This week, Congress took a significant step by releasing a stopgap funding bill that incorporated a substantial healthcare package. This move has sparked various reactions and implications within the healthcare sector. Provider groups are showing positive responses, with key provisions such as those targeting pharmacy benefit managers, extending telehealth flexibilities, and increasing payments to hospitals and physicians playing a crucial role.

Congress' Healthcare Package: A Game-Changer for Providers

PBM Reform

The legislation brings about proposed changes aimed at reining in pharmacy benefit managers' business practices. It is stipulated that PBMs must pass through 100% of drug rebates and discounts to employers or health plans. This is a significant move as it prohibits PBMs from linking their compensation to a drug's Medicare list price. Additionally, the package seeks to eliminate spread pricing in Medicaid, where PBMs have been keeping a portion of the drug payment amounts. These proposed changes, set to take effect in 2028, have been well received by the American Pharmacists Association. As APhA CEO Michael Hogue, PharmD, stated in a statement, "For years, APhA has advocated for these long overdue reforms to begin to stop PBMs' harmful business practices that have robbed many communities of the necessary health care services they have come to rely upon."This reform is set to have a profound impact on the pharmacy benefit management industry and ensure that the savings from drug rebates and discounts are passed on to the end users. It addresses a long-standing issue and has the potential to bring about much-needed transparency and fairness in the pharmaceutical supply chain.

Extended Telehealth Flexibilities

Congress is making efforts to extend Medicare telehealth flexibilities until the end of 2026. This extension allows patients to continue receiving telehealth services from the comfort of their homes. It also permits the use of audio-only communication for certain services, which is particularly beneficial for those in rural areas with limited access to in-person care. Rural health clinics and federally qualified health centers can now provide virtual care more easily.Chip Kahn, CEO of the Federation of American Hospitals, released a statement applauding these measures. He stated, "Congress' health package hits the spot — it protects rural health care and assures seniors continued telehealth services while preventing cuts to hospitals serving the most vulnerable. Together, these provisions will sustain critical patient care at the right time, in the right setting."This extension of telehealth flexibilities is a crucial step in ensuring that patients have access to quality healthcare services regardless of their geographical location. It helps bridge the gap between rural and urban areas and provides greater convenience and flexibility for both patients and healthcare providers.

Changes to Payment and Reimbursement

Congress' healthcare package includes measures to delay next year's Medicaid disproportionate hospital share pay cuts. This provides much-needed relief to hospitals and health systems that rely on these payments. Additionally, it temporarily boosts the Medicare physician fee schedule by 2.5% for 2025, offsetting the 2.83% payment reduction that CMS recently finalized for next year.Stacey Hughes, executive vice president of the American Hospital Association, celebrated these provisions in a statement. She said, "The AHA appreciates the House and Senate working together on this bipartisan healthcare package and urges Congress to pass this health care package that will ensure hospitals and health systems can continue to care for their patients and communities."These changes to payment and reimbursement are essential for the financial stability of hospitals and physicians. They help maintain the viability of healthcare institutions and ensure that they can continue to provide essential services to the public. It also shows the importance of bipartisan cooperation in addressing healthcare issues and finding solutions that benefit both providers and patients.