This week, Congress unveiled a crucial stopgap funding bill that encompasses an extensive healthcare package. This legislative move is pivotal in addressing urgent healthcare needs while ensuring that various stakeholders are adequately supported.
Provider groups are expressing optimism regarding this package, primarily because it includes provisions targeting pharmacy benefit managers (PBMs), enhancing telehealth services, and increasing financial support for hospitals and physicians. These measures signify a meaningful shift towards improving healthcare delivery and accessibility across the nation.
Transformative Reforms Targeting Pharmacy Benefit Managers
The proposed legislation outlines significant reforms aimed at regulating the business practices of pharmacy benefit managers. Notably, it mandates that PBMs must pass through 100% of drug rebates and discounts directly to employers or health plans, eliminating the potential for profit from these discounts. Additionally, the legislation will prohibit PBMs from tying their compensation to the Medicare list price of drugs. A crucial aspect of this package is the initiative to eradicate spread pricing in Medicaid, which allows PBMs to retain a portion of the payments made for medications. These reforms are anticipated to take effect in 2028 and have garnered positive feedback from the American Pharmacists Association.
“For years, the APhA has championed these necessary reforms to combat the detrimental practices of PBMs that have deprived many communities of essential healthcare services,” stated APhA CEO Michael Hogue.
Enhancing Telehealth Services for Better Accessibility
Congress is making strides to extend Medicare telehealth flexibilities until the end of 2026, a vital move that will allow patients to access healthcare services from the comfort of their homes. This extension will facilitate the use of audio-only communication for specific services, ensuring that even those without video capabilities can receive necessary care. Furthermore, it enables rural health clinics and federally qualified health centers to provide virtual care, expanding accessibility to underserved populations. Chip Kahn, CEO of the Federation of American Hospitals, expressed his support for these measures, highlighting their importance.
“Congress’ health package hits the mark — protecting rural healthcare and ensuring that seniors continue to benefit from telehealth services while preventing cuts to hospitals that serve the most vulnerable populations. Collectively, these provisions will sustain critical patient care at a crucial time,” he remarked.
Strategic Changes to Payment and Reimbursement Structures
The healthcare package proposed by Congress also includes strategies to delay the impending cuts to Medicaid disproportionate hospital share payments until 2027. This delay is crucial for maintaining hospital funding. Additionally, it aims to temporarily increase the Medicare physician fee schedule by 2.5% for 2025, effectively offsetting the 2.83% payment reduction that the Centers for Medicare & Medicaid Services (CMS) finalized for the upcoming year. These financial adjustments are designed to support healthcare providers in navigating the evolving landscape of healthcare funding.
Stacey Hughes, executive vice president of the American Hospital Association, applauded these provisions, emphasizing their significance for healthcare systems. “The AHA appreciates the collaborative efforts of the House and Senate in formulating this bipartisan healthcare package and urges swift passage to ensure that hospitals and health systems can continue to provide high-quality care to their patients and communities,” she stated.
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