This week, during consideration of a legislative package to reduce health care costs, the Senate Health Education Labor and Pensions Committee passed federal Tobacco 21 legislation.  If enacted, the bill would make 21 the legal purchase age for all tobacco products in all states.  The version passed by the Senate HELP does not include the provisions that were of concern to the public health community. 

The Tobacco 21 legislation was included as part of a larger legislative package to address health care costs and improve healthcare price transparency.  It is unclear if and when the legislative package will move to the Senate floor for consideration.  To date, 16 states have already passed state Tobacco 21 laws, with several other states considering tobacco-21 bills.

“Tobacco  21 legislation is a big step forward in reducing the death and disease caused by tobacco,” according to ATS Tobacco Action Committee Chair Michelle Eakin, PhD.  “While there are other important actions Congress and the FDA must take to address tobacco --  including raising tobacco taxes, graphic warning labels, regulation of flavors and effective regulation of e-cigarettes -- moving forward with Tobacco 21 legislation will have a big impact on reducing youth tobacco use.”

The bill also included several provisions intended to reduced health costs for consumers, prevent “surprise” medical bills and improve health care price transparency.  These other provisions include:

• Measures to ensure that emergency medical treatment is considered “in-network” to prevent patients receiving exorbitant “surprise medical bills.”

• Requirements to require hospitals to provide pricing to patients up-front as well as options to mediate billing disputes.

• Prohibits Pharmacy Benefit Managers (PBMs) from charging plan sponsors, plans, or patients more for a drug than the PBM paid to acquire the drug while also requiring PBMs to pass on all savings and rebates they receive to the plan sponsor.

• Creates a national vaccine awareness campaign and new grants to support state programs to increase access to vaccine and research on vaccine awareness.

The next step for the bill is passage on the full Senate floor, which Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are aiming to do before the August congressional recess. Several physicians and hospital groups have expressed concerns about the unintended consequences of the medical billing components of the legislative package – especially how it addresses out-of-network costs.  The legislative package is likely to undergo further changes as it moves through the legislative process.