WASHINGTON—U.S. Senator Bill Cassidy, M.D. (R-LA) today released a statement following the Senate Health Committee passage of the Lower Health Care Costs Act which includes 14 separate provisions authored or led by Cassidy to lower the cost of prescription drugs, protect patients from surprise medical bills, increase price transparency in health care, improve public health, and protect the private data of patients.
“This is a set of proposals that will benefit patients, addressing both their physical health and financial health,” said Dr. Cassidy. “The provisions I drafted were a result of speaking with patients and constituents in Louisiana – because of their input, patients across Louisiana and the United States will benefit.”
“Senators Cassidy and Hassan, and Murkowski have done valuable work to solve surprise medical billing by proposing a solution last Fall, and again this Spring, lighting a fire under Congress to end this harmful practice,” said Chairman Alexander. “I thank them for their dedication on the issue and working with Senator Murray and me toward a result.”
Cassidy’s specific provisions included in the package are:
- Protecting Patients Against Surprise Medical:
- Sec. 101. Protecting patients against out-of-network deductibles in emergencies.
- Requires that emergency health care charges to a patient are counted toward the patient’s in-network deductible.
- Ensures that patient protections for emergency services apply in all relevant settings of care.
- Sec. 102. Protection against surprise bills
- Patients are held harmless from surprise medical bills. Patients are only required to pay the in-network cost-sharing amount for out-of-network emergency care and for care provided by ancillary out-of-network practitioners, and for out-of-network diagnostic services at in-network facilities. Facilities and practitioners are barred from sending patients “balance” bills for more than the in-network cost-sharing amount.
- If a patient is stabilized after entering a facility through the emergency room, the patient must be given advance notice of any out-of-network care, an estimate of the patient’s costs for out-of-network care, and referrals for alternative options for in-network care. If a patient is not given adequate notice, the patient would be protected from surprise bills or out-of-network cost-sharing.
- S. 1895. Cassidy Amendment
- This amendment ensures that plans disclose when they do not have any in-network ancillary providers. Some studies have shown that 1 in 5 exchange plans do not have any in-network emergency physicians, and this amendment seeks to bring transparency around this to patients.
Legislation to lower the cost of prescription drugs:
- Sec. 202. Orange Book modernization
- Clarifies the information that FDA must include in the Orange Book about patents and exclusivities for drugs approved under Section 505 of the Federal Food, Drug, and Cosmetic Act.
- Requires FDA to remove patents and patent claim information from the Orange Book when the U.S. Patent and Trademark Office determines a patent or patent claim is invalid or inoperative to encourage drug development in the area no longer patented.
- Sec. 203. Ensuring timely access to generics.
- Maintains the use of citizen petitions to allow interested stakeholders, including drug companies, to notify FDA of concerns with pending generic and other follow-on drug applications.
- Addresses the abuse of the citizen petition process, which can be used to unnecessarily delay the approval of a drug application.
- Provides that FDA may deny a citizen petition that is submitted with the primary purpose of delaying the approval of an application and clarifies criteria that FDA may use to make this determination.
- Requires a petition to be submitted within 60 days after the petitioner knew, or reasonably should have known, the information that forms the basis of the petition.
- Requires HHS to establish procedures for referring a petitioner to the Federal Trade Commission if determined that a petition was submitted with the primary purpose of delaying the approval of another application.
- Sec. 204. Protecting access to biological products.
- Clarifies that biological products, including insulin products, that will transition from the drugs pathway to the biologics pathway in March 2020, cannot receive new, extended market exclusivities.
- Preserves certain unexpired exclusivities for biological products as FDA transitions the regulation of such products from the drugs pathway to the biologics pathway.
- Sec. 208. Clarifying the meaning of new chemical entity.
- Clarifies that eligibility for five-year new chemical entity (NCE) exclusivity is available only for a drug containing no active moiety that has been previously approved in the United States
- Ensures that drug manufacturers cannot receive NCE exclusivity for making small tweaks to old drugs – that only the most innovative or novel drugs qualify for exclusivity
- Improving Transparency in Health Care
- Sec. 301. Increasing transparency by removing gag clauses on price and quality information.
- Bans gag clauses in contracts between providers and health plans that prevent enrollees, plan sponsors, or referring providers from seeing cost and quality data on providers.
- Sec. 306. Health plan oversight of pharmacy benefit manager services.
- Requires that plan sponsors receive a quarterly report on the costs, fees and rebate information associated with their PBM contracts. Reporting will be structured to prevent the release of information that could lead to higher drug prices.
- Prohibits PBMs from engaging in spread pricing, or charging a plan sponsor, health insurance plan, or patient more for a drug than the PBM paid to acquire the drug. Includes reporting and pricing requirements for PBMs that own mail-order, specialty, or retail pharmacies.
- Requires the PBM to pass on 100% of any rebates or discounts to the plan sponsor.
- Sec. 309. Ensuring enrollee access to cost sharing information
- Requires providers and health plans to give patients good faith estimates of their expected out-of-pocket costs for specific health care services, and any other services that could reasonably be provided, within two business days of a request.
- Sec. 310. Strengthening parity in mental health and substance use disorder benefits.
- Requires group health plans and health insurance coverage to conduct comparative analysis of nonquantitative treatment limitations used for medical and surgical benefits as compared to mental health and substance use disorder benefits.
- Requires the Secretary of Labor to request that a group health plan or coverage submit the comparative analysis if they receive a complaint from an enrollee and that the Secretary request random submissions from 50 plans per year.
- If, upon review of the analysis, the Secretary finds that a plan or coverage is out of compliance with mental health parity law, the Secretary must specify actions for the plan or coverage to come into compliance.
- Improving Public Health
- Sec. 404. Expanding capacity for health outcomes.
- Authorizes the provision of technical assistance and grants to evaluate, develop, and expand the use of technology-enabled collaborative learning and capacity building models to increase access to specialized health care services in medically underserved areas and for medically underserved populations.
- Sec. 406. Innovation for maternal health.
- Establishes an HHS grant program for the training of health care professionals to reduce and prevent discrimination, including training related to implicit biases, in the provision of health care services related to prenatal care, labor care, birthing, and postpartum care. · Allows the Secretary to identify and disseminate best practices for such training.
- Ensuring the safety of patient data.
- Sec. 503. GAO study on the privacy and security risks of electronic transmission of individually identifiable health information to and from entities not covered by the Health Insurance Portability and Accountability Act.
- Requests a Government Accountability Office study to better understand existing gaps in privacy and security protections for health information as patients move their information to third parties, such as mobile applications, that are not covered by the Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules. The study would identify potential opportunities for improving the privacy and security protections for that health information.