May 22, 2024

Providers Lose 340B Lawsuit Appeal To Drug Makers

A U.S. Court of Appeals ruled that drug makers can limit and impose conditions on pharmacies participating in the 340B drug discount program. The federal government had sided with providers, but a federal court ruled against that position.

I am no friend of drug makers but this ruling is a good one.  The 340B program has been corrupted and abused by providers. It is not fulfilling its mission of getting discounted drugs to the most vulnerable. 

Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/second-appeals-court-rules-drug-makers-can-impose-340b-restrictions

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#340b #drugmakers #hospitals #providers


Hospitals Attack Drug Makers On Price and Shortages — But Here Is The Other Story

A new analysis by a hospital lobby says that drugmaker price hikes as well as drug shortages jeopardize patient access to care. I do not doubt the conclusion, but would also point out that hospitals abuse the system and contribute to price and costs in the drug world. A recent Health Affairs blog points out that hospital drug markups, sometimes even when they have access to the 340B program, are huge and distort drug prices in the system. It is an abuse of 340B. Another study finds that provider markups on specialty drugs increased 2024 commercial health insurance premiums by $13.1 billion. On average, providers charge 42% more than a specialty pharmacy for the same drug.

Additional article: https://www.healthaffairs.org/content/forefront/hospitals-drug-price-markups-incentivize-consolidation-and-reduce-funding and https://www.ahip.org/news/press-releases/new-research-highlights-premium-impact-of-provider-markups-on-specialty-drugs

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#drugpricing #hospitals


UnitedHealth Group Wants Lawsuit Dismissed

UnitedHealth Group wants a judge to dismiss a class-action lawsuit alleging AI algorithms were used to deny Medicare Advantage patient care.  It argues they must go through administrative appeals first.

#priorauthorization #claimsdenials #medicareadvantage


Oklahoma Restricts Prior Authorizations

Another state has passed a prior authorization (PA) law.  The Oklahoma law requires prior authorization procedures to be published on websites. Those with chronic conditions must be notified no less than 60 days prior to changes that will affect them. A denied PA must be reviewed on appeal by a specialist in the service area. Plans must respond to urgent requests within 72 hours and seven days for non-urgent requests. 

#priorauthorization #ok #healthplans


State Retirement Plans Lowering Costs Through MA

Large employers are moving to Medicare Advantage (MA) for their retirees.  The Kaiser Family Foundation finds a similar trend for state employee retiree plans.  Most states (34 + DC) offer MA coverage to their Medicare-eligible retirees. In 12 states, MA is the only option.

#medicareadvantage #egwp


— Marc S. Ryan

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