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OHIC seeks new cost‑growth authority and PBM transparency; hospitals and physicians raise solvency concerns
Summary
OHIC Commissioner Corey King outlined a plan to set mandatory cost-growth targets, require insurer data reporting, hold annual hearings, and use progressive enforcement against commercial insurers and large provider entities; hospitals warned that penalties could risk provider solvency, while advocates urged stronger oversight of PBMs and drug spending.
OHIC Commissioner Corey King told the committee his office is seeking stronger legal authority to formalize cost-growth targets, require insurer reporting, convene annual oversight hearings and, in limited circumstances, impose performance-improvement plans and financial penalties for commercial insurers or large provider entities that repeatedly exceed targets.
"We're gonna collect the data from insurers...and based on the data, we will call payers, providers, pharmacy benefit managers, pharmaceutical manufacturers, or other entities...to testify at a public hearing," King said, describing an annual transparency and accountability mechanism tied to economic indicators and quality metrics.
King described the proposal as five components: a cost growth target linked to economic indicators and quality measures, an all-payer primary care investment target, expanded public reporting, annual hearings, and new limited enforcement authorities for commercial insurers and defined "large provider entities." He said enforcement would not apply to Medicare or Medicaid but would target commercial insurers and provider entities with significant attributed member months.
The section on pharmacy benefit managers (PBMs) would require PBM data reporting to understand rebate flows and spread pricing. King said OHIC lacks the tools today to examine PBM practices and supported a one-time study and annual collection to advise future oversight.
Hospital and provider witnesses urged caution. Mike Straczynski of the Hospital Association warned that stronger enforcement authority and AHEAD-related global-budget steps could threaten hospital finances, and Dr. Anna Tia Fulton of Care New England said overly punitive performance plans could disproportionately burden mission-driven care providers.
Consumer and advocacy witnesses, as well as some provider groups, supported more transparency and pushed for full funding of OHIC's social and human services rate recommendations, stronger PBM scrutiny, and sustained investments in 988 and behavioral health infrastructure to avoid shifting costs onto hospitals.
King asked legislators to give OHIC authority to require data from PBMs and to carry out targeted enforcement for the commercial market. The committee requested additional cost and impact analyses before acting.
