Congress released a stopgap funding bill with a significant healthcare package, and provider groups are reacting favorably. They are mainly applauding provisions that reign in PBMs\u2019 business practices, extend telehealth flexibilities, and boost payments to hospitals and physicians.
\nThe post How Did Provider Groups React To Congress\u2019 End-Of-Year Healthcare Package? appeared first on Above the Law.<\/p>\n
This week, Congress released a stopgap funding bill<\/a> that included a significant healthcare package.\u00a0<\/p>\n 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.<\/p>\n PBM reform<\/strong><\/p>\n The legislation proposes changes that would reign in pharmacy benefit managers\u2019 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\u2019s Medicare list price. The package also seeks to eliminate spread pricing in Medicaid \u2014 which occurs when PBMs keep a portion of the amount paid to them for drugs.<\/p>\n These proposed changes \u2014 which are slated to take effect in 2028 \u2014 have been received well by the American Pharmacists Association<\/a>.<\/p>\n \u201cFor years, APhA has advocated for these long overdue reforms to begin to stop PBMs\u2019 harmful business practices that have robbed many communities of the necessary health care services they have come to rely upon,\u201d APhA CEO Michael Hogue, PharmD, said in a statement.<\/p>\n Extended telehealth flexibilities<\/strong><\/p>\n Congress is seeking to extend Medicare telehealth flexibilities through the end of 2026.<\/p>\n 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.<\/p>\n