The recently passed law does what this board called for – it brings drug manufacturers and herbal benefit managers under the Massachusetts Health Policy Commission’s health care costing process. This process currently provides oversight and transparency for insurers and hospitals. Expanding it would require drug manufacturers and PBMs to provide financial reports to federal regulators and allow regulators to produce public reports on drug prices, bringing much-needed transparency to the industry. Representatives of these groups would have to testify at the public meeting.
Unlike insurers and hospitals, however, there would be no way to hold drug manufacturers or PBMs accountable for adhering to a certain standard. cost growth.
In particular, the bill does not significantly change the way PBMs can operate, although it would require them to obtain a Massachusetts license with regulations related to conflicts of interest. PBMs have been accused of various practices that squeeze profits while driving up drug prices. But increasing transparency is a good first step that will give policy makers insight into what further changes are needed. Congress can also set state laws that regulate PBMs.
Another big change is that the bill would require insurers to pay for a single drug used to treat diabetes, asthma, and two of the most common heart conditions without cost-sharing and covering the drug. one for those diseases for less than $25 for a 30-day supply, starting July 1, 2025. Consumer advocacy group Health Care for All has been pushing for the plan This is to make medicines more affordable for common chronic conditions that affect people disproportionately. of color and lower class people.
That is an important goal. But the problem with mandating insurance coverage without reducing drug prices is that the policy simply shifts costs from consumers to insurers, and the increased insurance costs are passed on to all consumers through higher premiums. high. The Massachusetts Association of Health Plans estimates that the new rules will increase drug spending for all premium payers by 1 percent per year.
State regulators will have to review the cost-sharing program every two years. While there may be pressure from patient advocacy groups to add drugs that are cost-sharing prohibited, regulators will have to carefully weigh the benefits of increasing access to drugs against the costs. extras paid by all premium paying customers.
The market care bill is important because, as the collapse of Steward Health Care has shown, existing federal laws are not enough to ensure that health care institutions are financially stable. In fact, this bill expands the existing mechanisms for government care to cover all the players involved in today’s health care system and the many types of interactions that occur. It will introduce additional national reporting and auditing requirements for transactions involving private equity firms, real estate investment trusts and management service organizations.
Steward saddled the hospitals with debt by selling the property their hospitals were on, then charging the hospitals for rent. The law prohibits the sale of a large hospital campus and requires hospitals to disclose lease information in license applications.
The bill will initiate a nationwide health planning process, giving the Health Policy Commission the power to analyze which health care services are needed in which areas of the country.
In recognition of the increasing financial burden of consumers, the bill requires the Division of Insurance to consider the ability of consumers to authorize health insurance rates. But there is no bill that does anything about health care costs.
Another problem with the Council’s delay is that there is no opportunity to go back and forth with the governor, whose only choice is to sign the bill or let it die, since the Council concluded its session . And there are problems – and potentially political problems – in these bills.
For example, when reforming the Health Policy Commission, the Legislature removed the state auditor’s power to appoint three members, giving that power to the governor with an opinion from the Council of the Legislature. Auditor Diana DiZoglio, who has strong ties to the Legislature she is trying to audit, said the change impedes independent conduct and “represents clear retaliation to usurp power in my office and have that and keep it for yourselves.”
(A spokesman for the Speaker of the House Ron Mariano said that there will be less oversight, since the auditor’s election does not audit. It redistributes the votes given to the State Auditor and removes the seat held by the Secretary of Administration and Finance on behalf of the Insurance Commissioner,” the spokesperson said.)
That power play isn’t reason enough to deepen the law, however. It’s also not the case that debt doesn’t necessarily cover costs. State Senator Cindy Friedman (D-Arlington), who chairs the Joint Committee on Health Care Financing, described the package when she spoke on the Senate floor as “a first step.” The next step will be to monitor these changes and continue to assess what other changes are needed to control costs and reduce business practices that do not put patients first.
Articles represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
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