H.R. 3561

Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023

This bill expands hospital price transparency requirements and establishes additional reporting requirements with respect to prescription drugs and pharmacy benefit managers (PBMs). The bill also extends funding for various programs such as the Teaching Health Center Graduate Medical Education program, Community Health Center program, and National Health Service Corps.

Specifically, the bill provides statutory authority for the requirement that hospitals publish an annual list of shoppable services they provide, including specified pricing information. Beginning in 2025, a hospital may not use an internet-based price estimator tool to meet the publication requirement for shoppable services.

The bill also modifies the health insurance plan disclosure requirements to include the rates for certain in-network services and prescription drug payment information.

The bill further requires providers of diagnostic laboratory tests under Medicare to publish online certain price information. Medicare Advantage (MA) organizations must report information about payments made to providers in which the MA organization has an ownership interest. Medicare prescription drug plan sponsors must report certain price information for covered drugs.

Additionally, the bill requires health insurance plan issuers (or the PBM providing services on behalf of the plan) to report to the plan sponsor specified information about prescription drugs dispensed under the plan. This includes rebates, fees, alternative discounts, or other remuneration the plan receives from drug manufacturers.

Finally, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid.