Senate Health Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) released bipartisan discussion draft legislation entitled Lower Health Care Costs Act of 2019. The Act contains nearly three dozen specific provisions to reduce what Americans pay for health care, and is organized into the following five sections:
Ending Surprise Medical Bills: Provisions require patients to pay only in-network cost sharing amounts for out-of-network emergency care, and require that all emergency health care charges are counted toward patients’ in-network deductible.
Reducing the Prices of Prescription Drugs: Provisions require the publication of the “Purple Book” listing information about each licensed biological product, including marketing and licensure status, patent information and exclusivity periods, require the FDA to remove patent information from the Orange Book for patents that are invalid or inoperative, address the abuse of the citizen petition process which can be used to unnecessarily delay the approval of a drug application, and prevent first-to-file generic drug applicants from blocking, beyond a 180-day exclusivity period, the entrance of subsequent generics to market.
Improving Transparency in Health Care: Provisions ban gag clauses between providers and health plans that prevent seeing cost and data quality on providers, ban “anti-tiering” and “anti-steering” clauses in facility and insurance contracts that limit access to lower cost care, designate a nongovernmental, non-profit entity to improve the transparency of healthcare costs, and require that all bills be sent to patients within 30 business days.
Improving Public Health: Provisions authorize a national campaign to increase awareness of vaccines and combat misinformation, require the development of a guide on obesity prevention and control strategies, require the expansion and modernization of public health data systems, and establish a grant program to eliminate preventable maternal morbidity and mortality and to improve maternal health outcomes.
Improving the Exchange of Health Information: Provisions require commercial health insurers to make information available to patients through application programming interfaces, and incentivize health care entities to adopt strong cybersecurity practices.
Given the high cost of biologics, it is perhaps unsurprising that the Act includes many provisions relating to the use of biologics and biosimilars, including some that focus on educating patients and providers about their use. For instance, § 206 provides for developing continuing medical education programs that provide education on “the prescribing of, and relevant clinical considerations with respect to, biosimilar biological products.” That section also provides for the establishment of a website to provide educational materials to health care providers, patients and caregivers, regarding the meaning of terms, and standard for review for biosimilars.
Since the last Congress, the Senate Health Committee has held nine hearings on health care costs – five related to reducing the cost of care, and four investigating the cost of prescription drugs. At the conclusion of the last Congress, Chairman Alexander sent a letter to various stakeholders, including health policy organizations, governors, state insurance commissioners, doctors, hospitals, patients and innovators, asking for specific recommendations to help lower the cost of health care services. Chairman Alexander says he hopes to put the draft legislation to a Senate vote in July.