Congress mulls revival of December’s scuttled healthcare package
Key House and Senate lawmakers hope to revive a bipartisan healthcare package that failed to make it into the final December government funding bill. That package includes extended telehealth relief for Health Savings Account-qualifying High-Deductible Health Plans and commercial market Pharmacy Benefit Manager reforms. However, the outlook for this package remains unclear.
Congress included the healthcare package in a government funding bill late last year but dropped it, along with other components, at the behest of President-elect Donald Trump and Elon Musk, who has been tapped to head the newly proposed cost-cutting “Department of Government Efficiency.” Both criticized the overall size of the bill and its provisions unrelated to government funding, although the healthcare provisions did not come under direct fire. Still, lawmakers jettisoned most healthcare items from the scaled-down bill that ultimately passed and funds the government through March 14.
But after nearly two years of work on the legislation, key lawmakers in both chambers remain committed to passing the bipartisan healthcare package and are actively exploring options on how to move it forward, possibly as a standalone bill or as a rider on a March government funding measure. However, in remains to be seen how this effort will fit into an increasingly busy legislative calendar stacked with competing priorities.
The healthcare package included a two-year extension of pandemic-related telehealth relief (through plan years beginning in 2025 and 2026) for HSA-qualifying HDHPs. The extension would allow these HDHPs to continue covering telehealth and other remote care services on a pre- or no-deductible basis. Additionally, an otherwise HSA-eligible individual could continue to receive pre- or no-deductible coverage for telehealth and other remote care services from a stand-alone vendor outside of their HDHP. In both cases, the pre- or no-deductible telehealth coverage would not interfere with an individual’s eligibility to make or receive HSA contributions.
This telehealth / HDHP relief expired for calendar-year plan on Dec. 31, 2024, and will expire later this year for noncalendar-year plans. There is a chance the Congress could retroactively restore relief to the start of 2025.
The package also would require PBMs to not less frequently that every six months (or, at the request of a plan sponsor, not less frequently than quarterly) provide employer-sponsored group health plans with detailed data on prescription drug coverage, utilization and spending. This includes information on gross and net drug spend, drug rebates, spread pricing arrangements, formulary placement rationale and benefit designs. Summaries of these reports will need to be made available to health plans and individual participants. PBMs and third-party administrators would also have to annually disclose their direct and indirect compensation to plan fiduciaries.
In addition, PBMs would be required to pass through 100% of the rebates, fees, alternative discounts and other remuneration they get from drug manufacturers to group health plans.
PBM reforms in public programs would, among other things, eliminate the link between PBM compensation and list drug prices in Medicare and ban spread pricing in Medicaid. A provision to encourage site-neutral payment policies in Medicare would require each off-campus hospital outpatient department to use a unique billing code for that facility in order to bill the program.
The package also includes reforms aimed at streamlining the drug patents system for lower-cost generic medicines to enter the market.
Mercer will continue to work with employers and other stakeholders in urging Congress to pass the bipartisan healthcare package as soon as possible.
