The Senate Finance Committee unanimously voted to advance the Better Mental Health Care, Lower-Cost Drugs and Extenders Act, a comprehensive bill seeking increased transparency and comprehensive PBM reform. The bill also would create a list of discounted drugs with high rebates available in Medicare Part D and address various other healthcare issues. Among the provisions in the bill are the following:
- The Medicare physician fee schedule services statutory increase of 1.25% would increase to 2.5% in 2024, thereby slightly increasing the physician payment rate.
- Eligibility for bonuses under the Health Professional Shortage Area program would extend to non-physician healthcare professionals providing certain mental health and substance use disorder services.
- The HHS Secretary would be required to provide information on licensing requirements for furnishing telehealth services under Medicare and Medicaid, including clinicians providing telehealth services to patients in neighboring states.
- Network-based Medicare Advantage plans would be required to verify provider directory information at least every 90 days.
- Beginning in 2028, Medicare Part D plan sponsors offering preferred pharmacy networks would be required to contract with the following:
- At least 80% of essential retail pharmacies in the plan’s service area that are independent community pharmacies; and
- At least 50% of essential retail pharmacies in the plan’s service area that are not independent community pharmacies.
- Part D plans would have to base enrollee drug copays on the drug’s net price, including projected manufacturer rebates, rather than their Part D negotiated price.
