December 11, 2023 – Congresswoman Lori Chavez-DeRemer: House Passes Chavez-DeRemer-Led Proposal to Shine Light on Deceptive PBM Practices
Today, the U.S. House of Representatives passed the Lower Costs, More Transparency Act, which increases price transparency throughout the health care system, addresses the soaring cost of prescription medication, and provides patients with timely information about the cost of procedures and services. The Health Data Access, Transparency, and Affordability (DATA) Act, a bipartisan bill led by Rep. Lori Chavez-DeRemer (OR-05), was included in the package.
The proposal would increase fiduciaries’ access to data on different health insurance plans – bolstering transparency to streamline employers’ ability to compare plans and provide workers with high-quality, more affordable health benefits. The bill passed the Education and the Workforce Committee in July and is co-led by Rep. Mark Takano (CA-39) and cosponsored by Rep. Kathy Manning (NC-06).
“The Health DATA Act would ensure pharmacy benefit managers and third-party administrators are following the law and can’t intentionally withhold important information related to health plans. By taking overdue action to improve transparency, this pragmatic legislation will help lower costs for patients and bring much-needed accountability to the health insurance industry. I’m glad this bill received broad bipartisan support in the House today and hope the Senate will consider the bill quickly so we can get it to the president’s desk,” Chavez-DeRemer said.
Some pharmacy benefit managers (PBMs) and third-party administrators (TPAs) are using loopholes to circumvent current law by limiting the number of claims an employer can audit, limiting the number of audits an employer can conduct, demanding the audit be conducted by their own company, hiding indirect compensation received by the service provider for its role administering a plan, and demanding that the audit take place on the service providers’ premises.
The Health DATA Access Act would close these loopholes by ensuring that a contract or arrangement entered by an employer-sponsored health plan and the service provider may not:
- Restrict a plan fiduciary from auditing, reviewing, or otherwise accessing de-identified claims data;
- Restrict the plan fiduciary from choosing who will conduct any audits of claims; or
- Limit the number of claims that the plan fiduciary may audit in a given time period.
Full text of the bill is available HERE.
Download Right Now Oregon on the Amazon App Store
About the Author
Discover more from Right Now Oregon
Subscribe to get the latest posts sent to your email.
