News Briefs

News Briefs

April 9, 2020

✦ A case before the U.S. Supreme Court, which will determine how far states can go in regulating PBMs, will be delayed due to the COVID-19 crisis. Oral arguments in Rutledge v. Pharmaceutical Care Management Association were scheduled for April 27 but have now been postponed to an unspecified date. The case, which challenges a 2015 law enacted in Arkansas, concerns whether PBMs are acting as agents under the Employee Retirement Income Security Act of 1974 (ERISA) and therefore are exempt from state-level regulation. Read more at https://bit.ly/2Rmyuyd.

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News Briefs

April 6, 2020

✦ During the 2020 open enrollment period for the Affordable Care Act (ACA) marketplaces, approximately 11.4 million people selected or were automatically reenrolled in plans across all 50 states and the District of Columbia, according to new data CMS released on April 1. That means signups held steady compared with 2019, when 11.4 million enrolled, and 2018, when 11.8 million signed up. Average premiums in the 38 states that use HealthCare.gov, meanwhile, dropped 3% from $612 in 2019 to $595 in 2020.

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News Briefs

April 2, 2020

✦ A new lawsuit filed by the U.S. Attorney for the Southern District of New York accuses Anthem, Inc. of bilking the federal government out of millions of dollars through a one-sided chart review program. The civil fraud action (U.S. v. Anthem, Inc., 1:20-cv-02593) alleges that while conducting chart reviews aimed at identifying additional diagnosis codes for obtaining risk adjusted payment through the Medicare Advantage program from 2014 to 2018, the insurer neglected “its duty to delete thousands of inaccurate diagnoses” and “often generated $100 million or more a year in additional revenue” as a result. UnitedHealth Group was the subject of similar allegations in two separate whistleblower suits; the Justice Dept. in 2017 intervened in both but has since dropped one. View the complaint at https://go.aws/3axP1qP.

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News Briefs

April 1, 2020

✦ Herzuma (trastuzumab-pkrb) launched on March 16, bringing the total number of Herceptin (trastuzumab) biosimilars to four. Herzuma, from Teva Pharmaceuticals USA, Inc., a U.S. affiliate of Teva Pharmaceutical Industries Ltd., and Celltrion Healthcare Co., Ltd., is approved for all the indications of its reference product, which is from Genentech USA, Inc., a Roche Group company. Herzuma’s wholesale acquisition cost for a 150 mg vial is $1,402.50, while a 420 mg vial is $3,927, both 10% less than Herceptin’s WAC. Visit www.herzuma.com.

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News Briefs

March 30, 2020

✦ The U.S. Senate on March 25 passed a $2 trillion stimulus package aiming to lessen the economic blow of the COVID-19 pandemic on Americans and businesses — including the health care industry. America’s Health Insurance Plans praised the legislation, which sets aside $100 billion for hospitals, but hinted that more relief is needed for […]

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News Briefs

March 26, 2020

✦ President Donald Trump’s statements touting chloroquine and hydroxychloroquine as promising treatments for the new coronavirus has triggered hoarding of the drug and subsequent shortages, the New York Times reported. Those drugs, which have not been approved by the FDA to treat COVID-19, the disease caused by the coronavirus, are typically used to treat malaria, lupus, rheumatoid arthritis and other conditions. In response to the stockpiling of the drugs, states including Idaho, Kentucky, Nevada, North Carolina, Ohio, Oklahoma and Texas have all issued emergency restrictions or guidelines on how the drugs can be dispensed at pharmacies. Read more at https://nyti.ms/33MdDJu.

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