ICYMI: Murkowski Helps Pass Legislation Addressing Affordability and Transparency in Health and Reauthorizing Key Programs

ICYMI: Murkowski Helps Pass Legislation Addressing Affordability and Transparency in Health and Reauthorizing Key Programs

Washington, DC - Earlier this week, U.S. Senator Lisa Murkowski (R-AK) helped pass H.R. 7148, which includes legislation that extends critical healthcare and public health programs and implements long sought after health policy reforms. The bill includes a multitude of critical "health extenders" designed to reauthorize key public health programs and Medicare/ Medicaid payment policies, including an extension of Medicare telehealth flexibilities through December 31, 2027. It also includes new reforms, including several that will increase transparency and control prescription drug prices.

Background:

H.R. 7148 was the last appropriations package of Fiscal Year 2026, which included five of the final six spending bills. The bill also included new legislation intended to address affordability in the health system and reauthorization of key programs

Addressing Affordability and Improving Efficiency in the Health System

• Requires hospitals to use a separate identification number for off-campus outpatient departments to improve billing clarity and oversight of services provided in a hospital setting or in an outpatient clinic
• Expands Medicare coverage to include new cancer screening tests, external infusion pumps, and certain home infusion drugs that patients cannot administer themselves.
• Includes the Accelerating Kids' Access to Care provision, which requires states to create a clear process for out-of-state pediatric providers to enroll in Medicaid and CHIP and treat eligible children, improving timely access to specialty care.
• Increases transparency in generic drug approvals by requiring the FDA to disclose which ingredients make a generic drug different from the brand-name version.
• Establishes new rules for pharmacy benefit managers (PBMs) that change how they are paid and require clearer reporting on prescription drug spending to improve transparency.
  • Under Medicare Part D, PBMs are prohibited from earning payments tied to the price of a covered drug.
  • Requires PBMs to clearly define and consistently apply drug pricing terms in contracts with Medicare Part D plans.
  • Requires PBMs to provide annual reports to Medicare Part D plans with detailed information on drug prices and related costs.
  • Gives Medicare Part D plans new authority to audit PBMs.
  • For private employer-sponsored health plans, promotes clearer reporting on prescription drug prices and costs.
  • Requires PBMs to share detailed prescription drug spending data with employer health plans at least twice a year.
  • Ensures reporting includes total drug costs, rebates, discounts, and pricing practices.
  • Requires disclosure of how drugs are placed on formularies and the reasons behind those decisions.
  • Requires disclosure of benefit designs that steer patients toward pharmacies owned or affiliated with PBMs.
  • Requires health plans to provide enrollees with a plain-language summary of prescription drug spending.
  • Requires all prescription drug rebates and discounts to be passed through in full to employers or health plans.

Reauthorization of Critical programs: These programs strengthen the health care workforce, expand access to essential medical and social services, support vulnerable populations, and advance public health and prevention efforts while promoting innovation and flexibility in care delivery across communities.

• The Community Health Center Program and the National Health Service Corps programs are reauthorized through December 31, 2026, expanding access to primary care and supporting the health care workforce.

• The Teaching Health Center Graduate Medical Education Program is reauthorized through fiscal year 2029, increasing training opportunities for primary care providers in community-based settings.

• The Temporary Assistance for Needy Families (TANF) program is extended through December 31, 2026, providing continued support for low-income families and children.

• State-based maternal mortality review committees are reauthorized through fiscal year 2030, strengthening state efforts to identify and prevent maternal deaths.

• Public health and prevention initiatives addressing preterm birth are reauthorized through fiscal year 2030, promoting healthier pregnancies and improved birth outcomes.

• Updates and reauthorizes the Dr. Lorna Breen Health Care Provider Protection Act, which supports mental health and suicide prevention resources for health care professionals.

• The Priority Review Voucher program for Rare Pediatric Diseases is extended through fiscal year 2029, encouraging the development of treatments for rare childhood conditions.

• Medicare telehealth flexibilities are extended through December 31, 2027, alongside policy reforms designed to expand patient access to telehealth services.

• Extends a number of Medicare programs including the low-volume hospital payment adjustment, the Medicare-dependent Hospital program, Medicare ground ambulance add-on payments, and the Work Geographic Practice Cost Index Floor.

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