Weekly Update: Volume 1 (January 8, 2025)
Colorado
Hospital Association working on 340B protections. The Colorado Hospital Association is working with lawmakers to introduce legislation that would protect the extension of 340B pricing to a covered entity’s contract pharmacies. The CHA points to the fact that 89 percent of Colorado’s 340B hospitals have profit margins of 4% or less. Given flat reimbursement rates from Medicare and Medicaid and strained fiscal pressures since the pandemic, CHA argues that 340B entities are spreading the use of those savings as much as possible. Leading up to the impending debate at the Capitol, drug manufacturers claim that contract pharmacies and third-party administrators are frequently profiting in excess from the program, an unintentional result of the program’s expansion. The hope is to have legislation prefiled before lawmakers come back on January 8, 2025.
Maryland
Department of Health to provide $19 million to expand primary care access. The Maryland Dept. of Health announced a partnership with the Health Services Cost Review Commission to provide $19 million in startup funding to expand primary care access in underserved areas. Announced in late December, the funding is provided through the new Episode Quality Improvement Program for Primary Care, which will support eleven primary care practices in establishing new or expanding existing primary care locations. Ascension Medical Group is one of the eleven awardees.
Massachusetts
Legislature passes health care market reform bill. On the last day of the 2024 session, the Legislature passed H. 5159. The authorizing legislation provides the state’s Attorney General and state regulators oversight and transparency enforcement authority of transitions involving health care facilities and systems and private equity investors, health care real estate investment trusts and management services organizations. The package also implements reporting requirements for hospitals to disclose parent organization financial information and affiliated investors, submission of audited financial statements of a hospital’s out-of-state parent organization and its investors, and data pertaining to financial margins by payer type and investment data. The bill also enhances transparency and reporting requirements relative to prescription drug cost trends arising in the state, requiring pharmacy benefits managers and manufacturers to testify on an annual basis to such trends before state regulators. The bill currently sits with the Governor for her signature.
Michigan
Senate adopts package to address maternal mortality. Agreeing to and adopting legislation originally passed over by the House, the Michigan Senate passed a nine-bill package (HBs 5166-5173) aimed to improve the state’s maternal mortality rates. Of note, the package establishes a perinatal quality collaborative, requires insurers to cover blood pressure monitors for pregnant and post-partum mothers, enhanced access to mental health screenings for postpartum women, and establishment of a program registering perinatal facilities by a ranking system. The perinatal facility ranking bill was the only piece of the package not to receive bipartisan support.
Ohio
Legislature passes hospital price transparency bill. Before adjourning for the end of session, Ohio lawmakers passed HB 173 this December. The legislation will require hospitals to publish the cost for at least 300 shoppable services, inclusive of surgeries and other non-urgent care that could be scheduled in advance. However, there is an exception for hospitals to comply. Instead of posting the cost of those shoppable services, hospitals may instead offer an online price estimator. The bill also provides the Dept. of Health with authority to fine hospitals in violation and publish a list of hospitals who fail to comply.
Governor line-item vetoes medical free speech bill. Gov. Mike DeWine announced his intent to veto one part of HB 315. The provision came from HB 73, which would have prohibited the Dept. of State or the state medical and pharmacy licensing boards from disciplining health care professionals for “publicly or privately expressing a medical opinion that does not align” with the state’s best known health practices. The bill was originally introduced with the intent to allow the prescription of any FDA-approved medication that the physician in their sole discretion determines is medically necessary for their patient. The Governor’s office is concerned it strips any authority away from licensing boards tasked with regulating the professions.
Washington
Legislature to consider bill prohibiting cost-sharing on maternal health services. A legislative work group focused on maternal health has released their proposal to address known concerns with patients accessing maternal health services. SB 5075 would prohibit health insurers from imposing cost-sharing requirements on covered prenatal services including office visits, laboratory services, ultrasounds and other imaging, prenatal screening tests, prescription drugs, and prenatal vitamins. Postnatal services would also be protected from cost-sharing, including office visits, lactation specialists, cesarean section follow-up care and other services and prescription drugs. It’s likely the bill will receive a hearing in Senate committee during the month of January.