1. United States
2. Kan.
3. Letter

The PATIENT Act of 2023 aims to increase transparency and promote competition in the healthcare industry to help lower costs for patients. Key provisions include: Requiring hospitals to publicly disclose more detailed pricing information on items and services, including payer-specific negotiated rates. This data must be updated annually and made available in machine-readable formats without fees or subscriptions. Hospitals that fail to comply face significant civil monetary penalties. Mandating health plans disclose negotiated rates with providers, amount paid in rebates and fees, net prices for drugs by therapeutic category, and other cost data. This information must be provided in a self-service tool to plan enrollees and annually reported to plan sponsors. Assigning unique billing identifiers to off-campus hospital outpatient departments and capping their reimbursement rates from Medicare at the lower physician office payment levels over four years. This aims to eliminate payment differentials that incentivize hospitals to acquire physician practices. Requiring clinical labs to publicize cash prices and de-identified minimum/maximum negotiated rates with all health plans for government-specified shoppable services. Promoting transparency around pharmacy benefit manager (PBM) rebates, discounts, administrative fees, and common ownership interests with health plans or pharmacies. PBMs must pass discounts on to plans and report data on pricing and revenue streams annually. The legislation seeks to empower consumers with pricing data to make more informed decisions, improve competition by preventing anti-competitive PBM practices, and align healthcare reimbursement with lower-cost care settings. Through these measures, it aims to increase affordability while maintaining quality care.