This overview is excerpted from Manatt on Health, Manatt’s subscription service that provides in-depth insights and analysis focused on the legal, policy and market developments. For more information on how to subscribe and to activate a complimentary one week trial to Manatt on Health, please reach out to Barret Jefferds.
On September 18, the House Energy and Commerce (E&C) Committee held a full committee markup and advanced 16 bills. The committee unanimously advanced the Telehealth Modernization Act (H.R. 7623), the widely anticipated legislation to extend several pandemic-era Medicare telehealth flexibilities for an additional two years, through 2026. These flexibilities include permitting any site in the U.S., including a patient’s home, to be an eligible originating site for the delivery of telehealth services; allowing federally qualified health centers (FQHCs) and rural health clinics (RHCs) to serve as originating or distant sites for the delivery of telehealth services; permitting the use of audio-only telehealth for some services; and continuing to include qualified occupational therapists, physical therapists, speech language therapists, and audiologists as eligible telehealth practitioners. The E&C-advanced bill would also extend the Medicare Acute Care Hospital at Home Program for an additional five years—through 2029—and create a five-year virtual-only option for the Medicare Diabetes Prevention Program.
In order to pay for these program extensions, H.R. 7623 includes several policies impacting PBMs that have previously been shown to generate savings. Specifically, H.R. 7623 includes provisions to “delink” pharmacy benefit manager (PBM) income from prescription drug prices by prohibiting PBMs from deriving income or remuneration for covered drugs based on the manufacturer’s price of the drug and require PBMs to report drug-specific measures (utilization, aggregate rebates, associated fees) on an annual basis to the Department of Health and Human Services and the prescription drug plan to heighten transparency of PBM practices. Notably, E&C did not have an updated estimate from the Congressional Budget Office on how much the extension of these provisions would cost or the estimated savings generated from the PBM provisions—a step that will likely be necessary before including these telehealth policies in an end-of-year bill.
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