On January 15, the White House released a fact sheet outlining an affordability framework, dubbed the “Great Healthcare Plan”, which aims to lower prescription drug prices and insurance premiums without extending the Affordable Care Act’s (ACA) expired tax credits. The plan calls on Congress to codify the Administration’s voluntary “most favored nation” drug pricing agreements, increase access to over-the-counter medications, and eliminate what the White House characterizes as “kickbacks” paid by pharmacy benefit managers (PBMs) to intermediaries that raise insurance costs.
The framework also proposes directing federal subsidies to individuals rather than insurers, allowing consumers to purchase plans of their choice, while funding ACA cost-sharing reductions to lower overall federal spending on premiums. Additional provisions would impose new transparency requirements on insurers, including public reporting of claims denial rates, average wait times, pricing information, and the share of revenues spent on patient care versus overhead and profits. The proposal does not include implementation details, and it remains unclear whether the framework will be incorporated into a future reconciliation package.
For additional information, contact RCRC Senior Policy Advocate, Sarah Dukett.