S-1895 : Still Just a Bill

Lower Health Care Costs Act

This bill makes a series of changes relating to health care coverage, costs, and services.

Among other things, the bill

• applies in-network cost-sharing requirements to certain emergency and related nonemergency services that are provided out-of-network, and prohibits health care facilities and practitioners from billing above the applicable in-network cost-sharing rate for such services;
• revises certain requirements in order to expedite the approval of generics and biosimilars, including requirements relating to citizen petitions, application effective dates, and labeling;
• requires health care facilities and practitioners to give patients a list of provided services upon discharge and to bill for such services within 45 days;
• limits prices that pharmacy benefit managers (PBMs) may charge health insurers or enrollees for prescription drugs, based on prices paid by PBMs to pharmacies;
• establishes grant programs to support vaccinations and data modernization; and
• requires health insurers to make certain information, including estimated out-of-pocket costs, accessible to enrollees through specified technology (e.g., mobile applications).