Bennet Provisions to Stop Surprise Medical Bills, Improve Health Care Transparency Pass Senate Committee

Washington, D.C. – Colorado U.S. Senator Michael Bennet today announced the inclusion of several of his priorities in the Lower Health Care Costs Act, a comprehensive health package passed today by the Senate Committee on Health, Education, Labor and Pensions (HELP). Included in the package are Bennet-led provisions that will put patients first by working to improve the health care system in a variety of areas: ending surprise medical billing, lowering prescription drug prices, and enhancing transparency.

“Americans deserve to know how much they are paying for health care services at the point of care,” said Bennet. “I commend the HELP Committee for including a provision to end surprise billing in the health care package they passed today, in addition to several other measures that will lower costs for patients and bring needed transparency into the system. I look forward to working with the committee to ensure that we can protect patients from surprise medical bills while maintaining access to care, especially in rural areas.”

Bennet has worked to increase health care price transparency and lower costs since launching a bipartisan working group with U.S. Senator Bill Cassidy (R-LA) in March 2018. Recently, Bennet and Cassidy led the working group in introducing the STOP Surprise Medical Bills Act, legislation to protect patients from surprise medical bills.

Bennet-led provisions passed by the committee include:

Ending Surprise Medical Billing: The HELP package draws from Bennet’s STOP Surprise Medical Bills Act, which he introduced with Cassidy in May. The package stipulates that patients are only required to pay the in-network cost-sharing amount required by their health plan for emergency services when receiving care at an out-of-network facility or from an out-of-network provider when receiving scheduled services. Facilities and providers are barred from sending patients an additional bill in these scenarios. These requirements are also applicable to out-of-network ancillary and diagnostic services.

The HELP Committee adopted an approach which directs insurers to pay providers the median in-network rate for applicable out-of-network services. The STOP Surprise Medical Bills Act also utilized a median in-network payment with an option for providers or insurers to go to arbitration to settle a payment.

Improving Provider Network Transparency: This provision, adopted from the STOP Surprise Medical Bills Act, would require health plans to have up-to-date provider directories available for patients to access at their convenience.

Guaranteeing Enrollee Access to Cost-Sharing Information: Also adopted from the STOP Surprise Medical Bills Act, this provision guarantees the patient must be given an estimate of how much a service would cost from an in-network provider within two days of making the request—including deductibles, copayments, and coinsurance.

Lowering Out-of-Pocket Emergency Room Costs: A final provision adopted from the STOP Surprise Medical Bills Act would ensure that all patient charges for emergency health care visits are counted toward the patient’s in-network deductible, regardless of whether providers or facilities are out-of-network. Under current law, patients who receive emergency care out-of-network pay only their in-network copay and coinsurance, but often face much higher deductibles, leaving them with higher overall out-of-pocket costs.

Increasing Transparency by Removing the Gag Clause: The package adopts Bennet and Cassidy’s Know the Price Act, bipartisan legislation the senators introduced in May. This provision would provide more transparency for patients hoping to better understand the cost of services and procedures. The Know the Price Act would prevent the use of gag clauses between health care providers and insurers that are used to restrict a patient’s access to price information. These anti-competitive practices prevent consumers from obtaining the best cost for quality care.

Modernizing Generic  Drug Labeling: Two Bennet provisions related to prescription drugs were included in the larger HELP package. The first provision, adopted from Bennet’s MODERN Labeling Act introduced earlier this week with Senator Mike Enzi (R-WY), would authorize the U.S. Food and Drug Administration (FDA) to modify outdated drug labels to reflect new evidence relevant to the drug and its use. The bill would put the onus on the FDA to update drug labels and protect public health.

Lowering Prescription Drug Prices: Another provision adopted into the package which would remedy flaws in the prescription drug marketplace and act to reduce drug costs – is a bill first introduced by Bennet, Cassidy, Senator Cory Gardner (R-CO), and Senator Jeanne Shaheen (D-NH) in April. The Ensuring Timely Access to Generics Act addresses concerns with the citizen petition process, which allows interested stakeholders, including drug companies, to bring concerns to the FDA’s attention regarding pending drug applications. Currently, bad actors have discovered how to exploit this process by filing citizen petitions in order to delay the approval of generic competitors and extend their patent protections.

This provision would ensure the FDA’s ability to reject petitions intended to delay the entrance of generic drugs to the marketplace. It additionally would allow the FDA to refer cases to the Federal Trade Commission (FTC) for review, should the FDA believe the sole purpose of a petition is to delay approval of a more cost-efficient form of the medication.