Lower Health Care Costs Act


On May 23, 2019, the Senate Health Committee leaders released a bipartisan discussion draft to aimed at delivering better health care outcomes and better health care experiences at a lower cost. This bill is called the Lower Health Care Costs Act.


The key provisions of the bill and how they impact patients are as follows:


Tackle surprise medical billing by requiring out-of-network providers that are practicing in in-network facilities to accept the in-network rates as well as set prices for emergency services at the median contracted rate of the geographic service area for out-of-network facilities.


Reduce the cost of prescriptions by calling on better patient access to biosimilars and generics. Biosimilars? These are biologic medial products that are almost an identical copy of an original product that is manufactured by a different company.


Increase transparency by requiring disclosure of prices to patients administered by a third-party, non-government entity whom will create a database that patients, providers, and payers can use. No more gag clauses and no more spread pricing.

  • Gag Clause - A provision that may be incorporated in a physician’s contract with managed care organizations, which prevents him from being open with his patients about the terms of the patient’s coverage and therapeutic options

  • Spread Pricing - Refers to the difference between what the Prescription Benefit Manager (PBM) charges a patient or patient’s health insurance and what the PBM pays the pharmacy for dispensing the medication

Improved patient data access making it easier for patients to have access to their own medical records and access to their claims data to help them and their families select their care as well as access different providers.


Quality care standards to address lapses in vaccination rates, implementation of widespread patient education campaigns, grants for community education on vaccination rates, better use of telehealth, and an aim to address maternal and infant mortality.


Revising the Employee Retirement Income Security Act (ERISA) to require brokers and health insurers disclose compensation or incentives at the time the Employer or Individual Enrollee signs up for coverage.


All in all the bill contains almost three dozen specific provisions introduced by Senator Lamar Alexander and Senator Patty Murray. The Health, Education, Labor, and Pensions (HELP) Committee will be accepting comments which must be submitted by 5:00 pm on June 5, 2019, to be considered.


AJM Associates will keep you posted on the development of this bill as additional information become available.

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