Promoting Transparency and Healthy Competition in Medicare Act

Promoting Transparency and Healthy Competition in Medicare Act

This bill requires Medicare Advantage (MA) organizations and prescription drug plan (PDP) sponsors and pharmacy benefit managers (PBMs) under the Medicare prescription drug benefit to report certain information relating to their ownership interests in participating providers.

Specifically, MA organizations must report on items and services, patient risk scores and associated diagnoses, prior authorization requests, and incentive payments with respect to providers in which the MA organization has an ownership interest as compared to other providers.

Similarly, PDP sponsors under the Medicare prescription drug benefit must report on the prices of prescription drugs with respect to pharmacies in which the PDP sponsor has an ownership interest as compared to other pharmacies. The bill also prohibits PDP sponsors from contracting with PBMs in which the PDP sponsor has an ownership interest unless the PBM reports certain information on rebates and payments between the PBM, PDP sponsor, pharmacies, and drug manufacturers.

Bill 118 HR 3282, also known as the Promoting Transparency and Healthy Competition in Medicare Act, aims to increase transparency and competition within the Medicare program. The bill was introduced in the House of Representatives on June 18, 2021.

The main goal of this legislation is to ensure that Medicare beneficiaries have access to high-quality care at affordable prices. The bill seeks to achieve this by requiring Medicare Advantage plans to disclose information about their network providers, including the rates they pay for services. This information will help beneficiaries make informed decisions about their healthcare options and encourage competition among providers to offer better quality care at lower costs.

Additionally, the bill includes provisions to improve the accuracy of Medicare Advantage plan provider directories, making it easier for beneficiaries to find and access care. It also aims to address issues of surprise medical billing by requiring providers to give patients upfront cost estimates for non-emergency services. Overall, the Promoting Transparency and Healthy Competition in Medicare Act is designed to promote transparency, competition, and affordability within the Medicare program, ultimately benefiting Medicare beneficiaries and improving the overall quality of care.