CVS Caremark Loses Whistleblower Suit
CVS Caremark, the pharmacy benefits manager (PBM) of CVS Health, has been ordered to pay more than $289 million in damages stemming from a 2014 false claims lawsuit.
The court originally set damages at $95 million after finding in favor of the whistleblower and finding CVS Caremark pushed insurers to overbill the Medicare Part D program. The judge has now tripled the settlement because the company’s actions were financially motivated and eroded public trust.
CVS Health said it would challenge the decision.
Additional articles: https://www.modernhealthcare.com/legal/mh-cvs-caremark-medicare-overbilling-lawsuit-2/ and https://www.beckershospitalreview.com/pharmacy/cvs-caremark-ordered-to-pay-290m-in-false-claims-suit/
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#cvshealth #fwa #partd #aetna
https://www.fiercehealthcare.com/payers/pennsylvania-judge-hits-cvs-289m-fine-whistleblower-suit
Health Plans Turn To Variable Copay Plans To Lower Costs
More health plans are turning to variable copay plans to reduce costs and offer lower cost alternatives to employers and avoid passing on more premium and deductible costs on employees. MN-based HealthPartners said it will offer a plan that sets fixed copays by provider and eliminates coinsurance and deductibles. Aetna is rolling out a new plan for employers based on its variable copay plan. Blue Cross and Blue Shield of Minnesota launched a new investment arm focused on developing tools for its variable copay plan. UnitedHealthcare’s variable copay plans are among its fastest growing commercial product.
Variable copay plans are similar to tiered network plans. The assumption is that variable copays will mean consumers examine providers and likely choose the most cost-effective one. Unlike other vehicles, the plan should not mean consumers foregoing care.
Uptake of these products is so far low but gaining traction. In 2026, about a quarter of large employers are expected to offer alternative health plans, up from 17% this year. Another 36% are considering adopting the model by 2028.
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#employercoverage #commercial #coverage
https://www.modernhealthcare.com/insurance/mh-aetna-unitedhealthcare-variable-copay-plans/
BCBSA Antitrust Settlement
A federal judge has approved a $2.8 billion settlement resolving antitrust claims brought by healthcare providers against the Blue Cross Blue Shield Association and its independent plans. A class of millions of hospitals, physician practices, and other providers nationwide were involved. The plaintiffs said that the Blues conspired to drive up territories and therefore price fixed.
About $1.78 billion will be distributed to healthcare facilities, while $152 million is earmarked for medical professionals. The suit also requires major operational reforms by the plans. About 6,500 providers opted out of the settlement and will file new suits.
The settlement follows another major one that awarded $2.7 billion. In that case the BCBS companies were forced to eliminate an association rule that mandated two-thirds of national net revenues from health plans and related services come from Blue-branded products. It also struck a rule that required employers to procure their health insurance through the Blues plan in the company’s heaquarters area.
#bcbsa #blues #antitrust
https://www.beckerspayer.com/legal/judges-approves-2-8-billion-bcbs-settlement-with-providers
KFF Updates Uninsured Analysis
Healthcare policy group KFF has updated its apportionment of the expected uninsured increases by state based on the final One Big Beautiful Bill Act (OBBBA). It allocates the roughly 10 million due to lose coverage under the bill as well as adds the apportionment of roughly 4.2 million more who will lose coverage if the enhanced premium subsidies expire at the end of the year. Another 900,000 will lose coverage under a new Exchange enrollment rule but is not included in the KFF analysis.
#bcbsa #blues #antitrust
https://www.beckerspayer.com/legal/judges-approves-2-8-billion-bcbs-settlement-with-providers/
Drug Makers Losing In Medicare Drug Suits
A follow-up blog in Health Affairs Forefront again recaps the ongoing losses brand drug makers and other parties have faced as they challenge the Medicare drug negotiations law. As the article notes, so far courts that have considered the substantive claims against the law have upheld the program against various constitutional and statutory claims. In each, the courts’ decisions have noted the voluntary nature of Medicare participation.
#drugpricing #ira #medicare #partd #branddrugmakers
— Marc S. Ryan
