable. Together, these provisions will sustain critical patient care at the right time, in the right setting,” he stated.
Changes to payment and reimbursement
Congress’ package would delay next year’s Medicaid disproportionate hospital share pay cuts. It would also temporarily boost the Medicare physician fee schedule by 2.5% for 2025, which would offset the 2.83% payment reduction that CMS recently finalized for next year.
Stacey Hughes, executive vice president of the American Hospital Association, celebrated these provisions in a statement.
“The AHA appreciates the House and Senate working together on this bipartisan healthcare package and urges Congress to pass this health care package that will ensure hospitals and health systems can continue to care for their patients and communities,” she said.
Photo: MikeyLPT, Getty Images
