Anyone following health care policy may have noticed a rush of activity on Capitol Hill. Congressional committees have recently advanced proposals involving prior authorization, pharmacy benefit managers, and health care price transparency.
Why are so many bills moving at once?
Congress is approaching its annual August recess, when lawmakers leave Washington and spend several weeks working in their home states and districts. However, on Monday, July 27, President Donald Trump called on Senate Majority Leader John Thune to cancel the Senate’s upcoming break until lawmakers pass the SAVE America Act, a voting measure that would establish new proof-of-citizenship and identification requirements. Thune indicated that he would consider keeping the Senate in session if there were a viable path to passing the legislation, but Senate Republicans do not currently appear to have the votes needed to advance it. For now, the August schedule remains an important deadline shaping congressional activity.
The House and Senate are not expected to be back in session together until September 14, giving committees a limited window to advance their priorities. The separate fight over the Senate’s recess could further complicate the chamber’s final legislative sprint and affect how much time remains for health care proposals and other pending issues.
This recent healthcare policy activity could also help set the stage for lawmakers to assemble a larger health care package later in the year, although whether that happens, and which policies might be included, remains uncertain.
Here are four developments that patients should understand.
Addressing prior authorization delays
The Improving Seniors’ Timely Access to Care Act would modernize prior authorization in Medicare Advantage. The proposal is intended to make the process more transparent, encourage electronic prior authorization, streamline approvals, and reduce unnecessary administrative burdens.
The bill recently advanced through another House committee, bringing it closer to possible consideration by the full House (House Committee on Energy and Commerce).
For patients, prior authorization is more than paperwork. When an insurance company requires approval before covering a treatment, delays can mean postponed infusions or injections, worsening symptoms, and additional stress for patients and caregivers. Patients may also be asked to repeat authorization processes even when they have been stable on the same treatment.
During the Infusion Access Foundation’s recent Hill Day, the foundation and its patient advocates raised these concerns directly with lawmakers. Advocates explained how delays and administrative barriers can interfere with treatment decisions that should be made between patients and their health care providers.
Increasing oversight of PBMs
The House Oversight Committee has advanced the bipartisan Pharmacists Fight Back Act, which focuses on pharmacy benefit managers, commonly called PBMs.
PBMs operate between health plans, drug manufacturers, pharmacies, and patients. Although they are supposed to help manage prescription drug benefits, their business practices can influence which medications are covered, what patients pay, and where patients are permitted to receive their prescriptions.
The legislation would establish new PBM requirements in certain federal health plans, including fairer pharmacy reimbursement, greater use of manufacturer rebates to lower costs, and restrictions on steering patients toward affiliated pharmacies (House Oversight Committee).
For patients, the underlying issue is choice and access. When a PBM directs someone to an affiliated pharmacy or creates financial incentives favoring one medication over another, patients may have fewer options, even when their provider believes a different treatment or pharmacy arrangement is more appropriate.
These concerns are especially relevant to people receiving complex medications, including therapies that require careful coordination among patients, providers, pharmacies, and infusion centers.
During Hill Day, the foundation and its patient advocates also spoke with lawmakers about how consolidation and vertical integration in health care can limit patient choice. Advocates shared concerns that vertical integration can allow a small number of companies to control multiple parts of a patient’s care, creating financial incentives that may take priority over what is best for the patient.
Helping patients understand health care prices
Both the House and Senate are advancing health care price-transparency proposals, although the chambers are considering different approaches.
The Senate HELP Committee recently approved the Patients Deserve Price Tags Act, while the House Energy and Commerce committee advanced the Lower Costs, More Transparency Act. The proposals generally seek to make information such as negotiated insurance rates, cash prices, billing information, and expected patient costs easier to find (U.S. Senate HELP Committee, House Committee on Energy and Commerce).
Greater transparency will not solve every affordability problem. Still, clearer information may help patients compare options, plan for expenses, and ask better questions before receiving care.
August recess is an opportunity to speak up
Committee approval is only one step in a bill’s journey. Lawmakers must still decide which proposals receive votes, become part of a larger legislative package, or remain unfinished.
That is why August recess matters.
While members of Congress are home, patients and caregivers have opportunities to contact their offices, attend town halls or community events, and explain how federal health care policies affect their lives. A personal story about a delayed authorization, an unaffordable medication, limited provider options, being directed away from a preferred pharmacy or treatment location, or difficulty understanding medical costs can help lawmakers connect policy discussions to the people they represent.
The Infusion Access Foundation’s Congressional Advocacy Summer Toolkit provides practical tools to help you get started. It can help you prepare to contact your lawmakers, participate in local events, and share your experience clearly and confidently (Infusion Access Foundation).
Congress may be leaving Washington for August, but the policy conversation is continuing in communities across the country, and patients and caregivers deserve to be part of it.