June 24, 2024

Supreme Court Declines To Hear BCBS Antitrust Case

The Supreme Court declined to hear a case challenging the anti-trust settlement between the federal government and BCBS plans nationwide.  While no wrongdoing was admitted, BCBS plans were accused of anti-competitive behavior in the employer market because it limited employers to contracting with BCBS entities in their headquarters’ area and required a threshold for Blues revenue.

The appeals court argued the settlement does not preclude future actions. The high court agreed. Several employers argued the settlement was not enough and that it did preclude certain actions over time. I will be writing about this soon. While the settlement was somewhat of a defeat for the Blues and its association, it actually tends to underscore the anti-competitive aspects of the broader healthcare market and protects the Blues.

Additional articles: https://www.modernhealthcare.com/legal/supreme-court-bcbs-settlement-home-depot and https://www.beckerspayer.com/payer/supreme-court-rejects-home-depots-challenge-to-2-7b-bcbs-settlement.html

(Some articles may require a subscription.)

#bcbsa #blues #healthcare #coverage #employercoverage


HHS Finalizes Info-Blocking Rule

The Department of Health and Human Services (HHS) finalized a rule on information blocking under interoperability, outlining penalties for hospitals, providers, and accountable care organizations.

Additional articles: https://www.modernhealthcare.com/policy/ehr-information-blocking-rule-ban-hhs

(Some articles may require a subscription.)

#interoperability #healthcare


Employers And Health Plans Have Interest In ICHRA

Both employers and health plans seem to have interest in exploring the Trump-era Individual Coverage Health Reimbursement Arrangements (ICHRAs), where employers grant dollars for employees to purchase individual coverage (usually on the Exchange). Major investments are being made by health plans, but the verdict is still out on ICHRA’s ultimate success.

#ichra #healthcare #exchanges #aca #obamacare


New Generic GLP-1 To Come To Market

Some relief could come over time from high prices of GLP-1 weight-loss drugs. Teva Pharmaceuticals is launching the first authorized generic of Victoza, a GLP-1 authorized for diabetes treatment.  At the same time, Novo Nordisk, maker of Ozempic, is investing $4.1 billion in a new manufacturing Ozempic and Wegovy.

Additional article: https://www.beckershospitalreview.com/pharmacy/ozempic-maker-plans-4-1b-manufacturing-plant.html

#weightlossdrugs #branddrugmakers #drugpricing


New Navigator Funding For Exchanges

The Centers for Medicare and Medicaid Services (CMS) will fund $500 million over the next five years toward navigators designed to help people navigate the Exchanges. The agency will make $100 million available for navigator programs in 2024.

#aca #exchanges #obamacare #coverage 


Fitch Says Medicaid Pressures Should Be Short-Lived

While major health plans have signaled headwinds related to their Medicaid lines, Fitch Ratings says that the problems should be short-lived.

#medicaid #healthplans #managedcare


KFF Compares Biden And Trump Healthcare Records

As the election approaches, the Kaiser Family Foundation (KFF) has published a rather unbiased assessment of President Biden’s and former President Trump’s healthcare records and what may be in store for the next four years.

#election2024 #healthcare #biden #trump


— Marc S. Ryan

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