Joco Today

On Thursday, U.S. Senator Roger Marshall, M.D. (R-Kansas), questioned healthcare experts during a Senate Health, Education, Labor, and Pensions Committee hearing about solutions to rising healthcare costs. The panel included Ms. Chris Deacon of VerSan Consulting, Dr. Benedic Ippolito from the American Enterprise Institute, and Mr. Wendell Potter of the Center for Health and Democracy.

Senator Marshall focused on the importance of transparency in healthcare pricing. He highlighted his ongoing efforts with the Patients Deserve Price Tags Act, which aims to require price tags on health care services so patients can make informed decisions.

“I think that we have today before us a 90 to 10 issue. Maybe it’s 95 to 5. Americans are concerned about the cost of health care. Since I got here four years ago, eight years ago, four years ago in the Senate, I’ve talked about the pillar of transparency, more innovation and consumerism, letting patients be consumers again. So, it’s wonderful that we get an opportunity to address solutions. We’ve all described the product and the problem. Now let’s talk about solutions. I’m very proud of one of our signature legislation we’ve been working on for eight years, the Patients Deserve Price Tags Act. I appreciate Senator Hickenlooper’s support, Senator Hassan, Senator Grassley, she he and Ernst their support as well. Could you imagine walking into a grocery store, going to the meat department, and not seeing the prices on the different meats? Could you imagine going to a clothing store and not knowing what the prices are on the suits? Most of us walk up there, and we look at a suit, what’s the first thing I do? I look at the price of it. But in health care, they buried the prices. So what our legislation attempts to do is to get price tags on health care. What a novel thought, and a couple of thoughts on what our bill does, and get your reaction. Ms. Deacon, I’ll start with you as a consumer. You have a choice of getting your hip replaced at one facility for $10,000 another one is $50,000 and that’s not unreasonable numbers to compare a hip replacement 10 versus 50 How would you as a consumer how would that impact eventual cost of healthcare If you’re in self-insured plan and you’re running that plan how would it impact your decisions drive down cost healthcare?”

Ms. Chris Deacon responded by emphasizing that transparent pricing could lead consumers toward lower-cost options while allowing employers sponsoring insurance plans to reduce premium costs: “I mean as a consumer absolutely if I had out-of-pocket I would both evaluate for quality and cost determine value likely find myself at $10k clinic but as employer sponsor if all my members were have such information dramatically lower cost premiums every year especially for self-insured employers because more consumers able evaluate such terms.”

Marshall asked whether these changes could result in significant savings for employers: “And this is wild guess could it drive down cost health insurance employed self-employed fund 10 20 30 40% perhaps big number.” Deacon confirmed: “Yes we’ve absolutely seen employers able do that save 30-40% premiums.”

The discussion also addressed group health plans’ access to their own claims data—a point Marshall found problematic under current rules: “Dr Ippolito another component our bill ensures group health care plans have access their own claim data Can you believe it? I have self-insured plan can’t look my own claim data Would helpful us specifically self-insured plan?” Dr Benedic Ippolito agreed: “Well sure mean minimum if sitting there trying think about what services going use next year what kind plan looks good us If don’t know what services use can’t do that And so terms those basic tasks employer who agent this world many us tasked providing need information So yeah seems like baseline prerequisite.”

Turning attention to pharmacy benefit managers (PBMs) and drug pricing practices—an area where few companies control most market share—Marshall said: “So is there anyone this panel disagrees price tags could not be helpful driving down cost healthcare Does anyone want counter argument Okay good want turn delinking just second Of course talking pharmaceutical benefits PBMs right Very horizontally vertically integrated four companies three companies controlling 85% industry Many talked oligo monopolies forming here specifically Senator Kaine bill called delinking delinks money pharmacy benefit managers make from cost drug So PBMs create formularies really prevent using generic drugs less cost push more expensive ones So start Mr Potter Would reform such as delinking PBM compensation from list price medicines benefit patients meaningful ways drive down cost drugs?”

Mr Wendell Potter replied: “I absolutely agree think very important legislation think should be delinking That game incentivizes drug companies have higher list price then middleman showing they’re board sucking so much money from pharmacy supply chain When was Cigna Cigna didn’t own very big PBM It bought Express grips recently few years ago now largely PBM also has insurance plans.”

Recent discussions in Congress continue amid calls for greater transparency in medical billing practices across the United States. Rising costs remain an issue for many Americans who often lack clear information when seeking medical treatment or prescription medications.