This week, a significant development emerged from Congress in the form of a stopgap funding bill, which includes an extensive healthcare package that has garnered positive reactions from various provider groups. The centerpiece of this package focuses on several key provisions aimed at reforming the pharmacy benefit manager (PBM) landscape, extending telehealth flexibilities, and enhancing payments to healthcare providers.

Reforming Pharmacy Benefit Managers

One of the most noteworthy aspects of the newly introduced legislation is its proposed reforms targeting pharmacy benefit managers. Specifically, the bill mandates that PBMs pass through 100% of drug rebates and discounts to employers or health plans. Furthermore, it seeks to eliminate the practice of spread pricing in Medicaid—wherein PBMs retain a portion of the payment received for drugs, often at the expense of patient care and access.

These reforms aim to curtail the detrimental business practices that have plagued many communities and have been a long-standing concern for organizations such as the American Pharmacists Association (APhA). APhA CEO Michael Hogue praised the proposed changes, stating that these measures are essential to protecting crucial healthcare services and ensuring that patients receive the care they need.

Extending Telehealth Flexibilities

Another significant facet of the package is the extension of Medicare telehealth flexibilities through the end of 2026. This extension ensures that patients can continue accessing healthcare services from the comfort of their homes, while also allowing for the use of audio-only communication for specific services. Additionally, it facilitates the provision of virtual care through rural health clinics and federally qualified health centers.

Chip Kahn, CEO of the Federation of American Hospitals, expressed his support for these vital measures, emphasizing that they protect rural healthcare and ensure that seniors have continued access to telehealth services, all while preventing cuts to critical hospital resources. Kahn’s insights underscore the importance of timely and accessible healthcare, especially in underserved areas.

Adjustments to Payment and Reimbursement Structures

The healthcare package also introduces significant adjustments to payment and reimbursement structures for providers. Notably, it delays the impending Medicaid disproportionate share hospital cuts until 2027 and temporarily boosts the Medicare physician fee schedule by 2.5% for 2025. These provisions aim to offset the recent payment reduction finalized by the Centers for Medicare & Medicaid Services (CMS), thereby providing financial relief to healthcare providers.