PATIENT Act of 2023 Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023
Impact
The implementation of HB3561 is expected to significantly influence state laws related to transparency in healthcare pricing. By mandating disclosure of pricing information, it is intended to create a more competitive healthcare environment that may ultimately lead to reduced costs for patients. Moreover, it introduces accountability measures for pharmacy benefit managers (PBMs), requiring them to adopt pass-through pricing models that prevent inflated payment structures from being imposed on pharmacies, ensuring fairer reimbursement practices.
Summary
House Bill 3561, known as the 'Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023' or the 'PATIENT Act of 2023,' aims to enhance price transparency within healthcare, particularly regarding hospital and insurer pricing structures. The bill seeks to mandate that hospitals disclose standard charges for shoppable services in a consumer-friendly format, along with requiring regular updates. This initiative is designed to empower patients with better information on healthcare costs, allowing them to make informed decisions regarding their treatment options and financial liabilities.
Contention
Despite its potential benefits, HB3561 has faced criticism and concerns from various stakeholders. Some healthcare providers worry that the transparency requirements may inadvertently compel them to reveal proprietary pricing information, potentially undermining their competitive edge. Additionally, the focus on PBM practices raises questions about their relationships with drug manufacturers and could spark further legislative debate regarding the appropriate level of regulation in this area. The balance between transparency and maintaining a viable business model for healthcare entities remains a key point of contention.
Related
To amend title XVIII of the Social Security Act to require each off-campus outpatient department of a provider to include a unique identifier on claims for items and services, and to require providers with a department of a provider to submit to the Centers for Medicare & Medicaid Services an attestation with respect to each such department.
To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes.