Wyden introduces price transparency bill targeting payers

By | May 19, 2019

Dive Brief:

  • Senate Finance Committee Ranking Member Ron Wyden, D-Ore., introduced a bill Wednesday that would require health insurers to tell beneficiaries what the out-of-pocket costs would be for any in-network procedure or prescription drug they seek.
  • The Health Care Price Check Act stipulates that commercial insurers, as well as Medicare plans, provide an online tool and toll-free phone number for members to ask about cost of services and quality of providers. It would also require payers to tell patients when a provider is out of network.
  • Payer lobby America’s Health Insurance Plans told Healthcare Dive it is still evaluating the bill.

Dive Insight:

The legislation comes amid a growing push from the government for price transparency in healthcare. The Trump administration is considering requirements for payers to make public the negotiated rates they pay for services and has previously floated requiring providers to disclose the rates they negotiate with insurers, The Wall Street Journal first reported.

CMS has also targeted hospitals in its price transparency efforts. Since the beginning of this year, hospitals have been required to post their standard charges online in a machine-readable format. Standard charges, however, are rarely what insurers or patients end up paying, and hospital compliance with the rule has varied. CMS acknowledged it doesn’t have a mechanism for enforcing the requirement.

Another recent rule from HHS requires drugmakers include the price of their products in television advertisements, potentially beginning as early as July.

CMS already provides an app that shows traditional Medicare beneficiaries what services their plan covers. It’s part of a broader initiative for the program that includes tools for patients to help them determine out-of-pocket costs and compare prices.

But increased price transparency wouldn’t likely have much impact on insurers, which are “less exposed to risk” on the issue than other parts of the healthcare system, Brad Ellis, senior director of health insurance at Fitch Ratings, said in a statement Thursday.

“More transparency may serve to enhance healthcare consumers’ understanding of the mechanisms that drive insurance premiums higher, including increasing healthcare unit costs and the growing use of healthcare services,” he said. “Longer term, the goal may be to reduce premium rate increases by reining in drug prices, standardizing healthcare costs and exposing the cost effect of healthcare decisions, but this is a downstream issue.”

Wyden said in a statement the legislation is just one step toward an improved healthcare system in the U.S.

“In a grocery store, you can get a price check for a can of peas on Aisle 2. Health care is much more difficult, but it ought to be a lot easier for Americans to find out what they will have to pay before they get to a doctor,” Wyden said. “There’s more to do to lower health care costs, but transparency for consumers is an important first step. It’s time to pull back the curtain and get a price check on ‘Aisle Health Care.'”

Healthcare Dive – Latest News